Barriers, Levers, and Contrasts in Complex Care Pathways: The Case of Cancer amongst People Living with a Severe Mental Illness

QES n° 281
2023/09

ABSTRACT
The excess mortality of people living with a mental illness has been recognised as a public health issue for a decade in France. However, concrete initiatives to address it are still limited and require a better understanding of the complex somatic care pathways of this population, who presents multiple vulnerabilities. Leveraging an analysis of cancer care pathways - based on a dual qualitative and quantitative approach -, this research highlights disparities for people living with a severe mental illness, relating in particular to the receipt of recommended diagnostic tests, timeliness between diagnosis and treatments, post-treatment follow-up, and risk of death, while underlining the heterogeneity of the situations experienced. The differences identified in the care pathways could be linked with adaptations to the specific circumstances of individuals and their choices, but also with preconceptions about the difficulties associated with mental illness and inadequate care organization, which could be improved by dedicated public policies.

See also Questions d'économie de la santé n° 281 in French: Obstacles, ressources et contrastes dans les parcours de soins complexes : le cas du cancer chez les personnes vivant avec un trouble psychique sévère.