Challenging Health Outcomes/Integrating Care Environments: A Community Consortium To Tackle Health Disparities For People Living with Mental Illness

在英国和其他地方，患有严重精神疾病的人过早死亡，比一般人群年轻20岁，这种死亡率通常与可改变的医疗风险因素有关。吸烟、肥胖、缺乏身体活动、酗酒和药物滥用给卫生系统和更广泛的经济造成的巨大成本是众所周知的。例如，精神疾病患者的吸烟率是普通人群的三倍。然而，虽然患有严重精神疾病的吸烟者和普通人一样想要戒烟，但他们通常更容易上瘾，并且面临更大的戒烟障碍。同样，体重增加和肥胖是有精神健康问题的人的主要问题，增加了患糖尿病或心血管疾病的风险，所有这些都导致生活质量低下，加剧了精神症状。与有精神健康问题的人身体健康状况不佳相关的其他相互交织和可改变的风险因素包括自卑、失业、孤独、他人的低期望和社会排斥。由于一系列社会和心理原因，包括耻辱造成的损害，有精神健康问题的人获得可以改善其身心健康的当地文化和自然资源的机会相对有限。近年来，人们更加关注精神疾病患者的身体健康，但各项服务仍然零散且不协调。法定保健和社会保健服务与社区和志愿部门组织之间的关系可能尤其如此。此外，存在许多生活方式干预措施，这些干预措施对重度精神障碍患者有潜在的益处，但很少在社区环境中实施，并且缺乏证据表明开发有效的干预措施来帮助重度精神障碍患者。选择项目旨在建立一个由北爱尔兰各地的机构和人民组成的社区联盟，以最大限度地利用集体拥有的资源、技能和知识。我们将采用基于社区的参与性研究（CPBR），这是一种强大的“自下而上”方法，采用创新和包容性的方法，在共同设计和实施解决健康差距的解决方案时赋予弱势社区和人口权力。CBPR通过让社区参与解决人口健康方面的差距，有助于将研究和实践联系起来，并已在各种不利环境中作为挑战权力不平衡的有效手段加以使用。重要的是，我们的联盟将协助识别和开发我们社区中存在但普遍未得到充分利用的所有资产和资源。我们将根据经验与专家合作，采用基于艺术的方法，突出精神疾病患者的生活经历，以及排斥与身体健康之间的关系。到项目结束时，我们将建立一个强大的社区联盟，并制定一项商定的战略计划，以改善精神疾病患者的生活。

In the UK and elsewhere, people with severe mental illness die prematurely, up to 20 years younger than the general population, a mortality often associated with modifiable medical risk factors. The substantial costs to the health system and the wider economy caused by smoking, obesity, physical inactivity, alcohol misuse and substance abuse are well established. For example, smoking rates among people with a mental illness are three times higher than among the general population. However, while smokers living with severe mental illnesses are just as likely to want to quit as the general population, they are generally more addicted, and face greater barriers to quitting. Similarly, weight gain and obesity are major problems for people with mental health problems, increasing the risk of developing diabetes or cardiovascular diseases, all contributing to low quality of life and exacerbating psychiatric symptoms. Other interwoven and modifiable risk factors associated with the poor physical health of people with mental health problems include low self-esteem, unemployment, loneliness, the low expectations of others, and social exclusion. For a range of social and psychological reasons, including the damage done by stigma, people with mental health problems have relatively limited access to local cultural and natural resources which could improve their physical and mental health. In recent years, greater attention has been focussed on the physical health of people living with mental illnesses but services remain fragmented and uncoordinated. This disconnect may be particularly true in the relationship between statutory health and social care services, and the community and voluntary sector organisations. Moreover, many lifestyle interventions exist that are of potential benefit to people with SMI these are seldom implemented in community settings and there is a lack of evidence on the development of effective interventions to help people with SMI. The CHOICE project aims to build a community coalition of agencies and people across Northern Ireland to maximise the resources, skills and knowledge held collectively. We will use Community-Based Participatory Research (CPBR), a powerful 'bottom-up' approach which uses innovative and inclusive approaches to empower disadvantaged communities and populations in the co- design and implementation of solutions to address health disparities. CBPR helps bridge research and practice by engaging the community to tackle disparities in population health and has been used in diverse and disadvantaged settings as an efficient means of challenging power imbalances. Importantly, our coalition will assist in identifying and exploiting all the assets and resources that exist in our communities but remain generally underused. Working with the experts by experience, we will use arts-based approaches to highlight the experience of living with mental illness, and the relationship between exclusion and physical health. By the end of the project we will have developed a strong community coalition and an agreed strategic plan to improve the lives of people living with mental illness.