Ehrlich Carolyn, Chester Polly, Kisely Steve, Crompton David, Kendall Elizabeth
School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia.
Hopkins Centre, Menzies Health Institute, Griffith University, Meadowbrook, Queensland, Australia.
Health Soc Care Community. 2018 Jan;26(1):e47-e55. doi: 10.1111/hsc.12473. Epub 2017 Jul 6.
The poor physical health of people who experience severe mental illness (SMI) is an important public health issue that has been acknowledged, yet not properly addressed. People who live with SMI perform a myriad of complex tasks in order to take care of their physical health, while receiving unpredictable levels of support and assistance from health professionals. In this qualitative study, we aimed to uncover the kinds of work people with SMI do in order to look after their physical health. In a metropolitan area in Queensland, Australia, 32 people with lived experience of SMI participated in semi-structured, face-to-face interviews. Data were digitally recorded, transcribed verbatim and open coded. They were then themed using a constant comparative process. We found that people with SMI were engaged in a "rhythm of life with illness" that consisted of relatively short, acute and chaotic cycles of mental and physical illness, accompanied by much longer mental and physical illness recovery cycles. Participants engaged in three specific types of health-related work to manage these cycles: discovery work (and the associated role of the health professional); sense-making work to meaningfully interpret health and illness; and embedding work to become engaged self-managers of illness and producers of health. We discuss how varying levels of support from health professionals impact consumers' self-management of their physical and mental health; how health professionals influence consumers' experience of treatment burden; and implications for practice.
患有严重精神疾病（SMI）的人群身体健康状况不佳，这是一个已得到认可但尚未得到妥善解决的重要公共卫生问题。患有严重精神疾病的人在照顾自身身体健康的同时，还要完成无数复杂的任务，而他们从医疗专业人员那里获得的支持和帮助水平却不可预测。在这项定性研究中，我们旨在揭示患有严重精神疾病的人在照顾自身身体健康方面所做的工作类型。在澳大利亚昆士兰州的一个大都市地区，32名有严重精神疾病生活经历的人参与了半结构化的面对面访谈。数据进行了数字录音、逐字转录并进行了开放式编码。然后通过持续比较过程确定主题。我们发现，患有严重精神疾病的人参与了一种“带病生活节奏”，这种节奏由相对短暂、急性且混乱的身心疾病周期组成，同时伴随着长得多的身心疾病康复周期。参与者从事三种特定类型的与健康相关的工作来管理这些周期：探索工作（以及医疗专业人员的相关角色）；对健康和疾病进行有意义解读的意义构建工作；以及成为疾病自我管理者和健康创造者的融入工作。我们讨论了医疗专业人员不同程度的支持如何影响消费者对其身心健康的自我管理；医疗专业人员如何影响消费者对治疗负担的体验；以及对实践的启示。
