Improving physical ill-health and cardiovascular disease (CVD) prevention in people with severe mental illness

The NHS Long Term Plan identifies cardiovascular disease as a clinical priority and the single biggest condition where lives can be saved by the NHS over the next 10 years. The Plan sets the ambition for the NHS to help prevent over 150,000 heart attacks, strokes and dementia cases over the next 10 years and outlines how we, and partners in the voluntary and community sector and in other national organisations will meet this ambition.

There are significant health inequalities for people living with severe mental illness (SMI). Life expectancy is 15-20 years lower than the general population and people with SMI have a 53% higher risk of having CVD and 85% higher risk of death from CVD. This variation impacts on health and care systems and the NHS by causing:

  • Lack of prompt and timely identification of CVD risk factors
  • Inconsistent or lack of long term management of modifiable risk factors
  • Lack of or sub-optimal personalised care planning
  • High rates of unplanned and emergency care use
  • Stigma and the effect of diagnostic overshadowing

Today, the NHS RightCare Toolkit for Physical ill-health and Cardiovascular Disease (CVD) prevention in people with severe mental illness is published, developed in collaboration with Public Health England, the National Institute for Health and Care Excellence, NHS England’s National Clinical Director for Cardiovascular Disease Prevention, the British Heart Foundation, MIND, Rethink Mental Illness, and a range of clinical and patient representatives and stakeholders.

The toolkit sets out to health commissioners and providers 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 developing CVD should achieve better health outcomes.

Dr Matt Kearney, NHS England’s National Clinical Director for Cardiovascular Disease Prevention said: “Shockingly, people with severe mental illness die up to 20 years younger than the rest of the population. But they do not usually die from their mental illness, they die from highly preventable conditions like heart disease and stroke. The NHS Long Term Plan sets out commitments to tackle health inequalities, and this excellent new resource supports those commitments, assisting local health systems to improve the preventive care they offer to people with severe mental illness, and working with them to reduce their cardiovascular risk.”

The NHS RightCare toolkit provides a national case for change and a set of resources to support local health systems to concentrate their improvement efforts where there is greatest opportunity to address variation and improve population health.

Health systems can use this resource as a framework for their local improvement discussions.