CLAHRC Greater Manchester, in collaboration with Manchester Mental Health and Social Care Trust (MMHSCT) and Manchester Academic Health Science Centre (MAHSC), has developed and tested the implementation of effective and sustainable ways to improve the physical health of people with severe and enduring mental illness (SMI).
The new approach has been featured as a case study in a May 2014 British Medical Association report, and introduces Community Physical Health Coordinators (CPHC) within Community Mental Health Teams (CMHTs). The CPHC’s role is to discuss the best possible physical healthcare options for those people under the care of the CMHT. They do this with GPs and other health professionals via multi-disciplinary team (MDT) meetings held within GP practices.
People with SMI are often overweight through a lack of physical activity and an unhealthy diet. The high prevalence of smoking in this population, coupled with people with SMI finding that certain anti-psychotic medication can cause induced weight gain, can lead to an increased risk of developing cardio-metabolic disorders. People with SMI have been reported to have a reduced life expectancy of up to 25 years compared to the general population and this premature mortality is largely due to poor physical health.
Work on this project has been aiming to deliver on the following objectives:
- To establish a joint responsibility for the physical health of people with SMI by strengthening the coordination and collaboration between primary care and community mental health teams (CMHTs)
- To improve health outcomes for service users under the care of CMHTs
- To ensure that people with SMI are provided with improved access to, and made aware of, lifestyle services available within MMHSCT.
This new way of working has produced excellent outcomes, which are exemplified by Phillip*, Lewis* and Beverley’s* stories.
Phillip has schizophrenia and was notorious for missing his health checks and GP appointments. Before the introduction of a CPHC, he was only semi-compliant in attending his blood, cholesterol and ECG tests.
Information passed on by John* (CPHC) through his liaison with the GP practice, led Phillip’s Care Coordinator from the CMHT to prompt Phillip to attend his appointments. Phillip is now aware that he has to have regular blood, cholesterol and ECG tests to make sure that his physical health, as well as his mental health, is accounted for. Since the introduction of the CPHC, Philip has only missed one appointment; as part of the liaison and coordination with the GP practice this was picked up and Philip has attended an extra appointment in place of the one he missed.
Lewis had been suffering with recurrent ear infections; he is deaf in one ear and he has started to experience problems in the other. At first glance, it seemed that Lewis’ problem was caused by a build-up of ear wax; however, through regular contact with his Care Co-ordinator, Lewis continued to stress that he was struggling with his hearing. Lewis’ Care Co-ordinator informed and worked with the CPHC, who in turn liaised with Lewis’ GP. As a result of these discussions, Lewis’ GP arranged for him to be referred to an audiologist to have his hearing checked, which resulted in Lewis’ hearing aid being replaced. The involvement of the CPHC ensured that the Care Co-ordinator’s concerns about Lewis were followed up in a timely and appropriate manner; this coordinated approach has allowed Lewis to have a better quality of life.
Beverley had been suffering with depression and, following an overdose, the CPHC within the CMHT was able to improve the communication and coordination between Beverley, her Care Co-ordinator and her GP. The CPHC liaised with both the GP practice and Beverley’s Care Co-ordinator to ensure that the GP practice was kept up-to-date with any developments. Beverley’s Care Co-ordinator was able to speak to the CPHC, so that they in turn could speak on her behalf (as this made her feel supported).This sped up the process of Beverley’s GP receiving the discharge plan following her overdose. From here, Beverley received the appropriate medication and follow-up care.
The benefits of this new model of working are evident for all involved, from healthcare professionals to patients. Having a CPHC provides a link between professionals and service users that can often be missing. Attendance for appointments is much better and, overall, physical health has improved significantly for patients with SMI.
To find out more, please contact Michael Spence, CLAHRC Greater Manchester Programme Manager, or read the full evaluation report of the pilot project, including a section on the key ingredients required for spreading the model, along with a more practical CPHC and MDT guidance document.
*Names have been changed to protect anonymity.