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.

患有长期心理健康问题的人面临着严重的社会排斥。他们因可预防的原因而去世的时间也比一般人群要早得多。尽管大量研究强调主要慢性病和限制生命疾病的发病率要高得多，而且发现较晚，而且对严重精神疾病 (SMI) 患者的护理不够理想且分散，但这些不平等现象似乎根深蒂固。该人群的社会排斥的特点是在政策和社会层面上不可见，通过初级和二级护理服务满足这些复杂需求的挑战是巨大的。根据经验（第二阶段），采用利益相关者和专家的参与式方法，我们确定了关键对 SMI 患者实施社会处方的挑战。其中包括：（1）服务责任分散和护理分散； (2) 对社区参与的心理社会支持有限（或缺乏）； (3) 公众和自我耻辱导致过度依赖内部（机构）护理； （4）SMI政策混乱和忽视； (5)社区资产分配不均、短暂。尽管社会处方 (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潜在的解决方案，但针对这一人群的社会处方研究却很少。该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，能够适应他们各种交叉的医疗、社会和心理需求，同时影响他们所处的环境背景。 具有挑战性的健康成果/整合护理环境（CHOICE）联盟共同设计了一种交付模式，该模式增强了机构间合作，同时在社区层面提供了更多能力，以评估、适当规定并提供灵活、持续的支持，以使用广泛的资源（资产、例如艺术、休闲和体育）。在第三阶段，我们合作伙伴组织的社区导航员将接受行为改变技术方面的培训，以鼓励、指导和支持 SMI 患者使用这些资源。我们还将扩大同行支持的使用范围。这种方法旨在逐步促进提高自尊、自我效能和社会包容性的良性循环，从而提高生活质量和福祉。由于以前从未进行过此类研究，我们的多学科研究团队将开展适应性混合方法研究计划，以检查：（1）该方法的结果； （2）实施CHIOCE模式的障碍和促进因素，例如机构间合作与沟通的现实问题； (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经验丰富的专家来更深入地了解 CHOICE，他们在联盟和研究过程中发挥着强大和核心的作用。由于 CHOICE 联盟中所有关键利益相关者的参与，研究结果将对社会处方、社会包容和 SMI 患者健康方面的研究、政策和实践产生重大影响。