The perplexing issue of severe mental illness, physical health screening and primary care in England

2015 ◽  
Vol 22 (8) ◽  
pp. 647-652 ◽  
Author(s):  
S. A. Hardy
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Health Screening ◽  
Physical Health Screening

scholarly journals Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e019412 ◽  
Author(s):  
Frédérique Lamontagne-Godwin ◽  
Caroline Burgess ◽  
Sarah Clement ◽  
Melanie Gasston-Hales ◽  
Carolynn Greene ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Quality Improvement ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Effect Size ◽  
Realist Review ◽  
Health Screening ◽  
Feasibility Trial ◽  
Physical Health Screening

ObjectivesTo identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work.DesignRealist review.SettingPrimary, secondary and tertiary care.ResultsA systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6). The studies focused on breast cancer screening, infection preventive services and metabolic syndrome (MS) screening by targeting MS-related risk factors. The interventions could be divided into those focusing on (1) health service delivery changes (12 studies), using quality improvement, randomised controlled trial, cluster randomised feasibility trial, retrospective audit, cross-sectional study and satisfaction survey designs and (2) tests of tools designed to facilitate screening (10 studies) using consecutive case series, quality improvement, retrospective evaluation and pre–post audit study designs. All studies reported improved uptake of screening, or that patients had received screening they would not have had without the intervention. No estimation of overall effect size was possible due to heterogeneity in study design and quality. The following factors may contribute to intervention success: staff and stakeholder involvement in screening, staff flexibility when taking physical measurements (eg, using adapted equipment), strong links with primary care and having a pharmacist on the ward.ConclusionsA range of interventions may be effective, but better quality research is needed to determine any effect size. Researchers should consider how interventions may work when designing and testing them in order to target better the specific needs of this population in the most appropriate setting. Behaviour-change interventions to reduce identified barriers of patient and health professional resistance to screening this population are required. Resource constraints, clarity over professional roles and better coordination with primary care need to be addressed.

Physical health screening for patients with severe mental illness

2016 ◽  
Vol 20 (1) ◽  
pp. 21-25
Author(s):  
Tonsha Emerson ◽  
Kimberly Williams ◽  
Maxie Gordon
Keyword(s):  
Mental Illness ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Health Screening ◽  
Physical Health Screening

scholarly journals Systematic computerised cardiovascular health screening for people with severe mental illness

2014 ◽  
Vol 38 (6) ◽  
pp. 280-284 ◽  
Author(s):  
David Yeomans ◽  
Kate Dale ◽  
Kate Beedle
Keyword(s):  
Mental Illness ◽  
Cardiovascular Risk ◽  
Information Systems ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Cardiovascular Health ◽  
Significant Proportion ◽  
Clinical Information ◽  
Health Screening ◽  
Physical Health Screening

Aims and methodPeople with severe mental illness (SMI) die relatively young, with mortality rates four times higher than average, mainly from natural causes, including heart disease. We developed a computer-based physical health screening template for use with primary care information systems and evaluated its introduction across a whole city against standards recommended by the National Institute for Health and Care Excellence for physical health and cardiovascular risk screening.ResultsA significant proportion of SMI patients were excluded from the SMI register and only a third of people on the register had an annual physical health check recorded. The screening template was taken up by 75% of GP practices and was associated with better quality screening than usual care, doubling the rate of cardiovascular risk recording and the early detection of high cardiovascular risk.Clinical implicationsA computerised annual physical health screening template can be introduced to clinical information systems to improve quality of care.

scholarly journals A qualitative study exploring the barriers and facilitators of implementing a cardiovascular disease risk reducing intervention for people with severe mental illness into primary care contexts across England: the ‘PRIMROSE’ trial.

2020 ◽  
Author(s):  
Suzan Hassan ◽  
Samira Heinkel ◽  
Alexandra Burton ◽  
Ruth Blackburn ◽  
Tayla McCloud ◽  
...  
Keyword(s):  
Mental Health ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Mental Illness ◽  
Collective Action ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Mental Health Stigma ◽  
Cvd Risk ◽  
Healthcare Settings

Abstract Background: People with severe mental illness (SMI) are at greater risk of earlier mortality due to physical health problems including cardiovascular disease (CVD). There is limited work exploring whether physical health interventions for people with SMI can be embedded and/or adopted within specific healthcare settings. This information is necessary to optimise the development of services and interventions within healthcare settings. This study explores the barriers and facilitators of implementing a nurse-delivered intervention (‘PRIMROSE’) designed to reduce CVD risk in people with SMI in primary care, using Normalisation Process Theory (NPT), a theory that explains the dynamics of embedding or ‘normalising’ a complex intervention within healthcare settings .Methods: Semi-structured interviews were conducted between April-December 2016 with patients with SMI at risk of CVD who received the PRIMROSE intervention, and practice nurses and healthcare assistants who delivered it in primary care in England. Interviews were audio recorded, transcribed and analysed using thematic analysis. Emergent themes were then mapped on to constructs of NPT.Results: 15 patients and 15 staff participated. The implementation of PRIMROSE was affected by the following as categorised by the NPT domains: 1) Coherence, where both staff and patients expressed an understanding of the purpose and value of the intervention, 2) Cognitive participation, including mental health stigma and staff perceptions of the compatibility of the intervention to primary care contexts, 3) Collective action, including 3.1. interactional workability in terms of lack of patient engagement despite flexible appointment scheduling. The structured nature of the intervention and the need for additional nurse time were considered barriers, 3.2. Relational integration i.e. whereby positive relationships between staff and patients facilitated implementation, and access to ‘in-house’ staff support was considered important, 3.3. Skill-set workability in terms of staff skills, knowledge and training facilitated implementation, 3.4. Contextual integration regarding the accessibility of resources sometimes prevented collective action. 4) Reflexive monitoring, where the staff commonly appraised the intervention by suggesting designated timeslots and technology may improve the intervention. Conclusions: Future interventions for physical health in people with SMI could consider the following items to improve implementation: 1) training for practitioners in CVD risk prevention to increase practitioners knowledge of physical interventions 2) training in severe mental illness to increase practitioner confidence to engage with people with SMI and reduce mental health stigma and 3) access to resources including specialist services, additional staff and time. Access to specialist behaviour change services may be beneficial for patients with specific health goals. Additional staff to support workload and share knowledge may also be valuable. More time for appointments with people with SMI may allow practitioners to better meet patient needs.

Towards holistic dual diagnosis care: physical health screening in a Victorian community-based alcohol and drug treatment service

2016 ◽  
Vol 22 (2) ◽  
pp. 81 ◽  
Author(s):  
Lara Jackson ◽  
Boyce Felstead ◽  
Jahar Bhowmik ◽  
Rachel Avery ◽  
Rhonda Nelson-Hearity
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Outcomes ◽  
Physical Health ◽  
Dual Diagnosis ◽  
Health Screening ◽  
Community Based ◽  
People With Mental Illness ◽  
Mental Health Clients ◽  
Physical Health Screening

The poorer health outcomes experienced by people with mental illness have led to new directions in policy for routine physical health screening of service users. By contrast, little attention has been paid to the physical health needs of consumers of alcohol and other drug (AOD) services, despite a similar disparity in physical health outcomes compared with the general population. The majority of people with problematic AOD use have comorbid mental illness, known as a dual diagnosis, likely to exacerbate their vulnerability to poor physical health. With the potential for physical health screening to improve health outcomes for AOD clients, a need exists for systematic identification and management of common health conditions. Within the current health service system, those with a dual diagnosis are more likely to have their physical health surveyed and responded to if they present for treatment in the mental health system. In this study, a physical health screening tool was administered to clients attending a community-based AOD service. The tool was administered by a counsellor during the initial phase of treatment, and referrals to health professionals were made as appropriate. Findings are discussed in terms of prevalence, types of problems identified and subsequent rates of referral. The results corroborate the known link between mental and physical ill health, and contribute to developing evidence that AOD clients present with equally concerning physical ill health to that of mental health clients and should equally be screened for such when presenting for AOD treatment.

scholarly journals A qualitative study exploring the barriers and facilitators of implementing a cardiovascular disease risk reducing intervention for people with severe mental illness into primary care contexts across England: the ‘PRIMROSE’ trial.

2019 ◽  
Author(s):  
Suzan Hassan ◽  
Samira Heinkel ◽  
Alexandra Burton ◽  
Ruth Blackburn ◽  
Tayla McCloud ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Mental Illness ◽  
Collective Action ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Barriers And Facilitators ◽  
Normalisation Process Theory ◽  
Positive Relationships ◽  
Healthcare Settings

Abstract Background: People with severe mental illness (SMI) are at greater risk of earlier mortality due to physical health problems including cardiovascular disease (CVD). There is limited work exploring whether physical health interventions for people with SMI can be embedded and/or adopted within specific healthcare settings. This information is necessary to optimise the development of services and interventions within healthcare settings. This study explores the barriers and facilitators of implementing a nurse-delivered intervention (‘PRIMROSE’) designed to reduce CVD risk in people with SMI in primary care, using Normalisation Process Theory (NPT).Methods: Semi-structured interviews were conducted between April-December 2016 with patients with SMI at risk of CVD who received the PRIMROSE intervention, and practice nurses and healthcare assistants who delivered it in primary care in England. Interviews were audio recorded, transcribed and analysed using thematic analysis. Emergent themes were then mapped on to constructs of NPT. Results: 15 patients and 15 staff participated. The implementation of PRIMROSE was affected by: 1) Coherence, where both staff and patients expressed an understanding of the purpose and value of the intervention, 2) Cognitive participation, including mental health stigma, staff confidence levels, staff knowledge and staff perceptions of the compatibility of the intervention to primary care contexts, 3) Collective action, including lack of patient engagement despite flexible appointment scheduling. Limited time and resources hindered implementation. Positive relationships between staff and patients facilitated implementation, and access to ‘in-house’ staff support was considered important. Staff skills, knowledge and training facilitated implementation. However, perceptions of the applicability of the intervention to real-world contexts and accessibility of resources sometimes prevented collective action. 4) Reflexive monitoring, where the staff commonly appraised the intervention by reporting its value and identifying ways of improving it. Conclusions: Future interventions for physical health in people with SMI could consider the following items to improve implementation: 1) training for practitioners covering interpersonal skills, mental and physical health, in order to overcome stigma, increase knowledge, confidence and facilitate positive relationships with patients and 2) enabling access to resources including specialist services, additional staff and time.

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