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People with serious mental illness die at a much younger age than people in the general population largely due to preventable medical conditions, like cardiovascular disease, cancer, and diabetes. Because of our collective failure to act, this mortality gap has persisted for decades and continues to worsen despite advances in the access and quality of medical care for the general population. This book looks at decades of research on people with severe mental illness (SMI) and asks two questions: Why do people with SMI die at an earlier age than those in the general population without these disorders? And, what can be done to address these health inequities? Readers will come away with a better understanding of the factors that shape the physical health of people with SMI and an awareness of the interventions, programs, and policies aimed at improving the health of this underserved population.

Objective: A systematic literature review of randomized clinical trials (RCTs) assessing depression treatments in primary care for Latinos is conducted. The authors rate the methodological quality of studies, examine cultural and linguistic adaptations, summarize clinical outcomes and cost-effectiveness findings, and draw conclusions for improving depression care among this diverse population. Method: Electronic bibliographic databases, Web sites, and manual searches are used to identify nine peer-reviewed articles covering four RCTs. Results: Across trials, collaborative care models were more effective than usual care in reducing depression and improving functioning and accessibility to guideline-congruent care. Conclusion: The use of evidence-based treatments in primary care seems to be an effective and cost-effective strategy to reduce mental health care disparities among Latinos served in primary care.

Purpose: Over 50% of people with serious mental illness (SMI) smoke cigarettes. This study evaluated whether tobacco use impacted weight loss outcomes during a peer-led healthy lifestyle intervention (PGLB) for people with SMI living in permanent supportive housing (PSH). Method: Data from an effectiveness trial of PGLB examined whether baseline tobacco use moderated the effectiveness of the intervention compared to usual care (UC) in helping participants lose weight. PGLB was conducted in three sites in two U.S. cities between 2015 and 2018. Results: 63% of participants were current cigarette smokers. Smoking did not moderate the effect of the intervention. However, baseline tobacco use predicted greater weight loss ( b = −4.1, p = .022) over the course of the trial, regardless of treatment group. Discussion: Tobacco use was a significant driver of weight loss for study participants. Findings have implications for offering tobacco cessation treatment during healthy lifestyle interventions for people with SMI.

Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice.

Objective: Assuring research participants'capacity to provide informed consent has become increasingly important in health and mental health research, and each study faces unique capacity-assessment challenges, possibly requiring its own screening tool. This article describes the development and preliminary testing of a capacity-to-consent tool constructed for a study of psychiatric diagnosing in a community clinic. Method: A 10-item screening device based on four legal standards for demonstrating capacity (understanding, appreciation, reasoning, and voluntarism) was created and tested with 68 adult patients entering the study. Results: Only five participants (7%) failed the screen, 61 (93%) passed. No participants who passed at entry were later found in psychiatric evaluations to lack capacity. Conclusion: The tool was effective in identifying persons who could not demonstrate consent capacity, thereby protecting prospective participants.

Purpose: Healthy lifestyle interventions can improve the health of people with serious mental illness (SMI). Little is known whether demographic variables moderate the effectiveness of these interventions on health outcomes. Method: Data from an effectiveness trial of a peer-led healthy lifestyle intervention (PGLB) for people with SMI examine whether age, racial/ethnic minoritized status, and gender moderated the effectiveness of PGLB compared to usual care (UC) in achieving clinically significant improvements in weight, cardiorespiratory fitness, and cardiovascular disease (CVD) risk reduction. Results: Compared to UC, PGLB was most beneficial for participants age 49 and younger for achieving clinically significant weight loss and for racial/ethnic minoritized communities for achieving clinically significant weight loss and reductions in CVD risk. Conclusions: These findings suggest the impact of healthy lifestyle interventions for people with SMI may not be uniform and adaptations may be needed to make these interventions responsive to the needs of diverse populations.

Latinos with serious mental illness (SMI) experience health and health care disparities and may benefit from interventions that improve access to, coordination of, and receipt of primary care services. The aim of this qualitative study was to examine the experiences of Latinos with SMI and at risk for cardiovascular disease participating in Bridges to Better Health and Wellness (B2BHW), a culturally-adapted health care manager intervention delivered in a public outpatient mental health clinic. A total of 29 Latino participants completed a post-intervention survey that included an open-ended question about the three things they liked most about B2BHW; a subset of 16 participants participated in one of three post-intervention focus groups. Results indicate that what mattered most to participants was the health education they received, the positive relationships they formed with their health care managers, the care coordination assistance they obtained, and the motivation and activation they gained from this intervention. Study findings suggest that key elements of the health care manager intervention (e.g., care coordination, and patient activation) shaped participants' experiences with B2BHW and were perceived as beneficial.

Relative to non-Latino Whites, Latinos in the United States with major depressive disorder (MDD) show low engagement in antidepressant therapy, whether engagement is defined as pharmacotherapy access, medication initiation, pill-taking, or treatment retention. One potential reason for this disparity in depression care is the low cultural congruence of pharmacotherapy for this population. To examine Latinos' views of depression and antidepressant therapy, we conducted qualitative interviews with 30 Latino outpatients initiating antidepressants prior to their first treatment visit using the semistructured Treatment Adherence and Retention Questionnaire. These baseline interviews were randomly selected from data collected for a randomized controlled trial testing a novel intervention to enhance engagement by depressed Latino outpatients. Participant narratives were analyzed using open coding and the iterative analytical approach derived from grounded theory. Patient views about depression addressed stigmatizing views held by others in their social circle. Most participants directly refuted these views by providing alternate explanations to depression experiences. Antidepressant therapy narratives also revealed marked stigmatization, but participants tended not to refute these views. Instead, patients expressed concerns about antidepressants and showed marked ambivalence about seeking psychiatric care. Participants, however, did suggest ways in which clinicians and patients might collaborate to address their concerns about antidepressants. Some cultural views, such as concerns about addiction to or dependence on medication, may be negotiable barriers to treatment. Prescribing clinicians should address cultural views and concerns in order to improve Latino engagement in antidepressant therapy.

Stigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality—most only included evaluations after intervention or short follow-up periods (1–3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the interventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community.