Research That Matters (January 17 - 20, 2008)

Background and Significance: Persons with severe mental illness (SMI) have higher rates of medical comorbidity and mortality in comparison to the general population (Felker, Yazel, & Short, 1996). Chronic illnesses including adult-onset diabetes, cardiovascular disease, and HIV are prevalent among persons with SMI (Goldman, 1999). Despite this pattern of suboptimal physical health, research indicates persons with SMI utilize less general, preventive, and specialty health services (Carney, Allen, & Doebbeling, 2002; Cradock-O'Leary, Young, Yano, Wang, & Lee, 2002; Druss, Bradford, Rosenheck, Radford, & Krumholz, 2000). Symptoms of major psychiatric disorders, poor health status, and decreased use of health services pose a significant threat to recovery from mental illness by limiting individuals' access to fulfilling and enriching experiences in the community. In response, a qualitative research study was initiated to explore the factors that enable or discourage use of health services by persons with SMI living in the community. Methods: In-depth individual interviews were conducted with 22 persons with SMI residing in supported independent housing (SIH). Purposive sampling was used to identify participants that were similar to the population profile of SIH residents in terms of gender, psychiatric diagnosis, and physical health status. A semi-structured interview schedule was developed from 3 focus groups held within SIH programs (N=19). The constant comparative method, as informed by grounded theory, was used to analyze the transcribed interviews. In order to ensure credibility and trustworthiness of the findings, an audit trail and reflexive bracketing were used throughout data collection and analysis. Results: Analysis of the data resulted in a conceptual model that identified person-, provider-, and system-level factors impacting utilization of health services by persons with SMI. Person-level factors affecting utilization included negative health beliefs, psychiatric symptoms, and inadequate social support. In terms of provider-level factors, mental health providers, such as case managers and SIH staff, were instrumental in helping persons with SMI attend doctor's appointments, monitor health regimens, and access needed specialty services and health promotion activities. In addition, system-level factors included housing program policies which mandated residents comply with medical care as a contingency for program participation. Other system barriers included the cost of services, and poor integration of primary care with psychiatric care. Conclusions and Implications: This qualitative study helped to develop a conceptual model for examining utilization of health services among persons with SMI. In addition, results of the study highlight the centrality of the role of mental health providers in ensuring access to regular medical care for persons with SMI. As such, the results suggest social workers practicing with persons with SMI, and operating in a variety of mental health treatment settings, have the potential to reduce barriers to receipt of quality medical care for this population by providing individuals the tools to adequately monitor their health conditions, communicate with medical care providers, coordinate services among health providers to improve integration between primary and psychiatric care, and bolster social support around health concerns.