We must improve physical healthcare for people with severe mental illness

For people living with severe mental illness (SMI) there is a reduced life expectancy of 15-20 years, three times the likelihood of being a smoker or having high blood pressure, double the risk of obesity and diabetes and five times the risk of lipid imbalance. Dr Phil Moore looks at how we can improve physical healthcare for people with severe mental illness following a new publication from NHS England providing guidance for CCGs.

The figures are clear. This is why we must do more to support people with a SMI when it comes to their physical as well as mental health. If we were talking about cancer, we simply would not tolerate it. So, should we with SMI? Sometimes it is argued that the poor life expectancy is down to lifestyle choices. But then, so are many aspects of cancer. We must ask again, and continue asking, should we put up with this for SMI?

Reducing health inequalities is a key responsibility for commissioners, and one that we are ambitious about fulfilling. If we work at this together – commissioners and clinicians – it is possible to give the right care that will close the life expectancy gap. It needs us to focus on the priorities, whether we are commissioners, clinicians or people living with SMI. If you read nothing else in this guidance report published today, make sure it’s the priority actions on page eight. If we can positively deliver on all these in our local area, we can begin to make a substantial difference.

GPs like me see patients every day who are struggling with both their mental and physical health. It repeatedly brings home just how important it is that we do not settle for the fact it is difficult and rise to the challenge to change what is unacceptable. We can only do this with the help of experts by experience, patient groups and the voluntary sector who are vital to support people living with SMI to get their checks and then to attend the services that can help change and prolong their lives.

And it is not simply ‘them’ who need to change. If our services do not suit the way people with SMI access what we provide, then we need to change the way we provide them. That’s part of the role of commissioners in using co-production, working with patients, users and carers to design, deliver and monitor services.

The good news is that simply ensuring we all have the same healthcare interventions could reduce this. The bad news is that this does not happen universally. There are multiple reasons for this and there has been much discussion about them. The purpose of this guidance is to cut to the chase and encourage and support commissioners to grasp the nettle and deliver better physical health care to those of us with SMI.

Crucially, this new document published today includes examples of good practice from across the country including standardised physical health check templates in Bradford and enhanced primary care services in London. It helpfully lists the principles all commissioners need to embrace without stipulating the method of delivery, which will vary from area to area. What we should be ambitious to stipulate, however, is the elimination of this inequality by creatively commissioning first class physical health care for everyone, including those of us living with SMI.

Dr Phil Moore

Dr Phil Moore, Deputy Chair (Clinical) at NHS Kingston CCG, is a long-standing GP, a GP trainer and honorary teaching fellow at Imperial College.

Locally he is CCG lead on education and training, appraisal, cardiovascular services and mental health. He is leading on the development of mental health services in primary care across London as a member of the London Specialist Clinical Network for mental health.

Nationally he is on the Board of NHS Clinical Commissioners and chairs the Mental Health Commissioners’ Network.

Phil is a trustee and chair of a variety of charities and voluntary organisations, a GP trainer and honorary teaching fellow at Imperial College and a Visiting Fellow in Healthcare Management at the University of Surrey. He frequently speaks and chairs at national conferences.

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  1. Ella says:

    I was beaten by mother father and brother throughout childhood, sent off to friends and family who drugged and molested and raped me. Then got into a 23 year relationship at 20 with a man who beat me thousands of times, strangled me hundreds of times, and drugged and raped me, finally got courage to leave him 5 years ago. then went to doctors and police thinking finally I will get help fearful my family and ex would get in trouble but police did nothing, and doctors did suggest therapy, but said I had too many issues to deal with at GP so had a multitude of assesments and finally was diagnosed as suffering from PTSD last year but am told it will b at least another year be4 treatment. Is this right, I see so many others getting support who have loads of family, I have noone, me and my son who witnessed his father beat me hundreds of times, are both suffering and want to die, we have no family 2support us. Why is there nothing from the NHS, not even a website with worksheets, or support

  2. Julie Jaye Charles says:

    I am the CEO and Government Advisor of EQUALITIES NATIONAL COUNCIL. ENC is the SOLE council of its kind in England and Wales and we are recently informed possibly across Europe too. Led by people with mental health difficulties including other impaitments…. I am one of them I have rapid cycling bipolar, lupus, ulceration to legs,COPD, high blood pressure and spinal stenosis.
    I am just about able to manage my daily task both at home and work due to my multiple physical impairments and my challenge with bipolar.
    Please visit our webpage and/ or Google my name
    Julie Jaye Charles and you will find an abundance of information on both me and the work we do for the most vulnerable communities with both physical and mental health difficulties. We advocate for approximately 1.2k a year and the numbers are rising.
    We are endorsed by 8 Universities as we train placement social workers.
    I am also a visiting lecturer at Oxford university and would very much like to be involved in this work.

  3. Jane Owen says:

    The physical problems my paranoid schizophrenic son has had to endure is because of this. “He chose this” is all I ever hear. He can not “choose” anything! He has survived to 65 years of age “wandering” because he can not choose anything else. Because he is paranoid he cannot live the life that is desired. He has no skill and he cannot hold a job. It is a most hopeless situation. He recently suffered hypothermia as he cannot deal with the elements. Thank you for listening.