Challenging Health Outcomes/Integrating Care Environments: A Community Consortium To Tackle Health Disparities For People Living with Mental Illness

In the UK and elsewhere, people with severe mental illness die prematurely, up to 20 years younger than the general population, a mortality often associated with modifiable medical risk factors. The substantial costs to the health system and the wider economy caused by smoking, obesity, physical inactivity, alcohol misuse and substance abuse are well established. For example, smoking rates among people with a mental illness are three times higher than among the general population. However, while smokers living with severe mental illnesses are just as likely to want to quit as the general population, they are generally more addicted, and face greater barriers to quitting. Similarly, weight gain and obesity are major problems for people with mental health problems, increasing the risk of developing diabetes or cardiovascular diseases, all contributing to low quality of life and exacerbating psychiatric symptoms. Other interwoven and modifiable risk factors associated with the poor physical health of people with mental health problems include low self-esteem, unemployment, loneliness, the low expectations of others, and social exclusion. For a range of social and psychological reasons, including the damage done by stigma, people with mental health problems have relatively limited access to local cultural and natural resources which could improve their physical and mental health.

In recent years, greater attention has been focussed on the physical health of people living with mental illnesses but services remain fragmented and uncoordinated. This disconnect may be particularly true in the relationship between statutory health and social care services, and the community and voluntary sector organisations. Moreover, many lifestyle interventions exist that are of potential benefit to people with SMI these are seldom implemented in community settings and there is a lack of evidence on the development of effective interventions to help people with SMI. The CHOICE project aims to build a community coalition of agencies and people across Northern Ireland to maximise the resources, skills and knowledge held collectively. We will use Community-Based Participatory Research (CPBR), a powerful 'bottom-up' approach which uses innovative and inclusive approaches to empower disadvantaged communities and populations in the co- design and implementation of solutions to address health disparities. CBPR helps bridge research and practice by engaging the community to tackle disparities in population health and has been used in diverse and disadvantaged settings as an efficient means of challenging power imbalances. Importantly, our coalition will assist in identifying and exploiting all the assets and resources that exist in our communities but remain generally underused. Working with the experts by experience, we will use arts-based approaches to highlight the experience of living with mental illness, and the relationship between exclusion and physical health. By the end of the project we will have developed a strong community coalition and an agreed strategic plan to improve the lives of people living with mental illness.