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.