Table 3.

Individuals living with serious mental illness’ (ILSMI) and care team members’ (CTMs) recommendations.

Intervention recommendations	Description	Supporting quote
Preference for interventionist
Interventionist	The primary preference for an interventionist is a mental health provider. However, the interventionist could be any individual whom the ISLMI trust and can encourage care, such nurses, support group facilitators, case managers, peer support specialists, health coaches, family and/or friends, patient navigators, “medical providers”, and physicians’ assistants.	“Well, I’m sure that the therapist…can guide a person.” (ILSMI) “If there was a possibility of actually having people like case managers, or like a health coach who comes in to guide them, take them to their appointment, but then maybe follow up.” (CTM) “A lot of people are very suspicious, depending on in their disease. If they’re schizophrenic, then they’re not trusting too well. And so, probably a caregiver, someone in the family…That will help them do it.” (ILSMI)
Intervention location
Medical or mental health sites	The intervention should be implemented at sites with medical or mental health services, such as at medical offices, clubhouses, crisis centers, Alcoholics Anonymous, and adult intensive outpatient programs	“When you go into a doctor’s office they have little pamphlets there… so, written, written pamphlets and… things like that.” (ILSMI) “Now at the crisis center, type of thing, I know they do 2 groups a day…” (CTM)
Community and governmental sites	The intervention should be implemented at sites with community and government services, such as at shelters, social service offices, government assistance offices, insurance company offices, and food banks	“I guess places like social services, offices. Shelters, maybe?” (ILSMI) “You know certain doctors’ offices, welfare offices, social service offices, through their social workers…you could ask…. Just notices in places where people are, likely to be. Especially women.” (ILSMI)
Communication channels	The intervention could be delivered via many communication channels (e.g., TV commercials, billboards) to ILSMI and individuals within the community.	“Like TV, you know, the commercials for cancer, there’s a lot going on with that. Commercials get to the heart and also your doctors. Let them know you know that they you need this.” (ILSMI) “So, I think it would have to be something like PBS [News channel] or one of those…Something like that could be good, or even any sort of handouts.” (CTM) “If I was somebody…that’s afraid of going to the doctor or having interviews with somebody or something. Just getting something through mail or having a website, you know, to go to, you know, about these kinds of things.” (ILSMI)
Intervention content
Cancer education for ILSMI	ILSMI should be informed on what is cancer, how cancer can be asymptomatic, how genetic predisposition increases the risk for certain types of cancer, and how cancer can be prevented.	“Yes! Education for everything…well, again normalizing and educating you know that many people have lumps, that it doesn’t mean anything, it, yeah. It’s not automatically cancer or you have to have surgery, or you’re stage 4 or anything like that.” (CTM) “Maybe a relative in the family has had cancer and they’re concerned about their genes being, and they should make sure you’re not concentrating on their mental health but concentrating on other body parts.” (ILSMI)
Cancer screening education for ILSMI	ILSMI should be informed on the benefits and risks (e.g., physical harm) of cancer screening and on the different types of cancer screening available.	“Well just tell them…you have certain screenings and things available so they can have good long lives, healthy long lives.” (ILSMI) “Their therapist or a therapist in the program to really like weigh the pros and cons of getting screenings and why it’s so important to do it.” (CTM) “I think they would need to know the potential of an invasive procedure if you could get injured…people do get their, part of their colon can get nicked when they go in for a colonoscopy.” (CTM)
Logistical education for ILSMI	ILSMI should be informed on where to obtain cancer screening, how to initiate the screening process, how to get screening covered by insurance, and the importance of attending doctor appointments.	“Particularly telling them where to go and how to get involved in having these tests performed…and you need someone with serious mental health problems, you may need someone who could be like a care caregiver or teach.” (ILSMI) “I think just the education of what is going to happen and who is going to be there, who is going to be performing the screening, just information at a time, what the follow up is going to be and what does it mean and just kind of normalizing that. A lot of us don’t like these procedures.” (CTM)
Mental illness education for primary care staff	Primary care staff should be informed on how to recognize psychopathology symptoms, how certain psychopathology symptoms can impact cancer care, and how to be sensitive to the unique needs of ISLMI.	“That medical doctors don’t know a lot about psychiatric treatment, and… medications, and so I don’t know how much they talk to one another with regards to the subject matter, and so that’s what I would venture to say that it would be very helpful for there to be more education on all ends of it.” (CTM) “The thing to remember with schizophrenia is that they can easily get confused or overwhelmed so it’s a delicate balance. It’s almost…I don’t know if it’s a little bit like what you might get when you get a prescription, and there’s the basic…the basic way of taking it or doing it, and then you turn it over, and there’s all the chemical explanation. Which you need to know…” (CTM)
Intervention approaches
Activities of interventionist	Take patients to appointments Provide education Provide emotional and peer support Follow-up with care Encourage motivation, self-care, and comfort Help find and get to medical services and resources Find transportation	“Make sure that they have gotten a followed up on their referrals…Make some phone calls.” (ILSMI) “Well, you can make an appointment for them. If they want help, you can help them get an appointment. You can provide transportation for them.” (ILSMI) “If there was a possibility of actually having people like case managers, or like a health coach who comes in to guide them, take them to their appointment, but then maybe follow up.” (CTM)
Implement integrated care for ILSMI	Implement integrated care models to improve the collaboration, coordination, and communication between the mental health care and primary care systems.	“I think we need better collaboration as mental health providers with medical providers, especially for our patients.” (CTM) “So, if we would be able to coordinate to make it all in one center, I think it would be a lot more practical.” (CTM) “I think a lot more partnership between health and mental health and not seeing them as separate and understanding that you know my body connections that I have a mental health issue I am probably not going to follow up with physical health services.” (CTM)
Implement clinical strategies	Clinical strategies (e.g., motivational interviewing and group therapy) should be used to reduce negative attitudes and fear toward cancer screening, increase motivation to self-care, improve consolidation of health information, and reduce psychopathology symptoms before receiving cancer screening	“I can say is if you came in as a group, come in and talk to a group…And…stress the importance of it that’s the only thing I can really think of.” (ILSMI) “Motivational interviewing could maybe be used to get them to be comfortable with the screening…. I think that this could be easily sort of looped into our process and to really encourage them that it’s a good thing.” (CTM) “But probably the biggest thing is if they get some kind of counseling or supportive…feedback either from a nurse or a therapist about the importance of it…or family members.” (CTM)
Reduce stigma around mental illness and cancer care	Efforts should be made to reduce mental illness and cancer stigma among ILSMI, the community, and primary care providers.	“I know that there are a lot of stigmas with mental illness. That medical doctors don’t know a lot about psychiatric treatment. I would say that it would be very helpful if there is more education.” (CTM) “Decrease the stigma first of all and keep everybody in the loop. Like so, I don’t know how familiar you are with all the screenings everything, regulations for nursing and when people should go get things done changes so much” (CTMs)
Relieve economic burden through insurance, incentives, and/or free clinics.	Efforts should be made help ILSMI find insurance that covers cancer care; provide incentives to reduce the burden of travel and time; and provide free clinics that provide free cancer care.	“giving donuts…Cookies or something like that when, they do that for you know, giving blood.” (ILSMI) “Seriously, I mean I’ve seen them motivated by money because they’re on very fixed incomes.” (CTM) “The other thing is other incentives. Could be things like getting, buying them a bus pass…” (CTM)