Better monitoring can improve physical health outcomes for people with mental illness
Dolly Sud, a pharmacist in the Leicestershire Partnership NHS Trust, discusses the impetus for creating the database and some of the challenges she faced:
Dr Martin McShane’s recent blog pointed out that it is crucial for mental health to be valued on a par with physical health. It is one of the key challenges facing the NHS. If we get it right, we can help to improve the quality of life for people with mental illness, and reduce costs.
As a pharmacist, I see first-hand the disparity between the treatment of people with mental and physical health problems.
I have an interest in people who are taking antipsychotic drug therapy, and having seen the results of audits carried out by the Leicestershire Partnership NHS Trust and the Prescribing Observatory for Mental Health (POMH-UK), it was clear to me there is a low rate of physical health monitoring for people on antipsychotic drug therapy. This needs to change.
People who receive antipsychotic therapy are more likely to experience side-effects which negatively impact on their physical health, for example weight gain. This can lead to other associated health issues such as heart disease and diabetes. If we are able to identify these issues earlier then we can make real positive steps towards improving physical health outcomes for people with mental illness. Regular health monitoring is therefore vital.
To tackle this I brought together a multidisciplinary team comprising of a consultant psychiatrist and a consultant pathologist and myself, a pharmacist. Our first task was to identify the reasons why so few patients with mental health problems were monitored for physical health issues. Next we identified what work is currently being done to tackle the problem and assessed the strengths and weaknesses of these projects which were already underway.
Through these investigations we decided a centralised electronic database was needed to monitor the physical health of people on antipsychotic drug therapy. We analysed the success of similar models which monitored people who took other psychotropic drugs. Drawing on the team’s experience, expertise and the insight we designed the database with funding from Leicestershire Prescribing Group and the Senior Clinical Quality Group, local Clinical Commissioning Groups (CCGs).
The service will operate on an opt-in basis with people with mental health issues choosing if and where they would like to have their monitoring done – either at a GP surgery or a local acute trust. Crucially, people will be given the power to be involved and can contact the Leicestershire Physical Health Register (LPHR) at any point for help or information, or simply remove themselves from the scheme whenever they choose.
We hope the database will be expanded to encompass all healthcare settings in the Leicestershire locality to improve care for the benefit of patients. The journey so far has been challenging and the support required from the team and other colleagues cannot be underestimated. nor can administrative tasks, such as the day to day running of the database and maintaining updated records of GPs. We have also had to be prepared to compromise on staffing and budgets and to anticipate problems which may arise when the database is launched and during its early stages.
Ultimately, developing the centralised electronic database has been a rewarding process, giving us the opportunity to learn and work towards achieving improved patient care and parity of esteem . The database is person centred, important to the individual and could help to change the way we assess people with mental health, making sure that their physical health is not overlooked.
Dolly Sud spoke at a stakeholder event this week on how mental and physical health can be valued equally. During the day, invited experts by experience and clinicians explored how health and care services could be modernised and adapted to address the whole person and not just episodes of ill health. Feedback and ideas from the event, and the other national events happening as part of the Call to Action programme will be provided to commissioners to help with their five year strategic plans.
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2 comments
I agree that mental and physical health should be given equal attention, the problems are, many long term mentally ill patients no longer see a Psychiatrist, and the original Antipsychotic medication is never changed by the GP who now becomes their RMO, the reasons given is we are not sufficiently qualified in these specialist drugs.
Many of my clients go on to develop diabetes, due to weight gain, and inactivity.
I continue to read all NHS England’s bulletins, but nothing changes for the mentally ill.
I agree, unless the resources are put in it will not change. In Gwynedd, North Wales, we have a service run by 1 specialist nurse who ensures all clients with schizophrenia and bipolar disorder have an annual health check, usually done in primary care but can be flexible, some clients do not access primary care. The screening results are shared with primary care, the psychiatrist and care manager and ensures that the client accesses all services that they should do post screening. This service is funded by inequalities in healthcare funds via WAG. In other areas in north wales they have adopted the nurse led clinics held in CMHT s, and screen only clients that are open to them. The service in Gwynedd sees clients that are managed in primary care that are closed to CMHT, this supports primary care and maintains the link with secondary care, the nurse is dual qualified, RMN, RGN. Clients are supported and referred to exercise schemes, walking groups, food co-operatives in the area, given informational about side effects and assistance is given depending on their needs. GP surgeries are given talks about phys health and the association with high mortality rates, diagnostic overshadowing etc, as well as Cmht staff.