17 July 2017

Breaking Down the Barriers: transforming physical health checks for people with mental health needs. Camden and Islington NHS Foundation Trust

The Challenge

People with serious mental illness (SMI) are at greatest risk of poor overall health and premature mortality. Figures show that people with SMI on average die 15 to 20 years earlier than the general population due to preventable physical health problems. Premature and avoidable deaths in people with SMI could be significantly reduced if their physical health needs were identified much earlier and effectively managed.

People with SMI often do not access healthcare in the same way as the general population.  For a long time this group of people have struggled to get appropriate, timely information, advice and support for their physical health needs on subjects including diabetes, chronic obstructive pulmonary disease (COPD), and how to quit smoking. Effective communication and collaboration across primary and secondary healthcare settings in closing the care and quality gaps in physical health and the management of care in people with severe mental health illness needs to be number one priority across the NHS.

Breaking Down the Barriers logo

Addressing the problem

Camden and Islington NHS Foundation Trust’s (C&I) innovative approach focuses on the coordination and treatment of physical and mental health needs of people with psychosis and bipolar disorders, providing particular health treatment for COPD and diabetes. This is through physical health tests undertaken at special health and wellbeing clinics, use of a specially-designed physical health screening tool for tighter assessment and a programme of physical health training options for mental health staff.

The project’s key targets are:

  • reducing the suicide rate among psychosis patients by 20% by 2022
  • cutting the percentage of those smoking by 2% per year by 2020
  • widespread screening for diabetes to determine full prevalence up to 2020, before then reducing to stabilise at 18% or lower by 2022, reversing the national trend.

Progress highlights

Transforming the way physical health checks are carried out amongst patients with SMI and related needs

C&I set up a five-year programme known as the Integrated Practice Unit for Psychosis (IPU), working in partnership with Camden and Islington Clinical Commissioning Groups, local authorities, GPs, acute trusts and community health services. It is targeting 18 specific improvement outcomes addressing both mental and physical health, as well as wellbeing and quality of life.

Training

Breaking Down the Barriers (BDtB) programme, funded by Health Education England, North, Central and East London and supported by UCLPartners has facilitated the delivery of training sessions at the Trust on Physical Health Checks, who does what? including the National Audit of Schizophrenia health check, Lester tool and Health Improvement Profile (HIPs)The programme aims to raise awareness of the importance of and significant positive health outcomes that early and timely physical health checks could have on people with SMIs.

Refining the physical health checks approach

C&I has a comprehensive Physical Health Screening Tool (PHST) in place and flow chart which describes the process staff should follow. This is supported by staff training, in addition, C&I has recently audited its medical equipment to ensure that staff working in the service have the right equipment in place. The Trust’s approach to ensuring staff are skilled in physical health assessment and intervention is based on the use of physical health skills self-assessment and training passport. This builds on existing skills and learning is through formal training, use of a simulation suite and in-team training with the practice development team.

What's been the impact?

Anthony Jemmott, a Community Nurse Manager with the Trust’s Integrated Practice Unit (IPU) in Camden, attended one of the BDtB training sessions in 2016. He said: “The BDtB training supported the development of the IPU and the physical health and wellbeing clinics within C&I. It has raised staff awareness and gave them the confidence to address the physical health and wellbeing needs of our service users with SMI. The research shows that people with serious mental illness die younger than the normal population – not from the mental health problems, but from a preventable long-term physical health condition. By carrying out physical health screening on this client group we would detect early symptoms of preventable long term physical health conditions like diabetes and COPD, also make interventions in smoking cessation, and therefore reduce the prevalence of these diseases and mortality rates.”

Susan Cummins, Community Physical Health Matron, said: “The BDtB modules on COPD and diabetes are very informative and highly relevant to mental health staff working with service users who are more at risk of these conditions. The material is accessible to all staff, using plain and simple language. It is evidence- based and highlights the day to day challenges of treating and managing these long-term conditions. Participants are signposted to lots of other helpful resources for professionals. The sessions have been very well attended by a very broad range of disciplines and are highly engaging.”

Ronke Adejolu, Breaking Down the Barriers, UCLPartners, said: “NHS mental health professionals and the multidisciplinary workforce play a pivotal role and have exclusive opportunities to help people in their care to improve their physical health alongside mental health.”

Breaking Down the Barriers’ free physical health awareness training materials increase awareness, skills and knowledge across the NHS workforce to help in the early identification of key risk factors that are known to adversely affect the physical health of people with mental health needs, including subsequent management of care and timely referrals to appropriate services.

Resources

Access Breaking Down the Barriers physical health checks training resources

Training resources can be accessed via e-learning for Healthcare http://www.e-lfh.org.uk/programmes/breaking-down-the-barriers/

Further information

Please visit bit.ly/UCLPBreakingBarriers

Tweet us @UCLPartners #UCLPartnersBreakingBarriers

Call us direct +44 (0)20 3108 2319 or contact the Project Support Officer ellen.nelson@uclpartners.com

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