Thousands of people with serious mental illness (SMI) could now be saved from an early death thanks to an innovative scheme in Bradford helping to lead the parity of esteem agenda.
A new system is being used across Bradford and Airedale in 80 GP surgeries with 5,000 patients with serious mental illness; across five new clinics; and within hospitals with 200 plus beds in order to help improve the physical health of patients.
The template system, produced in bespoke versions for primary and secondary care IT, makes sure patients get key physical checks they are entitled to such as blood pressure pulse and respiration, height weight and body mass index (BMI) and blood tests.
Kate Dale, mental health nurse and physical health project lead for Bradford District Care Trust (BDCT) which is behind the scheme, said: “We know that patients with SMI are at risk of dying up to 25 years younger than the general population due to physical health problems.
“In our experience, the priority for these patients is their mental health and issues such as obesity, possible diabetes, cardiac risk and other lifestyle factors have not routinely been taken into consideration.
“The types of medication patients are prescribed can lead to weight gain that may not be monitored, leading to the possibility of undiagnosed diabetes, raised blood pressure and other physical health problems. If this tool was used nationally it could save many thousands of lives.”
The template includes: taking blood pressure, pulse and respiration, height weight and body mass index (BMI), blood tests and electrocardiogram (ECG), lifestyle assessment to include diet, exercise and smoking status, any issues relating to sexual dysfunction and referral to appropriate services if needed.
“Our data entry template system has seen a huge change in the perceptions and practicalities around treating this group of patients in primary and secondary care and we would be delighted to share it with the whole country and help save lives, reduce the risk of chronic physical health problems and ultimately lead to this population living healthier,” said Kate.
Dr Geraldine Strathdee, National Clinical Director for mental health for NHS England, said: “Improving the physical health care of people with mental illnesses is a major priority for NHS England and partners. The Bradford tool is a terrific, practical support tool to help every GP and practice nurse, and every psychiatrist and specialist mental health nurse to tackle one of the greatest ‘parity’ inequalities in British healthcare.
“The Bradford Care trust has now skilfully adapted the template for use in its secondary mental health care inpatient and community services. In addition, what is very impressive, is the close collaboration between mental health and GP leaders across Bradford.”
In 2009 an audit was carried out in Bradford looking at the base line physical health measures used in primary care and found the measures did not reflect patient’s needs.
In 2012 the SystemOne electronic Mental Health Physical Review Template was developed and introduced into primary care. It has now been published and gradually rolled out across all 80 GP surgeries. During the annual physical health check it helps support doctors and practice nurses structure how to detect the possible additional problems these patients may experience.
In 2014 following recommendations in The Antipsychotic Shared Care and Physical Health Guidance, which highlights the specific responsibilities of both primary and secondary care staff, BDCT published the RIO version of the template onto the secondary care IT system.
Last November, secondary care services opened five clinics which are now taking referrals from psychiatrists, doctors and advanced nurse practitioners and run eight sessions a week to carry out the baseline checks and monitor patients initiated onto anti-psychotic medication. Patients are monitored until stable enough to return to the care of their GP.
There has been significant uptake in use of the template in the five clinics and within the in-patient services which have more than 200 in-patient beds.
“Patients really do value being asked about their physical health,” Kate said. “If we can monitor patients from the outset of treatment, then we can make sure we can understand and capture any changes. We can offer education in terms of patients understanding the impact of antipsychotic treatment and for example: patients will understand that some medication will make them feel very hungry and we can talk about a healthy diet.
“In the long term this approach to caring will reduce the risk of long term physical health complications and this population will experience a longer and healthier lifespan.
“It has taken a lot of relationship building in order to roll this work out across primary care and more recently in secondary care. This has included developing the template for different IT systems and engaging with everyone around why we need to do this, but it has been worth it because we know it will save lives.”
Angela Moulson Clinical Specialist Lead Adult Mental Health and LD Bradford and Lead GP for this project has been crucial to the project’s success. She said: “We have been delighted to be part of this project and are so pleased to now see the improvements for patients being realised.”