Mike Spence and Carrie Hunt blog about the mental health task force, the five year forward view and addressing the physical health of people with serious mental illness.
People with serious mental illness (SMI) die, on average, 25 years earlier than the general population. This premature death is often caused by physical inactivity, an unhealthy diet and a high smoking prevalence, in combination with medication induced weight gain (which in return can lead to metabolic disorders like type 2 diabetes). We know this is a problem which needs to be addressed, the question is how can we go about this?
As far back as 2011 the ’no health without mental health’ strategy document highlighted improving physical health as one of its six objectives; this was followed by the NHS Outcomes and Operating Framework (2012/13) setting reduced premature mortality for people with SMI as a key improvement area. On the back of these policy documents Rethink Mental Illness launched their excellent ‘20 years too soon’ campaign, aimed at bringing clinicians, policy makers, academics and service users together to look at ways of addressing and improving the current situation. Rethink highlighted five key components of care to address:
- Integrated care – people with SMI often fall between the traditional gaps of primary and secondary care.
- Medication and side effects – service users are often unaware of the side affects of their medication.
- Reasonable adjustments in GP practices – service users often feel anxious in waiting rooms and find booking GP appointments difficult.
- Physical healthcare in inpatient settings – often limited, if any, physical activity offered.
- Accessing local services and support groups – service users were often unaware of the physical health services and support groups available.
Now let’s fast forward a few years: a number of physical health assessment tools have been developed (one by Rethink, one by Helen Lester and colleagues), NHS England have gone as far as developing a national Commissioning for Quality and Innovation (CQIN) involving the Lester tool, and, earlier this year, the Five Year Forward View (FYFV) for Mental Health was released. This is five years on from ‘no health without mental health’, yet one of the key findings related to physical health and mental health in the FYFV is that “it is one of the greatest inequalities in England”. So you might ask yourselves what has been happening over the last five years?
I’m quite proud of the fact that during this time, in collaboration with Manchester Academic Health Science Centre (MAHSC) and Manchester Mental Health and Social Care Trust (MMHSCT), the CLAHRC Greater Manchester team has been involved in a piece of work to improve the physical healthcare for people with SMI in the community setting. The full reports and information about the Community Physical Health Coordinator model are available on this website, along with a paper recently published in BMC Family Practice. In my view the reason why there has been no ‘quick fix’ is because the are so many variables to physical healthcare for people with SMI, there are often huge contextual factors associated to service delivery and provision, there is still a tension between organisations regarding who is responsible for physical health care, monitoring and intervention, and the care pathways are extremely complex. What CLAHRC’s work did is illustrate that, when working closely with commissioners, service providers, academics colleagues and services users, improvements to physical healthcare can be made. However, these are very context-laden and specific, but we were able to develop four ‘key implementation ingredients’ which are important to be considered on a wider level when looking to address the problem:
- Boundary spanning.
- Knowledge integration.
- Supportive organisational culture.
This brings me onto a very recent rapid evidence review looking at integrated care to address the physical health needs of people with SMI which includes our work with MMHSCT (along with 35 other approaches) and commends our approach as “one of the few clearly described and evaluated programmes.” The review provides further evidence to suggest that the management of physical health for people with SMI is complex, context driven and there are many barriers at differing levels within the system.
So all-in-all, there is a universally accepted need to improve the physical health management of people with SMI. At present we don’t have an ‘off the shelf’ solution to the problem, but we do have a number of examples of working which are looking to address the premature mortality gap and the learning from our work and others will be key to addressing the barriers to improve care. There is no quick fix: perhaps Rethink’s ‘20 years too soon’ might not only be applicable to the premature mortality of people with SMI, but also to where we are in relation to addressing the problem!
Our work around the Community Physical Health Coordinator model isn’t our only work in the field. Over the past few years we’ve collaborated with a range of partners to identify local priorities for future research on the physical health of people with SMI, whilst co-producing two evidence based information guides for service users and cares around antipsychotic medication, along with an excellent theatre performance about the lived experience of SMI.
For more information about our mental health programme please contact Mike Spence, Programme Manager.