Understanding The Needs Of Individuals With Mental Illness & Medical Comorbidities During Transitional Care

Individuals with mental illness frequently have medical comorbidities that compound the problems they face, causing lower quality of life and worsening health. Access to preventive services and receipt of timely diagnoses and treatments are necessary to keep this chronically ill population as healthy as possible and living in the community. In order to understand the perceptions and experiences of caregivers and individuals with mental illness and medical comorbidities, researchers in Australia conducted quantitative interviews with 16 individuals on their experience as they moved from tertiary to primary care services. “Mental health consumers’ with medical co-morbidity experience of the transition through tertiary medical services to primary care”, published online by the International Journal of Mental Health Nursing, reviews the results of these interviews (12 individuals with mental illness and 4 caregivers).

Study participants were recruited from the Mental Health Hospital Admission Reduction Program (MH-HARP), a four-year pilot program at the tertiary medical service in Melbourne (Victoria, Australia), specially designed for consumers with medical comorbidities who had two or more visits to the emergency department in the preceding 12 months. The goal of MH HARP is to assist in preventing avoidable inpatient medical hospital use by ensuring eligible consumers receive intensive support and care coordination for a period of up to six months; including links to appropriate community services, and assistance with learning health self-management. MH HARP clinicians, mainly mental health nurses, contacted consumers and their caregivers to assess their interest in participating in the program. Individuals were eligible for participation in the study if they: had complex medical needs; were previous recipients of MH HARP services; were older than 18 years of age; and were able to communicate in conversational English. Individuals were deemed ineligible if they were currently experiencing an acute episode of mental or medical illness.

Participants took part in semi-structured 45-60 minute, recorded interviews conducted in their homes, answering a set of broad questions, and providing details about their experiences and perceptions after receiving services through MH HARP. A team of researchers analyzed each participant’s responses and coded the information into themes, which together comprise the main findings of the study. In particular, participants indicated:

Accessing Tertiary Services Is Difficult & Time Consuming: Participants described long wait times for appointments, a perceived lack of support, and a feeling that adequate support was provided only when consumers reached a crisis point with their wellbeing. Participants expressed confusion when trying to navigate the variety of tertiary medical services.

They Experienced Inconsistent Engagement & Support From Tertiary Medical Clinicians: Participants reported tertiary medical clinicians were, as a group, inconsistent in how much they engaged with consumers and what types of support they offered, especially in the emergency department and inpatient ward. Participants gave high ratings to tertiary medical clinicians when they took time to understand the participant’s needs and explain their treatment. However, some participants experienced lack of sensitivity, empathy, or stigmatization from some clinicians.

They Experienced Lack Of Continuity Between Tertiary Medical & Primary Care Services: Participants indicated at times they experienced poor discharge planning, lack of communication and follow-up from the clinicians, and inconsistent and incorrect information provided at discharge.

In Spite Of Flaws In Care, MH HARP Clinicians Were Instrumental In Facilitating Their Transition: Overall, participants indicated MH HARP clinicians were instrumental in facilitating their transition from inpatient to outpatient care.

The authors point out the findings underscore the value and need for this augmented care program, however, organizational change is still needed to help transform the practice culture, particularly in regards to patient perceptions about care, support, and stigmatization. The scope of MH HARP clinicians should be expanded to work more closely with medical professionals to encourage more empathy for people with comorbidities; consumer-consultants should be employed in emergency departments and inpatient facilities to assist people with comorbidities to navigate the services available; and randomized controlled trials should be conducted on this model of care to evaluate its effectiveness.

The full text of “Mental health consumers’ with medical co-morbidity experience of the transition through tertiary medical services to primary care” was published online January 5, 2016 in the International Journal of Mental Health Nursing. An abstract was accessed and is available online at https://onlinelibrary.wiley.com/doi/10.1111/inm.12174/abstract.

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