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

有长期精神健康问题的人面临严重的社会排斥。他们死于可预防原因的时间也比一般人群短得多。尽管相当多的研究表明，严重精神疾病（SMI）患者的主要慢性疾病和限制生命的疾病的发病率要高得多，而且检测较晚，护理不够理想，而且支离破碎，但这些不平等现象似乎根深蒂固。对这一人群的社会排斥的特点是在政策和社会层面上不可见，用初级和二级保健服务满足这些复杂需求的挑战是巨大的。通过与利益相关者和专家合作的参与式方法（第二阶段），我们确定了对重度精神障碍患者实施社会处方的主要挑战。这包括：(1)服务责任的分散和护理的碎片化；(2)社区参与方面的社会心理支持有限（或缺失）；(3)公众和自我耻辱导致过度依赖内部（机构）护理；(4)对重度精神障碍的政策困惑与忽视；(5)社区资产分布不均、易逝性。虽然社会处方（SP）通过鼓励获得健康支持设施和资源以及机构间合作提供了一个潜在的解决方案，但针对这一人群的SP研究很少。这一人群的健康和社会护理需求需要富有想象力和细致入微的医疗保健模式，以适应其各种交叉的医疗、社会和心理需求，同时影响其存在的环境背景。具有挑战性的健康成果/综合护理环境（选择）联盟共同设计了一种交付模式，该模式加强了机构间合作，同时在社区一级提供更大的能力，以评估、适当规定和提供灵活、持续的支持，以利用广泛的资源（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伴支持。这种方法旨在逐步促进自尊、自我效能和社会包容的良性循环，从而提高生活质量和幸福感。由于这种类型的研究以前没有做过，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要和挑战；(4)可能影响项目运作方式的背景和结构因素。重要的是，我们将通过在联盟和研究过程中发挥强大和核心作用的经验丰富的专家，寻求对CHOICE的更深入了解。由于选择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、社会包容和重度精神障碍患者健康方面的研究、政策和实践产生重大影响。

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.