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Monday, 23 May 2016

Patient-centred workshop on physical health of people with severe mental illness

West Midlands Academic Health Science Network (WM AHSN) patient-centred workshop: Physical health of people with severe mental illness

By Prof. Carolyn Chew-Graham

Compared to the general population, the life expectancy of people with severe mental illness is reduced by around 15-20 years, with: 
–  a three-times increased risk of premature death 
–  about 75% of deaths being caused by physical disorders 
–  and cardiovascular disease as the single biggest and potentially preventable cause of premature mortality, more common than suicide.

The early phase of psychosis is a critical period for preventing or modifying cardiometabolic risk, avoiding premature death and reducing health inequalities 
–  Weight gain and metabolic disturbance may occur very early in the course of psychosis, accelerating within weeks of treatment initiation 

–  Health risk behaviours including smoking, alcohol and drug misuse, poor nutrition and physical inactivity are common and are powerfully influenced by the social determinants of health.

For this reason, Saeed Farooq and Carolyn Chew-Graham offered a workshop for the AHSN that aimed to highlight the need to manage the physical health of people with severe and enduring mental health problems, explore barriers to implementing the evidence and discuss a programme, which aims to support people with severe mental illness (SMI) make changes to their lifestyle, so reducing risk.

The workshop, held in Birmingham on 6th April 2016, began with Carolyn interviewing David Shiers, a retired GP from Leek, about his experiences in seeking care for his teenage daughter who developed a psychotic illness in her teens. David went on to describe the work he had done with the late Helen Lester, raising the profile of the need to ‘keep the body on mind’. Work done by Carolyn, as ‘Mental Health Champion’ for the Royal College of General Practitioners (RCGP), including the development of ‘fact-sheets’ for practitioners, is included the in RCGP ‘Mental Health Toolkit’.

Saeed presented the evidence for effective interventions aimed at reduced cardiovascular and metabolic risk in people with SMI, which was followed by discussion of why practitioners don’t act. The removal of some of the indicators from Quality and Outcomes Framework (QoF) was debated (Shiers & Chew-Graham 2014; Chew-Graham et al. 2014).

Following a break, featuring rather a lot of cake, which was unfortunate, given the topic, Professors Eleanor Bradley and Veronica Wilkie (Worcester University) presented their work on the ‘SHAPE’ Healthy Living Lifestyle Programme. This innovative programme supports University students to work with people with SMI and facilitate lifestyle and behaviour change around diet, activity, smoking, drugs and alcohol.

Further discussion focussed on the role of the clinician in careful prescribing of antipsychotic drugs (which contribute to cardio-metabolic changes) and monitoring of weight gain, and the respective roles of primary and specialist care.

We concluded the session agreeing that the importance of considering physical health in people with mental health conditions should lead to a slightly changed strap-line of ‘No mental health without physical health’.

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