NHS England » 10 key actions: Improving the physical health of people living with severe mental illness

Tackling the physical health inequalities faced by people living with severe mental illness (SMI) requires a comprehensive and integrated approach. For more information see our national guidance: Improving the physical health of people living with severe mental illness.

1. Co-production and lived experience

Design services to address the physical health of people living with SMI in equal partnership with people with lived experience and those who support them.

Annual SMI physical health checks are a core clinical focus of Core20PLUS5, NHS England’s approach for tackling health inequalities.
Understand and address the needs of different groups and communities, including those with protected characteristics and inclusion health groups.

Address barriers faced by people living with SMI in accessing physical health checks, other physical health services and adopting positive health behaviours. Proactive communications should include the importance of physical health for people living with SMI, address misconceptions, promote healthy behaviours and support self-management skills.

Reach out to people living with SMI to understand the barriers they face and what reasonable adjustments can be made, including providing services in homes or community settings. It can be particularly effective to work with peer support workers and voluntary community and social enterprise (VCSE) organisations to do this.

Consider the need to provide an annual physical health check for everyone severely affected by mental illness. At a minimum this should include everyone with a diagnosis of bipolar disorder, schizophrenia or other psychoses.
Care should always be person-centred, tailoring discussion to the needs of the person to enable shared decision-making. Delivery of physical checks should be trauma-informed and reasonable adjustments should be provided.
The core check (included in the Quality and Outcomes Framework) should consist of an alcohol consumption assessment, blood glucose or HbA1c test (as clinically appropriate), blood pressure, body mass index, lipid profile and smoking status.
It is recommended that integrated care systems (ICSs) commission services that go beyond this minimum and provide a comprehensive assessment of someone’s physical health, considering links with mental health and social needs. It is recommended to add: blood-borne virus and liver function screening; cardiovascular risk assessment (including Qrisk3); relevant national immunisation programmes; support to access national screening programmes (including cancer screening); oral health advice; assessment of physical activity levels; sexual and reproductive health assessments and advice; substance misuse assessment; and medicines reconciliation and monitoring.

Reduce the need for patients to make repeat visits to a service by delivering all elements of an annual physical health check in one appointment (unless this is not the patient’s preference). Use data to track progress and identify and address potential gaps.

Ensure people are supported to access relevant follow-up interventions (see the Lester Tool). This should include offering medical interventions (such as statins); a discussion on possible side effects of medications, eg rapid weight gain following initiation of new antipsychotic treatment; and support and resources for adopting positive health behaviours (such as regular exercise, balanced nutrition, smoking cessation, moderation of alcohol consumption).

Provide a carer’s assessment for people supporting a patient, with consideration of their physical, mental health and social needs.

For best physical health care for people living with SMI, services need to work collaboratively, including mental health, primary care, VCSE and local authority providers.
Encourage regular communication and information sharing (including data sharing) to ensure co-ordinated and holistic care. Information on medications, diagnoses and delivery of the SMI physical health check should be shared.
ICSs should ensure a local comprehensive model of care and develop a protocol defining roles and responsibilities across primary care, secondary care, VCSE and local authority services.

Develop personalised care and support plans that address the full needs of the individual, including mental, physical and social needs such as loneliness and isolation. These should involve shared decision-making between patients, family and friends, and the professionals supporting them. Access to personal health budgets should be supported where it is collectively agreed that this is the best way to meet needs.

Allocate resources to train staff in the importance of physical health of people living with SMI, how to manage their needs and how they can engage with services for support.
Ensure improving the physical health of people living with SMI is embedded in the leadership of integrated care boards, to maintain focus on tackling this health inequality.