|Contact||Michael Spence, Knowledge Transfer Associate, GM CLAHRC|
|Address||3rd Floor, Mayo Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD|
This project in Manchester seeks to address some of the problems associated with the 10-25 year mortality gap for people with a mental illness.
It focusses on the physical health needs of people with severe and enduring mental illness who are jointly managed by the mental health service and primary care.
People with severe mental illness (SMI) have been reported to have a reduced life expectancy of up to 25 years compared to the general population. This premature mortality is largely due to poor physical health; people with SMI are often overweight through a lack of physical activity and an unhealthy diet, there is a high prevalence of smoking in this population and patients find that certain antipsychotics can cause medication-induced weight gain. These factors can lead to an increased risk of developing cardio-metabolic disorders.
However, many of the physical health issues experienced by this group, e.g. cardiovascular diseases or diabetes, are either preventable or controllable via effective chronic disease management. It is also possible to address many of the outlined lifestyle issues by ensuring timely and patient-centred access to health promotion services e.g. smoking cessation and physical activity schemes. People with SMI often experience health inequalities when it comes to accessing physical health lifestyle services as this is rarely seen as a priority by health care professionals.
Aims and objectives
Since June 2012, Greater Manchester Collaboration for Leadership in Applied Health Research and Care (GM CLAHRC) has worked in collaboration with Manchester Mental Health and Social Care Trust (MMHSCT) and Manchester Academic Health Science Centre (MAHSC), to develop a sustainable integrated service user pathway that supports the prevention and early diagnosis, treatment and management of physical health problems, as part of the overall treatment of people with SMI under the care of community mental health teams.
The project aims to deliver the following objectives:
- To establish a clear shared responsibility for the physical health of people with SMI by strengthening the coordination and collaboration between primary care and the community mental health teams.
- To improve the health outcomes for service users by developing clear pathways and guidance on delivering physical health checks in a community setting, whilst ensuring that the physical health of people with SMI is assessed on a more regular basis and access to the appropriate care/service is promoted.
- To ensure that people with SMI are provided with improved access to and made aware of lifestyle services currently available within MMHSCT. In addition, improving existing health information targeted at service users to empower them to take care of their own physical health needs.
The key deliverables of the project are:
- The development and testing of a physical health link worker role.
- Testing the implementation of multi-disciplinary team (MDT) meetings between community teams and primary care to discuss the physical health of people with SMI. This is led by the physical health link worker, resulting in an action plan with shared responsibility across community teams and primary care.
- Identifying the training needs amongst community and primary care staff and delivering the appropriate training to address the physical health needs and support lifestyle change.
- Establishing a programme of physical health assessments delivered in a community setting.
- Increasing the utilisation of the existing physical health resources available within MMHSCT.
Community Physical Health Co-ordinator
At the start of the project it was quite clear that there was limited co-ordination and joint management of physical health, across organisational boundaries. This was addressed through the introduction of a boundary spanning Community Physical Health Co-ordinator role, who liaised with GPs via monthly or bi-monthly multi-disciplinary team meetings (based in primary care), to develop joint physical health action plans.
Initially, the project found that there was a variable level of knowledge and a skill base to effectively manage physical health, by mental health staff. The project introduced mandatory physical health training for all community mental health team staff, along with dedicated sessions with the local community lifestyle services.
The project has been highly successful, with 163 physical health related actions relating to 101 service users, generated from 24 multi-disciplinary team meetings. There is some clear evidence to demonstrate that physical health care is becoming increasingly co-ordinated, with more service users receiving the appropriate tests/checks, along with an increased number of service users being asked about their physical health and possible lifestyle interventions discussed.
Process and outcome measures
- the MDT meetings
- the use of lifestyle services
- interview data around
- the physical health link worker role
- the MDT meetings, and
- the increased physical health knowledge.
The project identified the following key enablers:
- Knowledge Integration
- Supportive organisational culture
- Severe Mental Illness and physical health project
- Evaluation report (coming soon)