'A positive thing by mentioning it': a qualitative study of experiences of brief physical health interventions for individuals diagnosed with severe mental illness in primary care

Objectives: The physical health of people diagnosed with mental illness is a significant source of health inequality, with this group being three times more likely to have a physical illness and dying 15-20 years earlier than those without diagnosed mental illness. Unhealthy lifestyles are a major contributor to this. The purpose of this study was to explore the barriers and facilitators of the Making Every Contact Count (MECC) approach, an opportunistic health promotion strategy for improving the physical health of patients with diagnosed mental illness in primary care. Methods: A qualitative study involving semi-structured interviews in which ten people diagnosed with mental illness from a Lancashire practice and ten GPs including stakeholders within the Clinical Commissioning Group were interviewed. Interview data was subject to thematic analysis. Results: Themes were identified relating to patient factors, clinician communication. and systemic factors. Patients were more likely to take on brief interventions if they trusted and had good rapport with their clinician. Clinicians, if given the chance, valued opportunities for discussing the effects of unhealthy lifestyles with patients. Systemic factors influencing the MECC approach included provision of continuity of care and the annual review, although some patients viewed the latter as rarely offering fruitful discussion. Some clinicians felt time and workload pressures prevented them from carrying out meaningful interventions. Clinicians felt further training was needed to support them delivering brief interventions. Patients were pleased to focus on physical health. Conclusion: Poor physical health of patients diagnosed with mental illness can be addressed using a 'making every contact count'-based approach. MECC is a low-resource approach based on building a relationship of trust and casually introducing physical health as a topic of conversation as the opportunity arises. The research highlights barriers and facilitators to doing this within primary care from both patient and clinician perspectives.