Sharing physical healthcare between people diagnosed with severe mental illness, mental health services and primary care providers: an Australian example.

Background: People diagnosed with severe mental illness (SMI) have a 13-30-year shorter life expectancy and higher rates of chronic disease than the general population in Australia [1] and internationally [2-5]. These health inequities are largely due to preventable physical health conditions [6], yet people diagnosed with SMI have poor access to appropriate primary care and integration between mental health and primary health services is often poor, non-existent or focuses solely on the person’s mental health. [5, 7, 8]

 

Approach: This paper draws on learning from three studies undertaken within a shared care program jointly resourced by Central and Eastern Sydney Primary Health Network (CESPHN) and three Local Health Districts (LHDs) in Sydney, Australia. These mixed methods studies involved two clinical trials of an online communication system for general practice, mental health services and service users; and an in-depth review of the shared care program and the codesign of a new program model.

 

Results:Many barriers to shared care were identified, including competing priorities and time constraints; lack of role clarity; and health funding systems that were not conducive to delivering integrated care.

 

Implications: Key enablers and opportunities, to address barriers, were also identified and contributed to the development of a new co-designed model of shared care that, if successfully implemented, promises to improve physical health outcomes.

This study was situated in Sydney Australia and, while the Australian model of healthcare funding presents some specific opportunities and challenges for integrated care approaches, inequitable physical healthcare access and poorer outcomes for people with severe mental illness are prevalent internationally [4, 9]. Hence, our findings, the co-design approach and the new co-designed shared care model, have relevance and potential translatability to other jurisdictions and settings internationally.

 

References: 1.Belcher J, et al., Exploring the physical health of patients with severe or long-term mental illness using routinely collected general practice data. Australian Journal of General Practice, 2021. 50(12): p.944-951.

2.Firth J, et al., The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry., 2019. 6(8): p.675-712.

3.WHO, Meeting report excess mortality in persons with severe mental disorders. 2015, World Health Organisation.

4.Ashworth M, Schofield P, and Das-Munshi. J. Physical health in severe mental illness. British Journal of General Practice. 2017. 67(663): p.436-437.

5.Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry 2015. 72: p.334-41.

6.De Hert M, et al., Physical illness in patients with severe mental disorders: Prevalence, impact of medications and disparities in health care. World Psychiatry. 10: p.52-77.

7.Liberati, E., et al., Diagnostic inequalities relating to physical healthcare among people with mental health conditions: a systematic review. eClinicalMedicine, 2025. 80.

8.Commission, A.G.P., Mental Health Public Inquiry Report. 2018: Productivity Commission. www.pc.gov.au.

9.Spooner Catherine, O'Shea Peri et al. Access to general practice for preventive health care for people who experience severe mental illness in Sydney, Australia: a qualitative study. Australian Journal of Primary Health, 2024,30.