Challenging Health Outcomes/Integrating Care Environments Ph3: A Community Consortium to Tackle Health Disparity for People Living with Mental Illness

People with severe mental illness (SMI) die prematurely, between 15 and 25 years younger than the general population [1, 2], due to modifiable medical risk factors [3, 4] and high rates of physical multimorbidity are well-documented (3-9). In addition to the significant costs and harms due to smoking, obesity, physical inactivity, alcohol misuse and substance abuse [5] for people with SMI, are also at high risk from weight gain, related to psychotropic medication[6]. People with SMI are more likely than the general population to live in disadvantaged neighbourhoods [7] and at higher risk of unemployment, poverty, social isolation, housing instability, crime victimisation[8]. Current evidence indicates that some behavioural interventions may help improve poor physical health outcomes in this population but have limited success in longer-term implementation[9]. Typically, such interventions neglect factors contextual factors and mechanisms related to the various dimensions of stigma in severe mental illness. Moreover, SMI is associated with chronic loneliness, which is also a predictor of poor physical and mental health outcomes. Some of the explanations for poor physical health and mortality may lie in problems and fragmentation in healthcare systems (10). The CHOICE model that we propose, is aligned to the NHS England Community Mental Health Framework [10]which seeks to remove the barriers between mental health and physical health, health, social care, voluntary, community and social enterprise (VCSE) organisations and local communities; and “to deliver integrated, personalised, place-based and well- coordinated care†across the primary-secondary care interface.