Quality of medical care for people with and without comorbidmental illness and substance misuse: systematic review of comparativestudies

There is strong evidence to support inequalities in medical caredisadvantaging those who have a psychiatric illness or a substance usedisorder. Despite promising approaches to shared care there is asubstantial gap in routine medical care for many individuals with mentalillness or substance use disorders.2,99,100 This is mostapparent in general (internal) medicine and cardiovascular care but mayalso be present in diabetes care and cancer care. There is littleevidence to suggest that the recommended enhanced medical care forindividuals with mental illness has been successfully implemented. Futurework must focus on the type and severity of mental illness, patientfactors such as adherence and systems interventions to increase thequality of care for those with chronic mental illness.