Tackling Health Inequalities-Improving the Physical Health Status

of People with Long Term Mental Health Problems

Lynne Murray, Well Person Service Coordinator, East Ayrshire Adult Mental Health ServiceCraig Stewart, Patient Services Manager, East Ayrshire Adult Mental Health service

The National Context

National Programme for Improving Mental Health and Wellbeing Stark report (2003)- found that people with mental health problems suffer from physical health problems at a much higher rate than the general population

Delivering for Health (2005)- 9 clear commitments for mental health which led on the Delivering for Mental Health Plan (2006)

General Medical Services (GMS) Contract (QOF Indicators)

The National Context

Rights, Relationships and Recovery (2006)- highlighted areas of positive practice and developed a Delivery Action Plan to support the development of mental health nursing in Scotland

Disability Rights Commission Report- Health Inequalities Experienced By People With Schizophrenia and Manic Depression (2005) England and Wales)

Delivering For Mental Health (2006)- delivery plan guiding services on the key elements required to meet the range of needs within local communities, 14 commitments, 3 HEAT targets

The National Context

Improve the mental health and wellbeing of everyone living in Scotland and improve the quality of life and social inclusion of people who experience mental health problems (National Programme for Improving Mental Health and Wellbeing)

Enhance capability in health improvement, health promotion and tackling inequalities (Rights, Relationships and Recovery, 2005)

Improve the physical health of those with severe and enduring mental illness by ensuring that every such patient, where possible and appropriate, has a physical health assessment at least once every 15 months (Delivering for Mental Health, 2006)

““Those who suffer from mental illness have Those who suffer from mental illness have greater risk of, and higher rates of, heart disease, greater risk of, and higher rates of, heart disease, diabetes, respiratory disease and infections. They diabetes, respiratory disease and infections. They also have higher rates of smoking, alcohol also have higher rates of smoking, alcohol consumption and drug misuse. They die younger consumption and drug misuse. They die younger and have a poorer quality of life”. (Delivering for and have a poorer quality of life”. (Delivering for Mental Health, the Scottish Executive, 2006)Mental Health, the Scottish Executive, 2006)

Some concerning Facts

The DOH Report “Choosing Health: Supporting the physical health needs of people with severe mental illness” states that :

There is evidence to suggest that problems with excess weight gain can be 2-3 times more prevalent in people with schizophrenia than in the general population

Approx 15% of people with schizophrenia may have diabetes and a similar percentage may have impaired glucose tolerance (DOH 2006)

The standardised mortality rate for respiratory and cardiovascular disease in people with schizophrenia and bipolar illness is 4 times higher than in the general population (DOH 2006)

Some concerning Facts

A report to the Disability Rights Commission in 2005 found that:

People with SMI in England and Wales were not offered follow up treatment at the same rate or quality (in terms of up to date/evidence based treatment) as the general population.

Further evidence highlights that under diagnosis of physical illness is common (Holt, R. Peveler, R 2006) with higher rates of preventable risk factors evident (Phelan, M 2001)

Inequities / deficiencies in physical health promotion and prevention for people with mental health problems

Primary Care services focus more on people`s mental health – physical illness missed or blamed on mental health symptoms

Not traditional role of mental health system to provide physical health interventions

Lack of co ordination between mental health and physical health providers

Barriers to detection and prevention of physical illness:

Belief both by physical and mental health care providers that people with SMI are not interested in or capable of making health improvement choices

DRC (2006) found “lazy fatalism” among health providers - SMI patients “just do” die younger and “just won’t” look after their health – therefore no effort made to improve access to treatment / health promotion to ensure equality

People with SMI may perceive that those involved in their care have low expectations of behavioural change, e.g. in terms of lifestyle, diet.

These negative attitudes can deter people from seeking help.

People may not be able to identify or express physical health needs

Barriers to detection and prevention of physical illness:

Primary Care NHS Trust

What happened in East Ayrshire• Bid submitted to the Change and

Innovation Fund for Well Person Service

• 2 year funding secured 2005-2007 with 1 further year extension

Well Person Service-East Ayrshire CMHT

The East Ayrshire Well Person Service is nurse-led and was set up in April 2005. The main purpose of the service is to facilitate physical health screening, treatment and management for people with severe mental illness (SMI) by promoting equal access to health services through partnership working with Primary Care

Service Aims and objectives

Increased awareness of physical health problems

Early detection and intervention in physical health problems, and improved outcomes

Improve access to treatment by developing a more integrated health screening service in partnership with Primary Care

To develop care pathways which will ensure that evidence based practice is delivered, and reduce gaps in services

Service aims and objectives

The development of a system which enables systematic collection of baseline health data for the target group

A service which meets the needs of this group regarding access, appropriateness, quality and patient satisfaction

A comprehensive health assessment for people with SMI in East Ayrshire

New joint working initiatives:

Referral pathway to community dentist

Weight Watchers referral scheme

Health promotion smoking cessation post

CMHT weight management class

New joint working initiatives:

Development of a Lifestyle group for clients and carers

East Ayrshire leisure development services- Men’s Health Worker, CHIP

CATCH walking group, Mind Your Step (In-patient)

Participation in Diabetes MCN, Long Term Conditions Management Action Plan and Keep Well Project 2010

The journey so far…….

Needs assessment (diet, exercise, smoking, alcohol, dentist)

Training sessions for health and Local Authority staff

Resource pack developed

People are now accessing more mainstream health resources, with gradual lifestyle changes which may lead to health improvements over time

Increase in CMHT knowledge of health/lifestyle issues for patients

National network established- SMHWBIG

The journey so far…….

Change in CMHT practice in providing, or improving access to, health promotion interventions as part of treatment. Subsequent culture change

Staff evaluation questionnaire relating to the WPS

Better systems in place to share information with Primary Care

Physical Health Integrated Care Pathway

Health and Wellbeing assessment (audit tool developed)

Next steps……

Further development of recovery-based approaches (not only for people with SMI)

Review ICP and incorporate it into condition-specific ICP’s

Examine outcomes from Health and Wellbeing assessment

Formal evaluation of people’s experience

Next steps

Ongoing development of the mental health nurse role in health improvement, health promotion and tackling inequalities.

Formal evaluation of the Well Person post

Work with others to develop health and wellbeing approaches across Ayrshire (continuing care wards and with people with mild/moderate mental health problems)

Ensure further integration and implementation of approaches with Primary Care Teams, particular around depression/anxiety and the Management of Long Term Conditions.

Conclusion

A very significant agenda with a variety of challenges

Continue to develop and facilitate access to physical health care services in a way that respects diversity and offers choice

Integrate this aspect of mental health service planning/delivery within community planning partnerships and health and wellbeing agenda (joint health improvement plans, single system working)

Further independent evaluation planned ? transferability of approach