Purpose

Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general population. This paper aims to explore the experiences of individuals accessing primary health care following discharge from secure services, and the practitioners who support them.

Design/methodology/approach

Face-to-face qualitative interviews were conducted with service users (n = 4) and mental health practitioners (n = 4) within a forensic community mental health team in one NHS Trust in England in 2019. Data were analysed using the Interpretative Phenomenological Analysis.

Findings

Four super-ordinate themes emerged: perceived importance of physical health, agency, responsibility and relationships. Service users mostly saw themselves as passive recipients of health care and prioritised their mental health over their physical health. Close working relationships meant that mental health practitioners were often the first contact for service users with any health issue and thus felt a sense of responsibility for their physical health care. Service users who did access primary care reported that consistency of professional, feeling understood and listened to without judgement or stigma were important.

Practical implications

Interventions for service users that include practicalities and strategies to facilitate independence in physical health care, and collaborative working between primary care and forensic mental health services, are encouraged.

Originality/value

This study highlights some of the unique challenges in forensics around improving physical health outcomes for individuals with SMI.

中文翻译：

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从法医安全服务出院后获得和参与初级卫生保健服务：服务使用者和心理健康从业者的观点

目的

与一般人群相比，严重精神疾病 (SMI) 患者（包括法医人群）的身体健康不平等和死亡率更高。本文旨在探讨个人从安全服务出院后获得初级卫生保健的经历，以及支持他们的从业者的经历。

设计/方法/方法

2019 年，在英格兰的一个 NHS 信托中，对法医社区心理健康团队中的服务使用者（n = 4）和心理健康从业者（n = 4）进行了面对面的定性访谈。使用解释性现象学分析对数据进行了分析.

发现

出现了四个上级主题：身体健康的重要性、能动性、责任感和人际关系。服务使用者大多将自己视为医疗保健的被动接受者，并将他们的心理健康置于身体健康之上。密切的工作关系意味着心理健康从业者通常是有任何健康问题的服务使用者的第一个接触者，因此对他们的身体健康护理有责任感。确实获得初级保健服务的服务使用者报告说，专业的一致性、感觉被理解和被倾听而没有判断力或耻辱感很重要。

实际影响

鼓励对服务使用者进行干预，包括促进身体保健独立的实用性和策略，以及初级保健和法医精神保健服务之间的协作工作。

原创性/价值

这项研究强调了法医在改善 SMI 患者身体健康结果方面的一些独特挑战。