Title: An innovative shared care model improves the physical wellbeing of people with severe mental illness (SMI)
Author(s): Nancy Granata, Ravi Krishnaiah, Heidy Van Engelen, Sue Gathergood
Background: Evidence indicates that people with severe mental illness (SMI) are at risk of premature natural death on average 15-20 years earlier than the general population due to physical health co-morbidities. In addition, evidence suggests that at every mental health contact, consumers need additional opportunistic physical health screening, education, and shared care with primary care services.
Aims/Objectives: To develop a sustainable partnership care model of service delivery that incorporates the overall physical, metabolic, and mental health of SMI consumers between specialist services and primary care setting. Therefore, translated and embedded into clinical practice places the consumer in the centre of care planning and participation.
Method: The shared care program was evaluated to assess success and to identify challenges and barriers faced. Consumers who consented to the GP shared care program had baseline physical Health and metabolic screening, intervention received, and longitudinal follow-up data collected for analysis.
Results: This Model of Care (MOC) embraces the development, implementation, and evaluation in a clinical setting. Pre/Post analysis of consumers and all healthcare professionals involved in care results indicate over 80% high satisfaction rates. Longitudinal evaluation data demonstrated the program had over 90% of consumer’s completed their physical and metabolic health baseline screened. Including ongoing follow up monitoring, for early detection on preventing comorbidities, with collaborative support intervention and access to allied enhance primary care services as required. Consequently, the development of two key procedures to achieve this outcome have now been sustainability embedded in clinical practice
Conclusion: Better collaboration between primary, secondary and tertiary care, results in good patient outcome and collaborative care planning for timely transition. Interventions that optimise social determinants of health and wellbeing include health promotion to maximise prevention and reduce the risks associated with the onset of illness is crucial.