A support, time and recovery worker has dramatically improved the physical health of patients being treated for mental illness by overhauling screening, monitoring and support. Amanda Derbyshire, who works for the Halton and Warrington Early Intervention Team at 5 Boroughs Partnership NHS Trust, established and developed a physical health and wellbeing pathway for patients after an audit showed screening was poor.
‘We know from national research about the importance of physical health needs,’ says Amanda. ‘People with mental illness are at increased risk of physical ill-health, especially individuals with schizophrenia or bipolar disorder, who die on average 16-25 years sooner than the general population. Yet less than 30% of people with schizophrenia receive annual physical health screenings'.
First, she liaised with GP surgeries and care co-ordinators to compile service users’ physical health records. Only 6% had received a baseline comprehensive health screening, falling to just 3% at the two-year stage of their treatment. She used the Royal College of Psychiatrists’ Lester cardio-metabolic tool - a simple assessment and intervention framework focusing on smoking, lifestyle, BMI, blood pressure, glucose regulation and blood lipids - for patients receiving antipsychotic medication as a template and combined it with the trust’s own comprehensive physical health assessment document.
Next she established a steering group linked to primary care, secondary care and included service user representatives and produced an educational DVD, featured on the trust’s website, and a GP leaflet detailing the importance of physical health screenings during treatment for a severe mental illness.
Best practice
And as there was no IT structure available to record and track screening results, she created her own evidence-based database, embedding best practice guidelines. ‘It highlights when service users' screenings are due to both myself and their care coordinator to ensure the appointment is booked,’ says Amanda. ‘It is a great system that I can pass on to people who need it. It was submitted to NICE and has been published as an example of best practice.’
Amanda signposts people for smoking cessation or gym membership where required, and holds regular and ongoing weight management/healthy lifestyle sessions - particularly for those who may be obese and need encouragement and support to adopt a healthier lifestyle (see case study, below). As a result of the screening programme, a number of clients with issues such as significantly raised blood pressure, undiagnosed high cholesterol and weight management problems have now had them addressed.
A re-audit shows an impressive dramatic increase in adherence to screenings - from 6% to 94% overall. Follow up as well as baseline screenings are completed and all results recorded and shared with GP practices. Intervention plans are initiated immediately, with weekly follow up appointments and screenings.
Attitudes in the early intervention team have also changed. ‘Initially the team was not sure what I was doing and why, although my manager was completely on board. They were focused on only the mental health aspect of their service users’ treatment. Now the whole team is on board and want the screenings for their patients.’ The Future
The trust plans to introduce a similar assistant practitioner role in each early intervention team. Amanda already plans for the future of her service: ‘We want to create a one-stop shop for physical screening instead of sending people to different appointments. I am also hoping to facilitate a service user-led health and wellbeing group, so they can work together and take the initiative for themselves'.
You can read a full case study report here http://rcni.com/newsroom/nurse-awards/physical-health-overhaul-patients-mental-illness-26141