Behind the Gaps: A Narrative Review of Healthcare Barriers for Individuals with Serious Mental Illness.

BACKGROUND: Individuals with serious mental illness (SMI) die significantly earlier and experience disproportionately higher rates of physical health issues compared with non-SMI groups. Despite advances in care, this mortality gap persists. One factor that contributes to this discrepancy is inadequate access to healthcare, as individuals with SMI are less likely to receive appropriate medical care. METHODS: To better understand this, we completed a narrative review synthesizing existing literature on common barriers to care faced by the SMI community. We reviewed 34 articles and identified three primary barriers to receiving healthcare. RESULTS: These included structural and logistical barriers (geographic location, access to technology and internet, disjointed medical and mental healthcare); intrapersonal- and patient-level barriers (symptoms and psychological impact of SMI, lack of awareness or prioritization of medical issues, medical mistrust, and limited health literacy); and provider- and system-level barriers (lack of knowledge or support for integrated care, lack of knowledge of SMI, stigma, and diagnostic overshadowing). CONCLUSIONS: We argue that addressing these issues requires a reorientation toward person-centered approaches that prioritize continuity, integration, and dignity in care for individuals with SMI, and we offer specific recommendations in service of these aims.