Improving Physical Healthcare of People with Mental Illness

We should have fewer cases where people are unable to get physical care due to mental health problems affecting engagement and attendance (or vice versa). And we need provision of mental health support in physical health care settings – especially primary care. – Five Year Forward View for Mental Health, 2016

Our local aim within the Northern England Clinical Networks is to reduce premature mortality of those with serious mental illness.

Why prioritise it?

Two extra people die every day in the North of England from a preventable, treatable physical illness just because they have a mental illness.

In December 2013 we held a network event to highlight the scandal and you can see a presentation or read the script from the event which led to us agreeing that the top priority for the Network is to bring the health outcomes of people with mental ill health in line with those of the general population.

Network programmes of work

Mental Health and CHD

Information from the Task and Finish Group working on the link between use of anti-psychotics and coronary heart disease

Reducing Premature Mortality

The overall programme of work focuses on improving the physical health of people with mental illness. There are two key strands to this work:

1. To ensure that service users are supported to make positive changes to their lifestyle:

a. as smoking is the largest direct cause of avoidable death in the UK and smoking amongst people with mental illness remains high, we focused on this as our initial work stream.

2. To support the national Commissioning for Quality and Innovation (CQUIN) measure ‘Improving physical healthcare to reduce premature mortality in people with serious mental illness’:

a. to ensure a complete assessment of physical health needs is carried out and shared between primary care, mental health services and with the service user;
b. to ensure that service users have access to appropriate smoking cessation, weight management, and drug and alcohol services.

We’d like to hear from you if you would like to share examples of work you are doing in this area. For more information or to get involved please contact us.

Useful Documents

List of Liaison Services across the Northern England Clinical Networks

NICE Local Government Briefing – Tackling the causes of premature mortality (early death) Published 20 February 2015

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People with mental illness are more likely to die early from physical health problems than those without mental illness. People with schizophrenia and psychosis die on average 15-20 years younger than the general population*. This can be due to lifestyle issues, adverse effects of medication and poor access to services. Read the full report.

*Thornicroft (2011), Chang et al (2011), Tiihonenet al (2009) as cited in The Schizophrenia Commission (2012) The Abandoned Illness: a report from the Schizophrenia Commission; London; Rethink Mental Illness

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Rethink Mental Illness and NHS England have developed a free toolkit to support implementation of the Physical Health CQUIN. The toolkit can be accessed at www.rethink.org/phc.

The toolkit is full of practical resources such as:

  • the Integrated Physical Health Pathway which supports primary and secondary care services to work together to monitor and address the physical health needs of people affected by mental illness
  • a poster which outlines the physical health tests that need to be done and what should happen next. This should be used in inpatient mental health wards
  • a self-assessment of readiness to implement (SARIT) for providers introducing the CQUIN, and
  • a physical health check tool to structure discussions and assessment of physical health concerns.

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National Audit of Schizophrenia (NAS) has developed a clinical resource called the Lester tool to provide a simple framework for identifying and treating cardiovascular and type 2 diabetes risk in patients with psychosis receiving antipsychotic drugs.

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The Royal College of Physicians and Royal College of Psychiatrists have produced a joint report on Smoking and Mental Health.

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Examples of Good Practice

Bradford Physical Health Monitoring Template

Bradford District Care Trust, Leeds and York Partnership NHS Foundation Trust and the West and South Yorkshire and Bassetlaw Commissioning Support Unit have worked together to develop a short, electronic physical health template to be used as a prompt by GPs during annual health checks for patients with SMIs across the Bradford and Airedale area. The content of the template is based on NICE guidance, is updated when guidance changes and uses standard QRISK2 cardiovascular risk calculators. Using the template has more than doubled the detection rate for at-risk patients than health-checks without it. You can read the full case study here.

You can read theĀ  Bradford Publication: Systematic computerised cardiovascular health screening for people with severe mental illness here. You can download a poster here and a slidedeck for training GPs and practice nurses here.

Training Resources

Dr Sheila Hardy, University of East Anglia, has developed a series of useful resources to support practice nurses to carry out physical health checks for people with Serious Mental Illness. The resources include online training modules, tips on improving SMI registers and how to approach inviting people for their health checks. The resources are available on the website http://physicalsmi.webeden.co.uk/