Schizophrenia is a complex mental health disorder that has a huge burden on the individual’s physical health. Despite its low prevalence, the disorder has been listed among the top ten contributors of health burden and disability around the world. People with schizophrenia usually suffer from a myriad of physical health conditions with 33 percent of the patients having three or more physical health problems. Schizophrenia has been linked with up to threefold increased risk of cardiovascular mortality. Risk factors such as metabolic disorders and lifestyle behaviours are the major contributors to cardiovascular-related diseases (CVD). Treatment of schizophrenia and its comorbid physical conditions often presents a challenge to health care professionals and caregivers due to the presence of multiple psychological and physical disabilities. However, with appropriate intervention at early onset, the likelihood of recovery will be highest. Primary care professionals are often the stable point of consultation for patients to seek help in the community. The partnership between the patient and primary care professionals is paramount in optimal management and continuity of care for schizophrenia patients with chronic physical illness.

Schizophrenia is a complex mental health disorder that has a huge burden on the individual’s physical health. Despite its low prevalence, the disorder has been listed among the top ten contributors of health burden and disability around the world. People with schizophrenia usually suffer from a myriad of physical health conditions with 33 percent of the patients having three or more physical health problems. Schizophrenia has been linked with up to threefold increased risk of cardiovascular mortality. Risk factors such as metabolic disorders and lifestyle behaviours are the major contributors to cardiovascular-related diseases (CVD). Treatment of schizophrenia and its comorbid physical conditions often presents a challenge to health care professionals and caregivers due to the presence of multiple psychological and physical disabilities. However, with appropriate intervention at early onset, the likelihood of recovery will be highest. Primary care professionals are often the stable point of consultation for patients to seek help in the community. The partnership between the patient and primary care professionals is paramount in optimal management and continuity of care for schizophrenia patients with chronic physical illness.

This paper gives an overview of what the GP Partnership Programme (GPPP), an integrated care programme, has achieved over a span of ten years, since its implementation in 2003 by the Institute of Mental Health, a tertiary mental health institution in Singapore. The GPPP is a collaboration between the GPs and IMH, for the care and management of stable patients with mental illness in the community and primary care setting. Since 2003, more than 1300 patients have been referred through the GPPP to a team of 51 GP-Partners for continued care within the community.