Health and care services: Improving physical health for people living with severe mental illness

If you are a health or care professional, there are lots of things to keep in mind when supporting your patients who have severe mental illness with their physical health.

NHS England defines ‘severe mental illness’ (SMI) as anyone diagnosed with schizophrenia, bipolar disorder or other psychosis or is having lithium therapy.

People with a severe mental illness are at risk of dying prematurely, in some cases 20 years earlier than the general population. Many of these deaths are preventable if conditions like high blood pressure, diabetes and cardiovascular problems are identified and treated early.

Research also highlights the risk of ‘diagnostic overshadowing’ – whereby staff overlook physical symptoms as a result of an individual’s existing mental health diagnosis.

GP surgeries, pharmacists, hospital teams, secondary care mental health services, social workers and social care providers, voluntary sector organisations, and other health and care services all have an important part to play in supporting and empowering people living with severe mental illness to improve their physical health.

These pages provide some information and resources to help this.

We have also co-designed some pages for people living with Severe Mental Illness and their family or carers – you can signpost your patients/clients to these pages:

Reasonable adjustments

Health and social care workers need to make the service they provide accessible for people with severe mental illness. This is called making ‘reasonable adjustments’.

People with severe mental illness may be nervous about visiting the doctor, so it’s also important to spend extra time on making they feel comfortable:

  • Make sure you explain what the appointment will involve so nothing unexpected happens
  • Allowing them to bring a friend or carer to their appointment to help them feel at ease
  • Let them ask questions
  • Check they understand what you have told them
  • Ask them if there is anything else you can do for them

Annual Physical Health Checks

If a patient is registered with their GP as having a severe mental illness, they should be invited to a full physical health check every year. This should include the completion of a Health Action or Care Plan, to help address any issues found during the health check. For more information about annual health checks see the resource section below.

For 2021/22, GP practices will be aware that the QOF will include all six elements of the comprehensive annual physical health check for patients with schizophrenia, bipolar affective disorder and other psychoses as defined in the NHS Long Term Plan.

As outlined in NHSE guidance, primary care teams are responsible for carrying out annual physical health assessments and follow-up care for:

1. patients with SMI who are not in contact with secondary mental health services, including both: a. those whose care has always been solely in primary care; and b. those who have been discharged from secondary care back to primary care; and

2. patients with SMI who have been in contact with secondary care mental health teams (with shared care arrangements in place) for more than 12 months and/or whose condition has stabilised.

Secondary care teams are responsible for carrying out annual physical health assessments and follow-up care for: 1. patients with SMI under care of mental health team for less than 12 months and/or whose condition has not yet stabilised; 2. mental health inpatients.

Some of the things you can do to help your patients with severe mental illness include:

  • Ask the patient whether there are any barriers that might prevent them attending a health check – it can sometimes be difficult for people with SMI to initiate that conversation.
  • Some people with SMI may have trauma related to healthcare environments which might prevent them from attending appointments. If you know or think this may be the case, try and broach the subject with your patient beforehand and work with them to develop strategies that will make attending possible.
  • During the Annual Health Check, work with your patient to do a Health Action Plan.
  • Discuss with them whether they are comfortable giving a friend or carer permission to speak to you about their healthcare needs.
  • Identify whether they have any other access needs, for example, if they have a SMI and a Learning Disability or Autism, or a physical disability.

How can social care or voluntary sector providers help?

You won’t be responsible for carrying out the physical health check, but depending on your role, you still have an important part to play in – for example:

  • If the person’s GP hasn’t contacted about their annual health check, you could support the person to contact their surgery and book the appointment
  • Encouraging and supporting the person to attend their health check
  • Encouraging and supporting with any follow up actions from the health check (e.g. health actions such as taking more exercise or taking up support to reduce or quit smoking).

Other resources for you

Covid-19 related resources:

Physical health check resources:

Training and professional resources:

Other health resources:

Support for people with SMI and their family or carers:

There are numerous resources available on the web pages for people living with SMI linked below. Resources include looking after their physical health during Covid-19, healthy eating, healthier lifestyles, exercise, information for carers, and links to information about local activities and events.

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