Table 1.

Table 1 Barriers to the recognition and management of physical diseases in patients with severe mental illness (SMI)

Patient and illness-related factors	Treatment-related factors	Psychiatrist-related factors	Other physician-related factors	Service-related factors
Not seeking adequate physical care due to symptoms of the SMI	Deleterious impact (e.g., obesity, type 2 DM, CVD,	Tendency to focus on mental rather than physical health 15	Stigmatization of people with mental disorders 7,13,17,21	Financial barriers, especially in developing countries 16, paucity
(e.g., cognitive impairment, social isolation and suspicion) 13	hyperprolactineamia, xerostomia) of psychotropic medication on physical health 14	with infrequent baseline and subsequent physical examination of patients 13	Physical complaints regarded as psychosomatic symptoms 2	of funding in some countries of general somatic care for patients with SMI 7
Difficulty comprehending health		Poor communication with patient or primary	Suboptimal and worse quality of care offered	High cost of (integrated) care 19
care advice and/or carrying out required		care health workers 15	by clinicians to patients with SMI 7,17,33,34,35,36,37,38.	Lack of access to health care
changes in lifestyle due to psychiatric symptoms and adverse consequences related		Physical complaints regarded as psychosomatic symptoms 2	Lack of assessment, monitoring and continuity of care of the physical health	17,19,22,23 Lack of clarity and consensus about who should be responsible for
to mental illness (e.g., low educational		Suboptimal and worse quality of care offered	status of people with SMI 2,14,39,40,41	detecting and managing physical
attainment, reduced social networks, lack		by clinicians to patients with SMI 7,17,32,33,34,35,36,37,38.	Unequipped or underfunded teams to	problems in patients with SMI 2,7,14
of employment and family support, poverty, poor housing) 12,14,17,18		Lack of assessment, monitoring and continuity of care of the physical health	handle behavioural and emotional problems of patients with SMI 46	Fragmentation or separation of the medical and mental health systems of care,
Severity of mental illness (SMI patients		status of people with SMI 2,14,39,40,41	Complexity and time intensity of	lack of integrated services 2,7,17,29
have fewer medical visits, with the most severely ill patients making the fewest visits) 20		Guidelines perceived as a threat to autonomy, not well known or not clinically accepted 43	coordinating both medical and psychiatric medications 17	Under-resourcing of mental health care that provides little opportunity for specialists to focus on
Health risk factors and lifestyle factors (e.g., substance abuse, poor		Lack of knowledge regarding medical issues 47		issues outside their core specialty 2 Lack of health insurance coverage 7,17
diet, smoking, lack of exercise and unsafe sexual practices) 2,20,24,25		Erroneous beliefs (SMI patients are not able to adopt healthy lifestyles, weight gain is mainly
Less compliant with treatment 26,27,28		adverse effect of medications, lower
Unawareness of physical problems due to cognitive deficits		cardiac risk medications are less effective)45
30,31 or to a reduced pain sensitivity associated with AP medication 30,31		Unequipped or underfunded teams to handle behavioural and emotional problems of patients with SMI 46
Migrant status and/or cultural and ethnic diversity 42
Lack of social skills 13 and difficulties communicating physical needs 44
DM – diabetes mellitus; CVD – cardiovascular disease; AP – antipsychotic