Multimorbidity Among People with Serious mental illness (MAPS): Mapping disease clusters, risk factors, trajectories, service barriers and outcomes

The impact of having many long-term conditions on health, use of health care and costs, and life expectancy is well understood in the general population, where this burden of "multimorbidity" is recognised as leading to poorer health outcomes. However, far less is known about how having multiple long-term conditions, both mental and physical, affects people with serious mental illness (SMI). This is despite there being a recognised 'mortality gap', where people with SMI tend to die at younger ages compared to the general population. This means it is vital to understand how having different combinations, or 'clusters' of illnesses for example cardiac diseases or respiratory diseases, might affect people with SMI, to understand who may be most at risk due to this 'disease burden' and how they can be supported. In this programme of work, we will bring together large data sets that capture many aspects of health and illness for people with SMI, to identify clusters of long-term conditions among people with SMI, identify the risk factors that contribute to these groupings, and understand their impacts on both health and illness, as well as on broader problems such as homelessness. The goal of this work is to help develop improved ways of delivering care and decrease the mortality gap. By working with service users, health professionals and policy makers, we will identify how our understanding of these 'clusters' can be translated into actions that improve service, lead to better care, and help reduce the risk and burden of illness.

To do this, we will 1) summarise and examine all existing evidence on this topic to help us come up with potential disease groupings, prevalence and outcomes. We will then 2) use health care records from people with SMI to understand how these patients use health care, the disease groupings they belong to, and whether certain risk factors affect some people more than others, as well as follow people over time to understand who is more at risk of being hospitalised or dying. We will also 3) hold interviews with people with SMI to understand in more depth their use of the health care system, their experiences with the NHS, how they acquired their long-term conditions over time, the experience of living with multiple health conditions, how their living situation affects their health and what help they would have needed. Finally, we will 4) combine all the findings to agree what these disease groupings mean for patients and services and find ways to improve how the NHS delivers care for patients in these groupings. This will include improving care pathways that both help existing service users within the 'clusters' and help to plan ways to reduce the number of people who end up with multiple illnesses, through enhanced prevention. Throughout the programme of work, service users will play an integral role in developing the research, helping to interpret and disseminate findings and co-producing solutions for improved care.

This research will have an impact on many levels. It will provide NHS health care professionals with information to help prevent the development of multiple long-term conditions among people with SMI, by better understanding who is most at risk. It will help the NHS understand how to improve the care of people with SMI who have many long-term conditions, by recognising how different 'clusters' have different needs. The core goal of this work is to improve the lives of people with SMI, by improving understanding of the burden of multimorbidity for this group and identifying ways to decrease that burden, support people living with complex combinations of illness, and help people live longer and healthier lives.

In the general population, there is an increasing recognition of the impact of multimorbidity (MM) on patient function, healthcare utilisation, costs, and mortality. However, little is known about the role of mental and physical MM in patients with serious mental illness (SMI). Thus, the goal of this proposal is to identify MM disease clusters among these patients, contributing risk factors, care trajectories, and outcomes to develop tailored models of care and help close the mortality gap in this population. To accomplish this, we will 1) undertake a systematic literature review to help conceptualise MM clusters, prevalence, and outcomes; 2) use large linked administrative data on SMI patients to examine care pathways, determine disease clusters, characterise risk factors for MM clusters within an inequalities framework, and follow patients over time to understand which are at greater risk of outcomes, such as mortality and avoidable acute care; 3) use qualitative methods to better understand how MM clusters impact on individuals within their everyday lives, and how patients within MM clusters interact with healthcare and other statutory services so as to identify gaps in provision; and 4) synthesise findings to identify strategies to prevent MM and optimise healthcare, engaging with key stakeholders to support effective implementation.

Our research will have an impact on several levels. It will impact on NHS practitioners and providers, by enabling the potential for early identification and prevention of MM in people with SMI. It will impact on policymakers through the development of a framework on conceptualising MM in SMI to guide policy. It will impact patients through improving health and social outcomes and reducing the burden of MM. Finally, it will impact through improved data linkage to examine MM, strengthened methods development as well as increased research capacity in this area.