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

挑战健康成果/整合护理环境第三阶段：解决精神疾病患者健康差距的社区联盟

• 批准号: AH/Z505420/1
• 负责人: Gerard Leavey
• 金额: $ 203.11万
• 依托单位: University of Ulster
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=AH%2FZ505420%2F1
• 关键词: Challenging; Health; Outcomes; Integrating; Care

People with long-term mental health problems face profound social exclusion. They also die much younger than the general population from preventable causes. Despite a considerable body of research highlighting much higher rates of the main chronic and life-limiting diseases, later detection, and sub-optimal and fragmented care for people with severe mental illness (SMI), these inequalities appear stubbornly entrenched. Social exclusion for this population is characterised by an invisibility at policy and social levels and the challenges in meeting these complex needs with primary and secondary care services are immense.Using participatory approaches with stakeholders and experts by experience (stage 2), we identified the key challenges for implementation of social prescribing for people with SMI. These include: (1) diffusion of service responsibility and fragmentation of care; (2) limited (or absent) psychosocial support towards community engagement; (3) public and self-stigma leading to over-reliance on in-house (institutional) care; (4) policy confusion and neglect on SMI; (5) uneven distribution and ephemerality of community assets. Although social prescribing (SP) offers a potential solution by encouraging access to health-supporting amenities and resources and interagency collaboration, there is scant SP research for this population. The health and social care needs of this population require imaginative and nuanced models of health care that can accommodate their various and intersecting medical, social, and psychological needs while simultaneously influencing the environmental contexts in which they exist.The Challenging Health Outcomes/Integrating Care Environments (CHOICE) coalition has co-designed a delivery model which enhances interagency cooperation while providing more capacity at the community level to assess, appropriately prescribe, and provide flexible, sustained support to use a wide range of resources (assets, e.g., arts, leisure, and sports). In stage 3, Community Navigators based in our partner organisations will be trained in behaviour change techniques to encourage, guide and support people with SMI to use these resources. We will also extend the use of peer-support. This approach is intended to facilitate, incrementally, a virtuous cycle of improved self-esteem, self-efficacy, and social inclusion that enhances quality of life and wellbeing.Because research of this type has not been done before, our multi-disciplinary research team will undertake an adaptive mixed methods research programme to examine: (1) the outcomes of this approach; (2) the barriers and facilitators in implementing the CHIOCE model, such as the real-world issues of interagency cooperation and communication; (3) the needs and challenges of the voluntary and community partners; (4) the contextual and structural factors that might influence how the project works. Importantly, we will seek to gain a deeper understanding of CHOICE through our experts by experience who have a powerful and central role in the coalition and in the research process.Due to the embeddedness of all the key stakeholders in the CHOICE coalition, the findings will have a major impact on research, policy and practice in social prescribing, social inclusion, and health of people with SMI.

有长期心理健康问题的人面临严重的社会排斥。由于可预防的原因，他们的死亡年龄也比一般人口小得多。尽管大量研究强调了严重精神疾病患者的主要慢性病和限制生命的疾病的发病率要高得多，发现较晚，以及次优和分散的护理，但这些不平等似乎根深蒂固。这一人群的社会排斥的特点是在政策和社会层面上的无形性，在满足这些复杂的需求与初级和二级医疗服务的挑战是巨大的。使用参与式的方法与利益相关者和专家的经验（第2阶段），我们确定了实施社会处方的SMI人的主要挑战。其中包括：（1）服务责任分散和护理分散;（2）对社区参与的社会心理支持有限（或缺乏）;（3）公众和自我羞辱导致过度依赖内部（机构）护理;（4）政策混乱和忽视SMI;（5）社区资产分布不均和短暂。虽然社会处方（SP）提供了一个潜在的解决方案，鼓励获得健康支持设施和资源以及机构间的合作，有SP的研究很少这一人群。这一人群的健康和社会保健需求需要富有想象力和细致入微的卫生保健模式，这些模式可以适应他们的各种和交叉的医疗、社会、和心理需求，同时影响他们存在的环境背景。健康结果/综合护理环境（选择）联盟已经合作，设计了一个交付模式，加强机构间合作，同时在社区一级提供更多的能力，以评估，适当规定，并提供灵活，持续支持使用广泛的资源（资产，例如，艺术、休闲和体育）。在第三阶段，我们的合作伙伴组织的社区导航员将接受行为改变技术的培训，以鼓励、指导和支持重度精神障碍患者使用这些资源。我们还将扩大使用同侪支持。这种方法的目的是促进，逐步，提高自尊，自我效能和社会包容，提高生活质量和福祉的良性循环。由于这类研究以前没有做过，我们的多学科研究团队将进行适应性混合方法研究计划，以检查：（1）这种方法的结果;（2）实施CHIOCE模式的障碍和促进因素，如机构间合作和沟通的现实问题;（3）志愿者和社区合作伙伴的需求和挑战;（4）可能影响项目运作的背景和结构因素。重要的是，我们将寻求通过我们的专家更深入地了解CHOICE，这些专家在联盟和研究过程中发挥着强大的核心作用。由于CHOICE联盟中所有关键利益相关者的嵌入性，研究结果将对社会处方，社会包容和SMI患者健康的研究，政策和实践产生重大影响。