In France, it is estimated that 4 million persons have some form of severe mental illness [1]. Persons with a diagnosis of severe mental illness (SMI) have a life expectancy that is 20 years lower than the general population, even after excluding suicide and accidents as the cause of death [2]. In addition, studies show that 19–57% of persons with SMI have at least one associated physical condition, including cardiovascular, gastrointestinal, respiratory, neoplastic, infectious, endocrine, and oral disorders. It is estimated that half of these comorbid conditions are undiagnosed [3, 4].
Unequal access to health services and quality of care are among the main reasons for the reduced life expectancy in individuals with SMI. As a result, cardiovascular risk factors (CVRF) are more frequent, regardless of the mental health diagnosis. For example, persons with SMI are 1.5–2 times more likely to have diabetes, dyslipidemia, hypertension, and obesity the general population [3], and they are less likely to undergo revascularization procedures after a myocardial infarction [5]. When seeking care, they may also be subject to discriminatory practices as a result of stigma and lack of communication skills [6]. This neglect in management and prevention of health problems is usually described by professionals as a result of the mental disorder or the side effects of medication [6, 7].
CVRF are a major cause of death in France, with nearly 150,000 deaths per year, representing more than 25% of all deaths [1]. The circumstances for the onset of CVRF depend mainly on age, lifestyle-based risk factors and environmental conditions, potentiating individually acquired or familial genetic susceptibilities (obesity, hypercholesterolemia, type 2 diabetes, high blood pressure).
It has been established that medical care accounts for only 10–20% of modifiable health factors [8], and, as a result health, strategies focus primarily on promoting positive health behaviors and limiting behavioral risk factors at all ages (tobacco, diet, and sedentary lifestyle in particular) through their identification and appropriate management [3]. This type of strategy was highlighted by the World Health Organization (WHO) in 2016 at the 9th Global Conference on Health Promotion [9], in accordance with the United Nations (UN) Sustainable Development Goals (SDG) agenda [10].
Worldwide, the occurrence, importance, and gravity of physical disorders have long been underestimated for individuals with SMI. In France, progress has been made under the combined pressure of clinical evidence, health professionals, and patient actions and organizations. However, recent studies show the gap in life expectancy between the general population and persons with SMI has continued to widen in France [11] and worldwide [12].
This observation led the WHO to define the promotion of physical health of individuals with SMI as one of the priorities of the 2013–2020 European Mental Health Plan [13], and a recent report from the 2020–2030 UN SDG agenda builds on this objective [14].
In recent years, there has been an increased recognition of the experiential knowledge of health care users [15] and their ability to adapt professional knowledge to the requirements of everyday life. In this model, health decisions are not based on the opinions of professionals but on service users’ right to self-determination regarding their health. This is in line with the orientation of UN and WHO policies towards a human rights-based approach [16]. Strategies based on the empowerment concept have been developed to enhance experience and rights of health care users.
This concept strives to shift the existing balance of power between individuals, groups, services, and governments [17]. At the collective and organizational level, empowerment aims to redefine the health care system and transform it into a learning organization that promotes change. It involves a change in attitudes, policies, training, and methods of providing care, including mental health care. Service users are thus in a position to manage their own “health capital”, to acquire certain rights, and to have a recognized central position in the organization of healthcare. Empowerment is becoming a fundamental concept in health promotion. It aims to increase the power to act and the ability to steer one’s own life in the medical and social spheres. It is a shift from a paternalistic and stigmatizing approach to emancipatory and rewarding dynamics [18, 19]. Thus, several perspectives can be considered: a clearer view of oneself and one’s ill health, better use of the healthcare system’s support services, improved management of life changes, and finally, more deft use of adjustment strategies to integrate ill health and therapy into one’s daily life [20,21,22].
Both individuals with a mental health disorder and their carers have expressed a willingness to share their experience, the difficulties they have encountered, and the strategies they have developed to limit the effects of social isolation and stigma. They have also expressed a desire to develop new strategies for coping and building confidence and self-esteem during times of hardship. It has been shown that a peer exchange process promotes identity building through individual and collective redefinition of the experience of mental health problems and re-appropriation of the health experience, available support and recommended therapeutic strategies [22]. In addition, health support initiatives tend to reinforce active and responsible health behavior. The redefinition of the health care user as a “patient-actor” requires individuals to engage in meaningful participation in decisions that affect them and to develop a practical approach to health care [21].
In parallel, health professionals must take into account the experience of individuals with a mental health disorder and avoid monopolizing health-related decisions [15, 16, 22]. A current challenge within the public health system is to expand the understanding of the factors that limit and facilitate the healthcare pathway for persons with severe mental disorders in order to improve the management of CVRF. The reasons for which health care consumers, carers and health professionals do not work together on this issue are still to be fully explored.
The main objective of this study is to use data from focus groups (FG) to develop and evaluate (feasibility) a health promotion program to encourage the physical health of individuals with severe mental illnesses through a reduction of CVRF.
