People with severe mental illness die on average 15-20 years earlier than the general population, often due to largely preventable physical illnesses such as cardiovascular disease and diabetes. There is also a huge financial cost to the NHS of more people living with multiple long-term conditions. This significant impact on individuals and the system, alongside rising demand, means integrating physical and mental health services and providing more holistic care is now needed more than ever.
Ahead of Mental Health Awareness Week, we spoke to NHS trusts about the work they and their partners are doing to improve physical health support for people with severe mental illness (SMI), who often face some of the most significant stigma and health inequalities.
Integrating physical and mental health services and providing care more holistically means better overall health outcomes and enhanced wellbeing for patients. National funding and focus, partnership working, harnessing data and digital, and much closer working between physical and mental health services have proven key to providing better coordinated and collaborative services and care.
For example, with the support of national funding and focus and partnership working, Sheffield Health and Social Care NHS Foundation Trust is collaborating with Primary Care Sheffield to deliver mental health care closer to primary care settings. This has helped patients better manage their weight and blood pressure, schedule cancer screenings, and in some cases access carer support and home equipment.
As well as being one of the early implementer sites for community mental health transformation, Somerset NHS Foundation Trust is one of the first trusts in England to provide community, mental health, learning disability and acute hospital services, following a merger of two trusts. Responding well to complex needs and reducing inequities – including between physical and mental health – is central to the trust's clinical strategy. One benefit of the closer working between services is the trust can more easily and reliably identify vulnerable patients on waiting lists, such as those with a learning disability or with a mental health referral, which has to date led to over 400 patients being re-prioritised and seen four to five months more quickly.
Partnership working and collaborative relationships also enabled Mersey Care NHS Foundation Trust to establish three mental health triage services with the police and ambulance services across Liverpool and Sefton. Mental health practitioners work with emergency response personnel in dedicated cars to treat individuals' physical and mental health needs at the same time. The services conduct proactive visits to high-risk areas as well as respond to requests for assistance. Between April 2022 and September 2023, they have supported around 4000 patients and helped to alleviate pressure on other frontline services.
Elsewhere, annual physical health checks for people with SMI are a crucial part of reducing premature mortality and it was a national ambition to carry out 390,000 by 2023/24. Challenges in access remain, with 361,210 receiving a full health check by the end of 2023/24. Crucially, individuals must also receive any necessary follow-up interventions. However, trusts and their partners are making real efforts to increase uptake.
With a focus on collaborative working and making better use of data and digital,Somerset NHS Foundation Trust has increased the number of checks received by patients. Working with Rethink Mental illness and Somerset ICS, the trust created four dedicated roles to deliver checks to people who hadn't previously engaged, and checks increased by 23% in three years. Furthermore, an 'in real time' digital dashboard has helped trust staff identify patients at risk of physical health complications and intervene earlier.Primary Care Sheffield, in collaboration with Sheffield ICB, has also improved uptake from 24 percent in 2021 to 80 percent, with 2,000 more people eligible.
It is also crucial to prioritise and take targeted steps to improve the physical health of people with SMI who are from marginalised groups as they often face additional and often unique challenges and barriers. Through personal health budgets (PHBs), East London NHS Foundation Trust, in collaboration with North East London ICS and The Advocacy Project, is supporting people to access activities, like boxing, to improve their physical health and manage the side effects of medication. Mersey Care NHS Foundation Trust's community physical health team also offer translation services and extended consultation times for patients with SMI, supporting equitable access to physical health care for individuals, particularly those from ethnic minority backgrounds.
Trusts need to continue prioritising physical health care for people with mental health conditions and further develop the integration of mental and physical health services. Trusts sharing expertise and specialist staff, collaborating with partners and improving how their services and non-NHS pathways join up are vital parts of these efforts.
To aid trusts' progress, funding needs to incentivise mental and physical health services to work together. Focus on transforming community mental health services also needs to be sustained given to the historical underfunding these services have faced. Implementing digital systems capable of sharing information seamlessly across organisations is crucial. More broadly, national policy must prioritise prevention, early intervention, and tackling the wider determinants of ill health.
When trusts work collaboratively and in partnership with others to deliver more integrated services and holistic care – and are supported nationally to do so – they can better support the physical health of people with SMI. Local and national focus should remain on closing the unacceptable and avoidable life expectancy gap for these groups of individuals. More integrated and holistic care would mean better services for all.
This blog was first published by HSJ.
About the author
