Review: Inequalities in healthcare provision for people with severe mental illness
Open accessAbstract
There are many factors that contribute to the poor physical health of people with severe mental illness (SMI), including lifestyle factors and medication side effects. However, there is increasing evidence that disparities in healthcare provision contribute to poor physical health outcomes. These inequalities have been attributed to a combination of factors including systemic issues, such as the separation of mental health services from other medical services, healthcare provider issues including the pervasive stigma associated with mental illness, and consequences of mental illness and side effects of its treatment. A number of solutions have been proposed. To tackle systemic barriers to healthcare provision integrated care models could be employed including co-location of physical and mental health services or the use of case managers or other staff to undertake a co-ordination or liaison role between services. The health care sector could be targeted for programmes aimed at reducing the stigma of mental illness. The cognitive deficits and other consequences of SMI could be addressed through the provision of healthcare skills training to people with SMI or by the use of peer supporters. Population health and health promotion approaches could be developed and targeted at this population, by integrating health promotion activities across domains of interest. To date there have only been small-scale trials to evaluate these ideas suggesting that a range of models may have benefit. More work is needed to build the evidence base in this area.
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Left untreated, SUD and MH conditions are associated with poorer overall health outcomes.
“Left untreated, SUD and MH conditions are associated with poorer overall health outcomes (Druss & Walker, 2011; Harris & Barraclough, 1998; Lawrence & Kisely, 2010).”
From The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders (2017) · cites this paper as Lawrence & Kisely, 2010
The Introduction (page not provided) reports excess mortality and worse physical-disease outcomes among people with severe mental illness, and says substance use increases their risk of physical illness. It does not establish that leaving substance use disorders or mental health conditions untreated is associated with poorer overall health outcomes; its discussion of untreated conditions concerns physical health problems in people with severe mental illness. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOur HRs reflect recent standardised mortality ratio estimates from the UK.
“In particular, suicide rates were lower than would be expected from Office for National Statistics (ONS) data67 but we would not expect these to be differential by diagnostic group and our HRs reflect recent standardised mortality ratio estimates from the UK.4,68”
From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [4]
The Introduction reports excess mortality in people with severe mental illness, but gives no recent UK standardised mortality ratio estimates or figures against which the citing authors’ hazard ratios could be compared. Searches for UK standardised mortality ratios and diagnostic-group hazard ratios found no passage establishing the claimed correspondence; page numbers were not available in our copy. (LLM, conf=0.70)
Experimental — accuracy not yet measured
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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“Left untreated, SUD and MH conditions are associated with poorer overall health outcomes (Druss & Walker, 2011; Harris & Barraclough, 1998; Lawrence & Kisely, 2010).”
BackgroundPreventive service use among people with and without serious mental illnesses.
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- Authors
- Lawrence, D., & Kisely, S.
- Affiliations
- The Kids Research Institute Australia (AU)
- The University of Queensland, Brisbane, Australia
- Corresponding author
- Lawrence, David
- ORCID
- Lawrence, David
- Venue
- Journal of Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2010-10-05
- Volume
- 24
- Issue
- 4_suppl
- Pages
- 61-68
- ISSN
- 0269-8811 (ISSN-L)
- 1461-7285
- PMC
- PMC2951586
- OpenAlex
- W2025374085
- Cited by
- 649
- References
- 106
- Citations by year
- 2026: 21 · 2025: 47 · 2024: 35 · 2023: 47 · 2022: 53 · 2021: 77 · 2020: 52 · 2019: 40 · 2018: 42 · 2017: 46 · 2016: 51 · 2015: 40 · 2014: 39 · 2013: 29 · 2012: 23
- FWCI
- 2.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychopharmacology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eSpace (Curtin University) (submittedVersion)
- Griffith Research Online (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- severe mental illness, health care disparities, physical health of people with mental illness, integrated care, case management, mental health stigma, adverse drug reactions, cognitive impairment, peer supporters, health promotion, population health
- MeSH terms
- Mental Disorders, Health Personnel, Health Services Accessibility, Humans, Mental Health Services, Quality of Health Care, Socioeconomic Factors, Disease Progression, Delivery of Health Care, Integrated, Healthcare Disparities, Social Stigma
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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