"A Neglected Topic": The Culture of Cancer Screening for People with Significant Mental Health Difficulties

Background: Individuals with significant mental health difficulties (SMHD) are 2.5 times more likely to die from cancer than those without SMHD. Lower uptake of organised cancer screening programmes in one proposed contributing factor. This thesis addressed two research aims: (1) The systematic review sought to synthesise the existing empirical evidence on interventions aimed at improving cancer screening uptake, knowledge and attitudes among individuals with SMHD; (2) An empirical study investigated the culture of cancer screening (i.e. the beliefs and attitudes that influence screening practices and behaviours) for individuals with SMHD within community mental health and general practice services in Ireland. Methods: (1) A systematic search across four databases was conducted and a narrative approach was used to synthesise data from the included studies. (2) Semi-structured interviews were conducted with 15 participants including psychiatrists and mental health nurses working in community mental health services and general practitioners and practice nurses working in general practice in Ireland. Data were analysed using thematic analysis. Results: The systematic review identified six empirical examinations of interventions. The qualitative study reported that mental illness stigma, the recovery model of care, poor knowledge and awareness of screening were among the factors contributing to a lack of focused efforts to address poor cancer screening uptake among those with SMHD in Irish services. Conclusions: Results highlight the need for more rigorous and longitudinal research examining interventions to increase screening uptake. There is also initial evidence to suggest a need for urgent action from policy makers and governmental bodies to address cancer screening uptake for this patient group through improved screening and mental health education, increased resources, and policy development to clarify roles and responsibilities relating to the physical health care of individuals with SMHD.