What makes it difficult for people with severe mental illness to access cancer screening, and what can make it easier?
Quick-read summary
Evidence suggests that people with severe mental illness are 2.1 times more likely to die from cancer before the age of 75, compared to people without severe mental illness, yet cancer screening uptake is low amongst this group.
This research explores the things that make it difficult for people with severe mental illness (SMI) to access cancer screening, and what could help.
It specifically looks at the challenges people with serious mental illness face when trying to access cancer screening.
Some of the main issues include poor communication with healthcare professionals, stigmatising attitudes, and accessibility problems like lack of transportation and noisy waiting rooms.
Things that could help people with serious mental illness to attend cancer screenings include support from friends, family, and healthcare providers, longer appointment times, and having the screening at a familiar place.
Knowing what can make it hard for people deciding to go to, or complete, cancer screening can mean reasonable adjustments are put in place.
It can help services to take a person-centred approach for people with SMI that recognises the needs and challenges they face.
This includes addressing stigma, improving awareness, enhancing access to healthcare services, and encouraging positive relationships between healthcare providers and people with severe mental illness.
By addressing these issues, we can work towards ensuring everyone has fair and equal access to cancer screenings, regardless of their mental health status.
What is the issue?
- Severe mental illness (SMI) has been defined as ‘people with psychological problems that are often so debilitating that their ability to engage in functional and occupational activities is severely impaired’. This includes Schizophrenia and Bipolar Disorder.
- People with SMI have a life expectancy of between 15 and 20 years lower than the general population.
- People with severe mental illness are 2.1 times more likely to die from cancer before the age of 75, compared to people without severe mental illness.
- Cancer screening is one way to improve the early diagnosis of cancers, by testing people who are asymptomatic. This means that they do not have symptoms.
- In the UK, there are three cancer screening programmes. They aim to screen people for cancer of the cervix, breast, and colon (bowel). You can find out more about the national cancer screening programmes here.
- There is no clear picture of what makes it harder for people with severe mental illness to decide to have screening, or around what can help them decide to go and then have/complete screening.
- This research aimed to build a picture of what makes it difficult for people with serious mental illness to access cancer screening, and what might help.
Research summary
The research team examined research papers from across the globe, which explored this issue.
Normalisation Process Theory (NPT) was used to consider issues of engagement with cancer screening, and areas to implement or make changes to practice that can help people with severe mental illness to attend screening.
The work involved five people who have lived experience of this issue, and who supported the entire study.
The research found the following key themes:
- Awareness and understanding of cancer screening – People did not know what screening was and when it was offered. Support from people and healthcare professionals around them can help with this as well as educational materials.
- Personal characteristics – Person mental health, lack of motivation, previous trauma, and fear of a positive test result can prevent people from accessing screening.
- Stigmatisation – Some people felt that screening staff were unaware of their diagnosis and did not understand how this affected their physical health. Some people felt that other physical conditions were prioritised over cancer screening.
- Not prioritised – The stress of organising the appointment around busy life, or the person may lack motivation to complete screening due to their mental health.
- Help to attend appointments/complete screening – Social support is needed to help the person arrange appointment to go to screening, reminder letters and texts to the person can also help.
- Transport – Some people are unable to drive or access their own transport to go to screening appointments, and using public transport caused anxiety. The study found that bowel screening at home removed this barrier.
- The screening environment – Rushed appointments, rough staff, noise levels, location of screening, navigation around day to day life (such as childcare). The study found that bowel screening being completed at home also removed this barrier.
- Services working together – Services did not work together to help the person – for example screening staff had no way of knowing if the person had any specific needs or when they were due for cancer screening.
Why is this important?
- Knowing what can make it hard for people deciding to go to, or complete, cancer screening can mean reasonable adjustments are put in place.
- It can help services to take a person-centred approach for people with SMI that recognises the needs and challenges they face. This includes addressing stigma, improving awareness, enhancing access to healthcare services, and encouraging positive relationships between healthcare providers and people with severe mental illness.
Who is this evidence useful for?
The evidence is useful for policymakers and commissioners of screening services, as well as health professionals such as GPs and nurses.
The evidence is also useful for people with severe mental illness and their friends/families/carers who may help them in going to cancer screening.
Read the full paper: Barriers and facilitators for people with severe mental illness accessing cancer screening: A systematic review – Tuschick – 2024 – Psycho-Oncology – Wiley Online Library – January 2024
Get in touch about this research
This work was led by Dr Kate Sykes, Northumbria University and Jill Barker, Teesside University.
Email address: kate.sykes@northumbria.ac.uk
Twitter handle: @DrKateSykes @PeccsStudy
Find out more about the Person-Centred Cancer Screening (PECCS) study
Funding
This work was funded by an Open Funding Competition grant from the NIHR ARC NENC