The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions

Claire Carswell, Jennifer Valeska Elli Brown, Jennie Elizabeth Lister, R.A Ajjan, S.L Alderson, S Balogun-Katung, Sue Bellass, K Double, Simon Gilbody, Catherine Elizabeth Hewitt, Richard I G Holt, Rowena Jacobs, I Kellar, Emily Jane Peckham, David Shiers, Jo Taylor, Najma Siddiqi, Peter Coventry

Research output: Contribution to journalArticlepeer-review


BACKGROUND: People with severe mental illness (SMI), such as schizophrenia, have higher rates of physical long-term conditions (LTCs), poorer health outcomes, and shorter life expectancy compared with the general population. Previous research exploring SMI and diabetes highlights that people with SMI experience barriers to self-management, a key component of care in long-term conditions; however, this has not been investigated in the context of other LTCs. The aim of this study was to explore the lived experience of co-existing SMI and LTCs for service users, carers, and healthcare professionals.

METHODS: A qualitative study with people with SMI and LTCs, their carers, and healthcare professionals, using semi-structured interviews, focused observations, and focus groups across the UK. Forty-one interviews and five focus groups were conducted between December 2018 and April 2019. Transcripts were coded by two authors and analysed thematically.

RESULTS: Three themes were identified, 1) the precarious nature of living with SMI, 2) the circularity of life with SMI and LTCs, and 3) the constellation of support for self-management. People with co-existing SMI and LTCs often experience substantial difficulties with self-management of their health due to the competing demands of their psychiatric symptoms and treatment, social circumstances, and access to support. Multiple long-term conditions add to the burden of self-management. Social support, alongside person-centred professional care, is a key facilitator for managing health. An integrated approach to both mental and physical healthcare was suggested to meet service user and carer needs.

CONCLUSION: The demands of living with SMI present a substantial barrier to self-management for multiple co-existing LTCs. It is important that people with SMI can access person-centred, tailored support for their LTCs that takes into consideration individual circumstances and priorities.

Original languageEnglish
Article number479
Number of pages14
JournalBMC Psychiatry
Issue number1
Publication statusPublished - 19 Jul 2022

Bibliographical note

© The Author(s) 2022.


  • Caregivers
  • Delivery of Health Care
  • Health Personnel
  • Humans
  • Mental Disorders/complications
  • Qualitative Research
  • Self-Management

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