Physical health checks for people with Severe Mental Illness: a primary care guide
What is severe mental illness (SMI)?
Patients with SMI will most likely have a diagnosis of schizophrenia or bipolar disorder.
Click for more information:
Why are these health checks important?
Due to a combination of lifestyle factors and the side-effects of antipsychotic medication, there is a high incidence of cardiovascular disease (CVD) causing premature death in people with SMI (15 years for bipolar disorder and 25 years for schizophrenia). It is therefore necessary that these patients have an annual physical health check in order to identify risk factors for CVD. A comprehensive physical health check carried out by a competent practitioner will also provide the opportunity to offer education regarding lifestyle and ask about other physical conditions. Link to Positive Cardiometabolic Health chart. Link to updated for 2014: The Lester UK Adaptation of the positive cardiometabolic health resource
Preparing to carry out health checks for people with severe mental illness
1. Identify a practice nurse to be responsible for carrying out the health checks
2. Ensure the practice nurse receives appropriate training to feel confident in carrying out the health checks. Find out what is available in your area. Link to learn about training. Training also available for mental health clinicians.
Reading the links on this website will be informative –
Medication - click on module for antipsychotic online learning module: Module, Click here for practice nurse e-learning modules
Neuroleptic injection protocol
Neuroleptic injection follow up
Mental capacity act
Community Mental Health Team.
Integrated Physical Health Pathway
Links for professionals
3. Check your SMI register for accuracy - Click on link to sort out SMI register or quick sort out register
4. Work out how you are going to set up your clinics, for example: how do you run your diabetes clinics? How much time will the practice nurse realistically need? (We recommend 45 minutes for each health check).
5. Identify your Community Mental Health Link Worker (approximately half your patients on the SMI register will be in contact with secondary care)
6. Prepare your template – link to computer template or paper template
Inviting patients for a physical health check
1. If they are under the care for the Community Mental Health Team (CMHT), inform the link worker of the invitation
2. Send out the invitation letter 10-14 days before the appointment – link to invitation letter Link to Health Check leaflet
3. You may want to include a patient pre-assessment form – link to pre-assessment form
4. Consider telephoning patients the day before to remind them
Carrying out the health check
1. Explain to the patient why they have been invited and the purpose of each procedure
2. Use the Health Improvement Profile for Primary Care (HIP-PC) manual to guide you – link to HIP-PC.
3. There are a number of tools which you may use when carrying out the health check – link to Care plan PC, WRAP, SESCAM, ARIZONA sexual experience scale, Safe sex questions, GASS, GASS (CL), CVD Risk Food diary, Biopsychosocial
4. Provide your patient with any relevant leaflets – link to leaflets, links for patients, dentist guide, debt leaflet, BHF patient advice booklet.
5. If the patient needs any follow up appointments, arrange these and explain why. Request permission to share results of the ecg and/or blood tests with the CMHT where appropriate
After the health check
1. Inform the patient of the results from blood tests
2. If appropriate, inform the patient’s Community Mental Health worker of results – link to liaison form
3. Check the patient has attended for follow up appointments
If the patient did not attend
1. Send second invite letter – link to follow up letter
2. Telephone the patient, carer or CMHT as appropriate
Useful website: http://www.rcgp.org.uk/mental_health/resources.aspx
The primary care guide to mental health Health Improvent Profile
The contents of this website were originally created as part of the PhyHWell project
©Sheila Hardy, University of East Anglia and NHS Northampton
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