The information in this guide is reproduced from https://physicalsmi.webeden.co.uk/ with the kind permission of Dr Sheila Hardy, Education Fellow, UCLPartners and Visiting Fellow for Primary Care, University of Northampton. Sheila is the co-author of The Primary Care Guide to Mental Health: A Practical and Theoretical Guide for Nurses and AHPs
This guide aims to support primary care staff to undertake physical health checks for people with Severe Mental Illness. It was developed for the Northampton Physical Health and Wellbeing project sponsored by NHS Northampton for her PhD at University of East Anglia. It was used in a project Promoting the safe management of people with Severe Mental Illness by training practice nurses in primary care.
What is severe mental illness (SMI)?
Patients with SMI will most likely have a diagnosis of schizophrenia or bipolar disorder. For more information:
Why are these health checks important?
Due to a combination of lifestyle factors and the side-effects of antipsychotic medication, there is a high incidence of cardiovascular disease (CVD) causing premature death in people with SMI (15 years for bipolar disorder and 25 years for schizophrenia). It is therefore necessary that these patients have an annual physical health check in order to identify risk factors for CVD. A comprehensive physical health check carried out by a competent practitioner will also provide the opportunity to offer education regarding lifestyle and ask about other physical conditions.
Preparing to carry out health checks for people with severe mental illness
1. Identify a practice nurse to be responsible for carrying out the health checks
2. Ensure the practice nurse receives appropriate training to feel confident in carrying out the health checks.
Mental Health Trusts across North East and Central London, supported by UCLPartners, are providing free mental health training for Practice Nurses. Dates are currently available for Module 1, ‘Mental Health Awareness’ and participating Mental Health Trusts are offering a variety of training dates from December through to March 2014 for you to choose from. Book online at https://www.surveymonkey.com/s/practicenursetraining
Reading the following
- Antipsychotic online learning module
- SSRI learning module
- Neuroleptic injection protocol
- Neuroleptic injection follow up
- Lithium monitoring
- Mental capacity act
- Community Mental Health Team
- Integrated Physical Health Pathway
- Links for professionals
3. Check your SMI register for accuracy
4. Work out how you are going to set up your clinics, for example: how do you run your diabetes clinics? How much time will the practice nurse realistically need? (We recommend 45 minutes for each health check).
5. Identify your Community Mental Health Link Worker (approximately half your patients on the SMI register will be in contact with secondary care)
6. Prepare your template
Inviting patients for a physical health check
1. If they are under the care for the Community Mental Health Team (CMHT), inform the link worker of the invitation
2. Send out the invitation letter 10-14 days before the appointment
3. You may want to include a patient pre-assessment form
4. Consider telephoning patients the day before to remind them
Carrying out the health check
1. Explain to the patient why they have been invited and the purpose of each procedure
2. Use the Health Improvement Profile for Primary Care (HIP-PC) manual to guide you
3. There are a number of tools which you may use when carrying out the health check
- Care plan PC
- ARIZONA sexual experience scale
- Safe sex questions
- GASS (CL)
- CVD Risk
- Food diary
4. Provide your patient with any relevant leaflets
5. If the patient needs any follow up appointments, arrange these and explain why. Request permission to share results of the ecg and/or blood tests with the CMHT where appropriate
After the health check
1. Inform the patient of the results from blood tests
2. If appropriate, inform the patient’s Community Mental Health worker of results
3. Check the patient has attended for follow up appointments
If the patient did not attend
- Send second invite letter
- Telephone the patient, carer or CMHT as appropriate
Useful website: https://www.rcgp.org.uk/mental_health/resources.asp