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Mental health staff to introduce physical ‘MOT’ to reduce deaths
Thousands of mental health staff will soon be giving lifestyle MOTs to patients as well as assessing psychological health to reduce avoidable deaths.
Mental health trusts all over the country will now receive financial rewards for carrying out the checks, including smoking status, diet, weight, blood pressure, glucose and fats or lipids, and ensuring identified illnesses are treated.
The move is the world’s largest ever physical health in serious mental illness improvement initiative and is considered key to helping patients avoid early death due to conditions such as cardiovascular disease, lung disease and liver disease.
Of the 300,000 patients with serious mental health (SMI) conditions in England, such as bi-polar, psychosis and schizophrenia, many are dying of the same conditions as the general population, but up to 15 years earlier; they have the life expectancy of people living in the 1950s.
People with SMI often do not access healthcare in the same way as the general population so introducing these checks and getting treatment started while they are admitted to hospital is deemed crucial.
Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, said: “We are committed to making sure that mental health is treated the same way as physical health and NHS England is working hard to close the gap between the two with great support from partners and the field.
“The national financial incentive we have introduced this year for trusts is the world’s largest ever initiative in improving physical health in people with severe mental ill health conditions and will be a clinical quality game changer. It’s England’s first significant landmark in this area.
“We are starting by targeting in-patients who we know are most at risk, and where there are major opportunities to increase knowledge about healthy lifestyles and support smoking cessation. They are also in the best position to receive both assessments and treatment for those common conditions that are killing our patients 14 to 20 years early.”
The initiative also vitally incentivises and promotes excellent communication between the mental health service and the patients’ GPs and practice nurses who continue the physical health care post discharge. This collaboration is key to sustainability as care after discharge is as important as care on the ward.
The move is just one of a number by NHS England to make sure the physical health of people with serious mental illness is treated in the same way as for the rest of the population and also taken as seriously as mental health in the inpatient setting.
Providers of mental health services will receive a financial incentive for meeting specific targets on undertaking physical health checks and delivering interventions. The incentive is being paid through the national CQUIN (commissioning for quality and innovation) scheme, set from April 1 2014. The professionals carrying out the checks will include mental health nurses, psychiatrists, health care assistants and psychologists.
The CQUIN will require them to provide interventions where a patient has poor physical health, and this could include referring the patient to another consultant or providing education and services such as weight management, stop smoking, diabetes or other relevant lifestyle programmes.
And patients taking anti-psychotic medications, who often make up the majority of mental health in-patients, are an important part of the drive. They are at the highest risk of gaining weight due to the side effects of such medications and will be specifically targeted.
Dr Strathdee added: “New research is indicating that for patients taking anti-psychotic medicines, the weight gain is maximum in the first 6 to 8 weeks. Worries about weight gain can be a key factor in patients choosing not to take medication. By intervening earlier with these patients, we can make sure they are well advised and supported around lifestyle choices which minimises side effects and reduces the development of physical ill health conditions later in the treatment.
“Implementing such a programme at this scale will require the commitment of all commissioners, mangers and clinical staff across the country. We know it can be done. We are already hearing of whole services where wards are already smoke free, and where these physical checks are being put in place. We are gathering live examples of where innovation using new technology, educational support and practical implementation tools are being developed. This best practice needs to be disseminated.”
Clinical Commissioning Groups (CCGs) which commission the majority of mental health services locally are being urged by NHS England to make sure their providers are aware of the new CQUIN and arrangements and supported with implementation.
Care and Support Minister, Norman Lamb, said: “I want to build a fairer society where people with mental health problems get the same quality of health care as everyone else.
“Through the Mandate, we’ve asked NHS England to make real progress towards equality for mental health by March 2015 and I welcome this initiative, which is a hugely positive step forward.”
I am pleased to hear a serious view is being taken about the physical well being of the patients. I am proud to say that our Trust are well ahead in this initiative.
Most of our staff is not getting much progression through KSF. This incentive of money will be good news to the front line staff who is doing the job. I hope this is not siphoned by senior management.
HI could anyone clarify which services this will apply to?
The physical MOT applies to all people with serious mental illness and will start by tackling inpatients.
Depending what shows up within the checks, the person will then be referred on for further care and/or interventions for their specific physical illness.
Those carrying out the initial checks will include mental health nurses, psychiatrists, health care assistants and psychologists.
This is good to see – it has been used sucessfully in Australia for over a decade – by the Royal Flying Doctors (RFDS) Public Health Service and is called Pitstops and was aimed more at men but also included MH issues.
I facilitated a fair number of sessions on an isalnd in the Barrier Reef after 200 construction workers were brought in post Cyclone Larry, a captive but receptive audience.
There was much talk of offering the service where ‘men’ are at footie games , when waiting at the garage for the care MOT (roadworthy), in a shop on the high street next to the sandwich bar.
? should this not already be happening with the over 40s – the NHS Health Check?
All patients with metal illness should have a Health Check as part of their Annual Review and have equal access to all lifestyle services
Whilst they have equal access to NHS Health Checks and ‘Lifestyle services’ whilst living in the community this is clearly not working as life expectancy is so much lower in those with SMIs. This is because, as the article says, those with SMIs are likely not to access healthcare in the same way and can have a much higher risk due to the side effects of anti-psychotic medication.
Patients in inpatient settings, unfortunately do not always get the same access to physical healthcare as those in the community which is the reason that this CQUIN has been launched.
The CQUIN is a good first step to addressing the serious inequalities faced by patients with SMIs.