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. 2018 Jan 9;19(1):12.
doi: 10.1186/s12875-017-0687-0.

Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care

Elisabeth Björk Brämberg  1   2 , Jarl Torgerson  3 , Anna Norman Kjellström  4 , Peder Welin  5 , Marie Rusner  6   7
Affiliations

Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care

Elisabeth Björk Brämberg et al. BMC Fam Pract. .

Abstract

Background: Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15-20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system's difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness.

Methods: Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated.

Results: The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients' individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients' access the health care).

Conclusions: Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be strengthened by introducing professional contacts, such as liaison physicians and case managers. This is also important to reduce stress and responsibility among relatives.

Keywords: Barriers and facilitators; Health services accessibility; Qualitative research; Semi-structured interviews; Severe mental illness.

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Conflict of interest statement

Authors’ information

Not applicable.

Ethics approval and consent to participate

The Regional Ethics Review Board in Gothenburg approved the study (Reg. no. 276–16). Before the interviews all participants were informed that participation in the study was voluntary, that they could withdraw at any time without giving any reason and that it would not be possible to identify the participants when the results were reported. Written informed consent was obtained from all participants.

In the present study we have included patients suffering severe mental illness. In order to ensure that the patients were able to provide consent to their participation, managers in primary and specialized health care were engaged in the recruitment of patients. The managers received information from the project group regarding the study’s inclusion and exclusion criteria. Thereafter, they started the recruitment. Furthermore, we have also assured that all patients who took part in the study had an ongoing contact with out-patient psychiatric care.

Consent for publication

All participants (patients, relatives, clinicians) consented to publication of their anonymous quotes.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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