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

Objectives
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 AHCs, for people living with SMI sharing protected characteristics in the UK, as identified in Core20PLUS5.
Design
Mixed methods systematic review.
Data Sources
MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, Google Scholar and the grey literature were searched from 1st January 2004 – 30th January 2025.
Eligibility Criteria
Inclusion criteria were adults >18years of age living with SMI. We included studies of annual health checks (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.
Data Extraction and Synthesis
Two reviewers independently assessed the evidence for inclusion using the eligibility criteria at title, abstract and at full text screening. QuADS 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.
Results
36 studies were included. 5 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.
Conclusions
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.