Patients with severe mental illness (SMI) have shorter life expectancy than people without SMI, mainly due to overmortality from physical diseases. They are treated by professionals in three different health and social care sectors with sparse collaboration between them, hampering coherent treatment. Previous studies have shown difficulties involved in establishing such collaboration. As the preparatory phase of an intervention to improve physical health of people with SMI and increase collaboration across sector borders, we explored different actors’ experiences of barriers for collaboration. We collected qualitative data from patients, professionals in general practice, psychiatry and social psychiatry involved in the treatment of these patients. Data consisted of notes from meetings and observations, interviews, focus groups and workshops. Analysis was by Interpretative Phenomenological Analysis. The study revealed many obstacles to collaboration and coherent treatment, including the consultation structures in general practice, sectors being subject to different legislation, and incompatible IT systems. Professionals in general practice and social psychiatry felt that they were left with the responsibility for actions taken by hospital psychiatry without opportunity to discuss their concerns with psychiatrists. There were also cultural differences between health care and social psychiatry, expressed in ideology and language. Social psychiatry had an existential approach to recovery, whereas the views of health professionals were linked to symptom control and based on outcomes. Meanwhile, patients were left in limbo between these separate ideologies with no leadership in place to promote dialogue and integrate treatments between the sectors. Many obstacles to integrated trans-sectoral treatment of patients with SMI seem related to a lack of an overriding leadership and organizational support to establish collaboration and remove barriers related to legislation and IT. However, professional and ideological barriers also contribute. Psychiatry does not consider general practice to be part of the treatment team although general practitioners are left with responsibility for decisions taken in psychiatry; and different ideologies and treatment principles in psychiatry and municipal social psychiatry hamper the dialogue between them. There is a need to rethink the organization to avoid that the three sectors live autonomous lives with different cultures and lack of collaboration.

中文翻译：

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严重精神疾病患者的跨部门治疗障碍的经验。定性研究。

与没有SMI的人相比，患有严重精神疾病（SMI）的人的预期寿命短，这主要是由于身体疾病导致的死亡率过高。在三个不同的卫生和社会护理领域，他们之间的合作稀疏，阻碍了他们的连贯治疗。先前的研究表明建立这种合作涉及困难。作为改善SMI人群身体健康并加强跨部门协作的干预措施的准备阶段，我们探讨了不同参与者在协作障碍方面的经验。我们从涉及这些患者治疗的患者，全科医生，精神病学和社会精神病学方面收集了定性数据。数据包括会议和观察，访谈，焦点小组和研讨会的笔记。分析是通过解释现象学分析进行的。该研究揭示了协作和连贯处理的许多障碍，包括一般实践中的咨询结构，受不同立法约束的部门以及不兼容的IT系统。普通科和社会精神病学专业人士感到，他们不得不对医院精神病学采取的行动负责，而没有机会与精神病医生讨论他们的担忧。卫生保健和社会精神病学之间在文化上也存在差异，以意识形态和语言表达。社会精神病学采用一种现有的康复方法，而卫生专业人员的观点则与症状控制和结果有关。与此同时，患者在这两种意识形态之间处于混乱状态，没有领导才能促进对话和整合部门之间的治疗。SMI患者跨部门综合治疗的许多障碍似乎与缺乏建立协作并消除与立法和IT相关的障碍的领导和组织支持缺乏有关。但是，专业和意识形态方面的障碍也有所贡献。精神病学不认为普通科医师是治疗团队的一部分，尽管全科医生对精神病学决策负责。精神病学和市政社会精神病学中不同的意识形态和治疗原则阻碍了它们之间的对话。