Improving access to physical healthcare for older people in mental health settings: the ImPreSs-care qualitative study

Background: Older people with serious mental ill health have high levels of physical comorbidity. Despite this, mental health services receive limited physical health support from primary or secondary care. This study investigated the facilitators and barriers to delivering physical healthcare for older people in mental health settings. Methods: In total, 54 semi-structured interviews (REC:22/IEC08/0022) were conducted with different stakeholders [staff (n = 28), patients (n = 7), carers (n = 19)] across two mental health hospitals. Interviews explored the facilitators and barriers to delivering physical healthcare for older people (>65 years) receiving secondary mental healthcare (dementia and psychiatric disorders). Data were analysed thematically, underpinned by a framework of integrated care for individuals living with multimorbidity. Results: A ‘multidisciplinary approach’ was valued, particularly to identify patients for targeted physical health support. There was felt to be a loss of physical health ‘training and skills’ over time, particularly amongst nursing and medical staff. Admissions to the acute hospital were potentially avoidable through improved ‘support and availability of physical health expertise’, to provide more proactive than reactive care. Alongside improved training and support, managing advanced care planning, end of life care and polypharmacy were perceived to facilitate improved physical healthcare in mental health settings. Conclusions: Lack of senior physical health leadership (e.g. geriatrician or general practitioner) and loss of skills and confidence in managing physical health in mental health settings have led to a low threshold for admissions to the acute hospital. In particular, services should support advanced care planning and end of life care from physical causes in mental health settings.