Achieving more for people with severe mental illness

The National Medical Director for NHS England highlights why the new NHS RightCare toolkit for physical ill-health and Cardiovascular Disease (CVD) prevention in people with severe mental illness (SMI) is a vital resource for commissioners:

People who have SMI clearly need appropriate support to manage their condition and the work of the NHS Mental Health Transformation programme aims to improve that support.

However, many people with severe mental ill health also suffer from physical ill health and this is often linked with their mental health and its treatment.

The shocking figures are that people with SMI on average have 15 to 20 years shorter life expectancy than the general population. Most of this reduced life expectancy is due to a higher rate of physical conditions such as cardiovascular disease. Some of the drugs used to treat SMI can cause obesity and thus increase cardiovascular risk.

Also, health and care workers supporting people with SMI may not be aware of the associated risks of physical ill health, or may not know how to provide support for such conditions and may focus only on an individual’s mental health.

There are real opportunities to address this.

All people with SMI should be offered an annual physical health check. This should explore risk factors for CVD such as smoking, obesity and high blood pressure. And where such conditions are found, the person with SMI should be offered appropriate support and treatment.

Unless we deal with this systematically we will perpetuate the inequality of care experienced by many people with SMI and which is associated with a significant reduction in life expectancy. Mental and physical health should be promoted and supported in a balanced way to achieve both quantity and quality of life for people with SMI.

The NHS RightCare Toolkit for Physical ill-health and CVD Prevention in people with Severe Mental Illness provides local health systems with guidance, developed in collaboration with Public Health England and other experts in CVD prevention and mental illness, on how to ensure early detection, primary prevention, long term management of modifiable risks, and personalised care and support planning through shared decision making.

In doing so, people and patients with Severe Mental Illness and at risk of CVD should achieve better health outcomes.

Professor Stephen Powis

Stephen Powis is the National Medical Director of NHS England and Professor of Renal Medicine at University College London.

Previously he was Medical Director (and latterly Group Chief Medical Officer) of the Royal Free London NHS Foundation Trust from 2006 to 2018. Professor Powis was also a member of the governing body of Merton Clinical Commissioning Group for five years and a Director of Healthcare Services Laboratories LLP.

He is a past Chairman of the Association of UK Universities (AUKUH) Medical Directors Group and has been a member of numerous national committees and working groups, including the Department of Health Strategic Education Funding Expert Group. He is a past non-executive director of the North Middlesex University Hospital NHS Trust, including a period of eight months as acting chairman.

He is a past chairman of the Joint Royal Colleges of Physicians Training Board (JRCPTB) Specialty Advisory Committee (SAC) for Renal Medicine and a former board member of Medical Education England. He was Director of Postgraduate Medical and Dental Education for UCLPartners from 2010-13. He is a past treasurer and trustee of the British Transplantation Society and a former member of the UK Transplant Kidney Pancreas Advisory Group.

He has also served as a member of the Renal Association Executive Committee. He was Editor of the journal Nephron Clinical Practice from 2003 to 2008. In 2017 he became the inaugural Editor-in-Chief of the journal BMJ Leader. He has been a trustee of several charities, including the Royal Free Charity and the Healthcare Management Trust.

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