Enhancing physical health support for people living with severe mental ill-health: Understanding the implementation landscape

Background People living with severe mental ill-health (SMIH) experience premature mortality and morbidity relative to the general population. In the United Kingdom national policy advocates for targeted and tailored physical health promotion to address this, yet implementation is limited and variable. Using a regional health system as a case study, we sought to understand whether and how health systems might facilitate or impede the implementation of a service that spans conventional silos and responsibilities (mental and physical health). We adapted the Consolidated Framework for Implementation Research (CFIR) to provide a guiding framework for mapping and evaluating the policy, practice, and delivery landscape. Methods Informed by our community advisory group of experts by lived experience (n = 10), we recruited system actors using initial snowball then maximum variation sampling approaches. Using a combination of workshops, interviews and focus groups, data were collected from professionals working within the systems (healthcare or community organisations; n = 16) and those living with SMIH in the region (n = 26); these were supplemented by relevant policy and service-related documentation identified during the process of engagement. We used the methodology of interpretive description to analyse data iteratively and collectively. Results Recognition of the need for more integrated and holistic forms of health support for people living with SMI was strong both within and outwith the system; existing services were experienced as fragmented and reactive. However, the implementation landscape is challenging. Cross-context constraints dominate, including communication and technological challenges, and explicit and specific policy directives or examples of good practices were limited. A lack of clarity regarding roles and responsibilities led to uncertainty about by whom, and how, change would be driven. Conclusions Despite observations of strong advocacy and ambition for change, the implementation of enhanced physical health support for those with SMIH is likely to struggle without system reform. There is a role for stronger operationally-focused policy and practice guidance, monitoring, and incentives in this specific context. Supportive change needs to boost the implementation drivers of allocated resource, specificity of leadership responsibility, and explicit prioritisation, alongside valuing locally-led innovation.