Evidence
View commentaries on this research

This is a plain English summary of an original research article

People with a lung condition and severe mental illness can find it difficult to access primary care. Research outlined the barriers faced by people with both of these long-term conditions. It suggested that social prescribing could help overcome some of the problems.   

This study included people who had both a severe mental health condition (such as psychosis), and a lung condition that causes breathing difficulties (asthma or chronic obstructive pulmonary disease, for example). It found that people with both conditions could be disabled and isolated.

Participants said that they found it difficult to leave the house to access healthcare, and often relied on friends and family to take them to appointments. Once at a consultation, they found that clinicians used medical jargon, and did not consider how both of their conditions, together, impacted their health and wellbeing.

The study concluded that this group of people need support to navigate the healthcare system. Regular contact with the same clinician was helpful. It recommended that social prescribing could help them build support networks.

Further information on mental health conditionsasthma and chronic obstructive pulmonary disease is available on the NHS website.

What’s the issue?

Severe mental health conditions include psychosis (people may see, hear or believe things that are not real) and bipolar disorder (extreme mood swings). The anxiety, depression and disordered thinking associated with these conditions mean people often struggle to manage their own health. On average, they live 20 years less than others in the general population.

A long-term lung condition adds further challenges. The combination of lung and mental health conditions is common, partly because people with severe mental health conditions are more likely than others to smoke. They are also more likely to live in deprived areas.

People with both severe mental health and lung conditions tend to have poor access to healthcare, and poor outcomes. For example, they are admitted to hospital with breathing issues more often than people without severe mental health conditions.

The NHS has introduced measures to improve healthcare for people with lung conditions. Personalised care plans include support to help people self-manage their condition, such as by quitting smoking. However, there is little research into the experiences of people with both severe mental health and lung conditions.

These researchers interviewed people with both conditions about their experiences in primary care. A wider panel (including researchers and those with lived experience, but also GPs, nurses and charity workers) discussed the interviews and developed recommendations to improve the quality of care.

What’s new?

The study included 16 people who had both a severe mental health and a lung condition. They were aged 45 – 75 years, and were being treated at one of 8 GP practices in South Yorkshire. Most were current or ex-smokers, lived alone, did not have formal qualifications and lived in areas of deprivation.

Researchers asked them about their experience of their conditions and the care they receive.

During the interviews, 3 key themes emerged.

  • A lack of social support. People tended to rely heavily on friends and family. Many felt isolated and were either unable or reluctant to leave their own home. Poverty, unemployment, poor access to transport, and the burden of mental health symptoms increased their disability. One said: “When I’m really ill, I can’t leave the house, I can’t leave my bedroom, I can’t go anywhere, I can’t do anything.”
  • Challenges of self-managing health. People could struggle to understand medical jargon during consultations and might not fully understand their condition or how to manage it. Many self-managed anxiety by smoking. Community schemes to help people quit smoking did not always accommodate complex psychological needs. One participant said: “I’ve nowt else in my life but smoking… I’ve always been told what to do and what not to do and smoking’s something I choose to do on my own.”
  • Difficulty in accessing healthcare. People often did not trust practitioners they did not know. Most found it difficult to navigate the fragmented healthcare system, and often waited until they were very unwell before seeking urgent care. They felt that practitioners did not recognise how their conditions interact, and did not adapt treatment plans accordingly. One interviewee said:  “…if I get…restless about asthma and that kicks off like a bit of a panic attack, and then that’s sort of where the bipolar comes in.”

Discussion groups involved 21 people in all (clinicians, charity workers, commissioners, health and social care managers, and people with lived experience).

Potential solutions included:

  • continuity of care: seeing the same clinician each time
  • helping people to navigate the healthcare system, and ensuring that their experiences inform service design
  • social prescribing to help people build up support networks and, for example, helping them get involved in local walking groups or gardening projects.

Why is this important?

This research demonstrates how severe mental health conditions can interact with lung conditions. The combination can make people disabled, isolated, and unable to access quality healthcare.  

Friends and family help many people with these conditions access healthcare. Social prescribing could help people build up social networks they can rely upon, as well as improving their physical and mental health.

A key finding was that people with both conditions need a person-centred approach. Treatment plans need to meet the needs of the individual, and they may need help to manage their own health. Many people will need support to get through the healthcare system. Such measures could reduce the need for emergency healthcare.  

What’s next?

Social prescribing interventions need to be developed and assessed to see if they improve people’s health. Interventions should help people to build up their support networks, which could in turn help them to access healthcare.

The research team created a visual summary to share with practitioners. It highlights issues raised in the paper.  

The infographic describes what social prescribing (S.P) interventions may involve and the steps needed to deliver them within the community. Descriptive text provided at the bottom of the article.

All but one of the interviewees were White British. Cultural barriers to discussing mental health may have discouraged people from other ethnic groups, along with the lack of interpreter support for non-English speakers. Further studies are therefore needed to see if the findings apply to other ethnic groups.

Materials for participants must be clear and simple, to enable people with lower health literacy to take part in research. The researchers say this population is often the most underserved.

The study was conducted in South Yorkshire. Further work should assess whether these findings apply elsewhere in the UK.

You may be interested to read

This NIHR Alert is based on: Mitchell C, and others. Primary care for people with severe mental illness and comorbid obstructive airways disease: a qualitative study of patient perspectives with integrated stakeholder feedback. BMJ Open 2022;2:e057143

Lived experience of people with mental and physical health conditions: Coventry P, and others. Living with complexity; marshalling resources: a systematic review and qualitative meta-synthesis of lived experience of mental and physical multimorbidity. BMC Family Practice 2015;16:171

Information about many mental health conditions is available from the charity Mind

Asthma and Lung UK has further advice about managing anxiety and asthma and managing COPD (chronic obstructive pulmonary disease).

Infographic credit and permissions: NIHR Evidence has permission to feature the visual summary above, which was created by Nifty Fox Creative and commissioned and funded by the grant.

Infographic descriptive text: The infographic describes social prescribing interventions and the steps needed to deliver them. It outlines the need:

  • for early intervention
  • to draw on community resources to develop partnerships within the care sector
  • to rebuild support networks through local projects, and to create a sense of belonging
  • to support people with disabilities to remain in work
  • to make services flexible to meet people’s personal needs
  • to secure funding for social prescribing interventions
  • to train individuals to support this group of people. 

Funding: This research was part-funded by the NIHR CLAHRC Yorkshire and Humber, an NIHR RCF grant from Sheffield and Social Care NHS Trust and a small grant from the Clare Wand Charitable Fund (BMA).

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.


  • Share via:
  • Print article

Comments

Study author

We showed that the detrimental effects of severe mental illnesses and lung conditions can overlap and compound each other. People are often isolated because of their mental health condition, and the breathlessness caused by their lung condition makes it difficult for them to leave the house. This creates a vicious circle. Individuals become increasingly housebound, their condition worsens, and they are unable to access healthcare.

We found that people with severe mental health conditions and a lung condition received differing levels of support from different GP practices. The extent to which support was personalised also varied. To standardise care for this population, treatment guidelines need to be updated. They need to recognise the barriers to the self-management of lung conditions for those with severe mental health conditions. Clinicians should personalise treatment plans to cater for the individual needs of each patient.

Caroline Mitchell, Senior Clinical Lecturer and GP, University of Sheffield

Lived experience

I have personal experience of living with COPD, as well as other health complications, and I am well aware of the psychological impacts of living with multiple health issues.

The research shows that practice is fragmented, and that different care pathways could be more integrated. People’s psychological needs should be addressed alongside treatment of respiratory conditions and management of any other health issues.

Social prescribing improves support for triggers of anxiety such as financial or housing difficulties. It can reduce the impact of social and economic issues on anxiety and physical health. A holistic approach to the design and delivery of support could improve people’s lived experience of their conditions.’

The study underlines the need to improve poor health literacy and people’s understanding of their condition. It highlights the need for both formal and informal support, and for continued relationships with healthcare systems. Professionals need to take a holistic approach and consider when attendance is necessary for people with multiple health issues and social and economic difficulties.

Philip Collis, Public Contributor, Leamington Spa 

Researcher

People with severe mental health conditions and respiratory issues face difficulties in accessing care. This study describes how care could be better designed to meet their needs and could increase awareness among primary healthcare workers.

There are a number of useful ideas. Personalised smoking cessation could acknowledge the role that smoking plays in stress reduction. People could receive support to navigate (often complex) care pathways. None of the respondents used online or written materials, so alternatives are needed. And an approach that builds community and individual resources would be helpful.

David Kessler, Professor of Primary Care, Bristol Medical School, University of Bristol 

Nurse Researcher

This robust research raises awareness of the complexity of managing severe mental health conditions and respiratory issues. Raising awareness of the importance of social support could be helpful.

However, we need to develop and test interventions that could benefit this group of people.

Lindsay Welch, Postdoctoral Researcher in Health Sciences, University of Southampton

Back to top