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Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies

Published online by Cambridge University Press:  02 January 2018

Alex J. Mitchell*
Department of Liaison Psychiatry, Leicester General Hospital, and Department of Cancer and Molecular Medicine, Leicester Royal Infirmary, Leicester, UK
Darren Malone
Lakes District Health Board, New Zealand, and Department of Health Science, Leicester University, UK
Caroline Carney Doebbeling
Department of Internal Medicine, Indiana University School of Medicine, Regenstrief Institute, Indianapolis, USA
Alex J. Mitchell, Department of Liaison Psychiatry, Leicester General Hospital, Leicester LE5 4PW, UK. Email:
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There has been long-standing concern about the quality of medical care offered to people with mental illness.


To investigate whether the quality of medical care received by people with mental health conditions, including substance misuse, differs from the care received by people who have no comparable mental disorder.


A systematic review of studies that examined the quality of medical care in those with and without mental illness was conducted using robust critical appraisal techniques.


Of 31 valid studies, 27 examined receipt of medical care in those with and without mental illness and 10 examined medical care in those with and without substance use disorder (or dual diagnosis). Nineteen of 27 and 10 of 10, respectively, suggested inferior quality of care in at least one domain. Twelve studies found no appreciable differences in care or failed to detect a difference in at least one key area. Several studies showed an increase in healthcare utilisation but without any increase in quality. Three studies found superior care for individuals with mental illness in specific subdomains. There was inadequate information concerning patient satisfaction and structural differences in healthcare delivery. There was also inadequate separation of delivery of care from uptake in care on which to base causal explanations.


Despite similar or more frequent medical contacts, there are often disparities in the physical healthcare delivered to those with psychiatric illness although the magnitude of this effect varies considerably.


There is strong evidence to support inequalities in medical care disadvantaging those who have a psychiatric illness or a substance use disorder. Despite promising approaches to shared care there is a substantial gap in routine medical care for many individuals with mental illness or substance use disorders.2,99,100 This is most apparent in general (internal) medicine and cardiovascular care but may also be present in diabetes care and cancer care. There is little evidence to suggest that the recommended enhanced medical care for individuals with mental illness has been successfully implemented. Future work must focus on the type and severity of mental illness, patient factors such as adherence and systems interventions to increase the quality of care for those with chronic mental illness.

Review Article
Copyright © Royal College of Psychiatrists, 2009 


Declaration of interest



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