# Access, inequalities and annual health checks (AHCs) for adults living with severe mental illness in the UK: a mixed-methods systematic review

## TL;DR

This study reviews access to health checks for adults with severe mental illness in the UK, highlighting inequalities and the need for better research.

## Contribution

The study identifies gaps in research on access inequalities to health checks for people with severe mental illness and protected characteristics.

## Key findings

- Only five studies applied reasonable adjustments to increase access to annual health checks, but lacked proper evaluation.
- Most studies ignored factors like deprivation and ethnicity, and few addressed barriers for diverse cultural backgrounds.
- No evidence was found for interventions successfully improving access to health checks for people with severe mental illness.

## Abstract

Individuals living with severe mental illness (SMI) are at a significantly higher risk of mortality. This mixed-methods systematic review identifies and explores factors, including access inequalities to annual health checks (AHCs), for people living with SMI sharing protected characteristics in the UK, as identified in Core20PLUS5.

Mixed-methods systematic review.

MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, Google Scholar and the grey literature were searched from 1 January 2004 to 30 January 2025.

Inclusion criteria were adults >18 years of age living with SMI. We included studies of AHCs, short health screening interventions, health promotion interventions, considering or aiming to improve uptake and/or access to screening for people living with SMI. We included mixed-methods and quantitative studies: randomised controlled trials, non-randomised controlled studies, cohort studies, cross-sectional studies and process evaluations. We also included qualitative studies.

Two reviewers independently assessed the evidence for inclusion using the eligibility criteria at title, abstract and at full-text screening. Quality Assessment with Diverse Studies was used for methodological quality. Analysis used Levesque’s Conceptual Framework of Access as an a priori framework and dimensions of equality from Core20PLUS5 and PROGRESS PLUS. Separate and independent quantitative and qualitative narrative syntheses and integration of the evidence from both occurred.

36 studies were included. Five studies applied reasonable adjustments to increase access to AHCs but lacked evaluation, controls and comparisons. 26 studies failed to discuss deprivation or ethnicity and only 6 studies discussed barriers and facilitators of access to AHCs for people of different ethnic, linguistic or cultural backgrounds. There was no evidence for interventions improving access to AHCs. Access focused primarily on dimensions of services, over abilities to access AHCs for people living with SMI.

There are access inequalities to AHCs for people living with SMI sharing protected characteristics. Robust research is urgently needed to identify, modify and ameliorate barriers to the policy recommended AHCs.

CRD42023437905.