Improving the Physical Health of People with Mental Health Problems: Actions for Mental Health Nurses

Objectives

Promote parity of esteem by improving the physical health, wellbeing and life expectancy of people with mental health problems through holistic, person-centred care that treats physical, psychological and social needs as interconnected.[1][2][3]The overarching aim is to reduce health inequalities and premature mortality, particularly for people with severe mental illness, by ensuring equitable access to prevention, assessment, treatment and support for healthier lifestyles.[1][2][4]

• Ensure physical and mental health needs are assessed together, with an individual action plan and shared care plan reflecting the person’s priorities, preferences, circumstances and recovery goals.[4][5][6]
• Improve access to routine health checks, screening, early detection and evidence-based intervention for cardiometabolic risk, cancer, diabetes, cardiovascular disease and other preventable physical-health conditions.[4][7][8]
• Address major risk factors through smoking cessation, healthy eating and weight management, physical activity, alcohol and substance-use support, sexual and reproductive health, medicine optimisation, oral health, pain management and falls prevention.[9][3][6]
• Reduce cardiometabolic risk among people with psychosis and schizophrenia through assessment of body mass, smoking, lifestyle, blood pressure, glucose regulation and blood lipids, alongside lifestyle support, medication review and referral where required.[8][10]
• Support smoke-free mental health inpatient units and facilities for adults, children and young people, alongside accessible cessation advice, medication and specialist support.[4][11][12]
• Promote nutrition, physical activity and weight management, recognising the effects of dietary circumstances and psychotropic medication on obesity and related health risks.[13][14][15]
• Identify and address co-existing alcohol and drug use, including harm reduction and treatment or referral for people who are not ready or able to pursue abstinence.[16][17][18]
• Include sexual health, contraception, sexual dysfunction, violence and abuse within comprehensive assessment, while protecting privacy, dignity and safety.[19][20]
• Improve oral health and reduce falls-related harm, with particular attention to people at elevated risk because of age, medicines, mobility, cognitive impairment or environmental hazards.[21][22][23]

Implementation

Delivery relies on integrated action by mental health nurses and multidisciplinary partners across inpatient, community, primary, secondary and social care services.[9][7][24]Nurses are expected to assess, monitor, refer, provide evidence-based interventions and support healthier lifestyles, while recognising professional limits and obtaining specialist input where necessary.[1][3][5]

• Coordinate care between general practitioners, psychiatrists, pharmacists, care coordinators, practice nurses, social care, specialist services, carers and voluntary-sector organisations, with consent-based information sharing and clear responsibility for follow-up.[6][25][24]
• Use routine physical-health assessment covering lifestyle, family history, smoking, diet, exercise, weight, body mass index, blood pressure, glucose and lipids, supplemented by relevant tests and examinations.[7][26][24]
• Apply the Integrated Physical Health Pathway, the Lester Tool or Positive Cardiometabolic Health Resource, and locally appropriate tools to structure monitoring, intervention and communication between primary and secondary care.[27][24]
• Develop workforce competence through continuing professional development, local training, higher-education partnerships and multidisciplinary shared learning, including skills in physical-health assessment, nicotine replacement therapy, medicine management and responding to diagnostic overshadowing.[3][5][11]
• Use collaborative behavioural support, including brief advice, motivational interviewing, psychoeducation, cognitive behavioural approaches, realistic goal setting and tailored lifestyle interventions.[6][12][28]
• Establish referral and escalation pathways for smoking cessation, dietetics, sexual health, dental care, physiotherapy, optometry, substance-misuse treatment and specialist metabolic or medical review.[28][18][29][23]
• Review psychotropic medicine benefits, adverse effects, interactions and adherence with patients and carers, and involve prescribers and pharmacists in decisions to continue, alter or stop treatment.[30][25][31]
• Implement multifactorial falls prevention through medication review, assessment of mobility, cognition, vision, continence and postural hypotension, environmental adaptation, exercise and multidisciplinary quality improvement.[23][32]
• Use quality-improvement and comparison methods, including RightCare pathway review, local data, audit, plan-do-study-act cycles and care bundles, to identify unwarranted variation and improve services.[5][33][32]
• Use the Commissioning for Quality and Innovation payment framework to incentivise comprehensive cardiometabolic assessment and treatment for people with psychoses.[3]NHS England’s stated outcome target was for an additional 280,000 people with severe mental illness to have their physical-health needs met by 2020/21.[1][4]

Monitoring & Evaluation

Monitoring centres on routine, person-centred physical-health assessment, documented care planning, repeated review and communication between mental health, primary care and other relevant services. It combines national quality incentives and targets with clinical measures, local audit, service comparison and incident reporting, but does not provide one consolidated document-wide evaluation or accountability framework.[3][24][34]

• Monitor physical-health needs through assessments covering lifestyle, smoking, diet, physical activity, family history, weight or body mass index, waist circumference, blood pressure, glucose regulation and blood lipids.[3][7][26]
• Record assessment and treatment results and share them with individuals, clinical teams and general practitioners; incorporate findings into care plans, Care Programme Approach reviews and discharge communications.[3][6][24]
• Review progress with the individual, repeat relevant assessment measures, gather evidence of change and revise priorities or care plans as needs change.[6]
• Apply the 2016/17 Commissioning for Quality and Innovation indicator on comprehensive cardiometabolic risk assessment and treatment for people with psychoses, including documented and shared results.[3]
• Work towards the national outcome that, by 2020/21, 280,000 additional people with severe mental illness would have their physical-health needs met; the material also refers to a quantified national reduction in premature mortality, with implementation beginning in 2017/18.[1][4]
• Use the Lester Tool, also called the Positive Cardiometabolic Health Resource, and associated physical-health pathways to guide risk assessment, intervention selection and monitoring of people with psychosis or schizophrenia.[27][8]
• Undertake baseline reviews after initiation or change of antipsychotic medication, assess weight weekly for the first six weeks, review at 12 weeks and reassess principal physical-health measures annually; review abnormalities at least every three months where indicated.[26]
• Maintain psychiatric responsibility for physical-health and antipsychotic-effect monitoring for at least 12 months after treatment initiation or until stabilisation, with subsequent transfer to primary care through shared-care arrangements where appropriate.[31]
• Monitor medicine effects and adverse effects using approved rating scales, including effects on metabolic, cardiovascular, sexual, oral and gastrointestinal health, and record the rationale for continuing, changing or stopping treatment.[30][25][31]
• Assess nutrition and weight before and during relevant medication, including baseline waist circumference and body mass index, and use tools such as the Malnutrition Universal Screening Tool where relevant.[13][28]
• Assess physical activity through reported days and minutes of moderate-to-vigorous activity; examples include weekly basic observations and blood-pressure checks and audits of confidence and physical-health change.[35][36]
• Use validated alcohol-use disorder screening for people aged 16 and over, and monitor emerging substance-use patterns, including new psychoactive substances and chemsex-related drugs.[17][18]
• Include sexual health screening, sexual dysfunction and understanding of sexual-health risks in routine assessment, alongside local safeguarding procedures for sexual or domestic abuse.[19][20]
• Monitor dental access, attendance at dentist-recommended check-ups, oral-health risks and dry-mouth symptoms; use routine pain assessment to support earlier identification of underlying physical-health problems.[21][29]
• Monitor falls through incident reporting, post-fall protocols, audit, evaluation and quality-improvement cycles; relevant measures include overall falls and injurious-fall rates. In England, mental health facilities reported 28,178 falls in 2013, including 1,292 causing moderate harm, 105 causing severe harm and 13 deaths.[33][32]
• Use RightCare local data and the Atlas of Variation to compare outcomes, identify unwarranted variation and outlying organisations, then review pathways and develop an evidence-informed case for change.[5]
• Evaluate local implementation of cardiometabolic improvement approaches, including Lester Tool pilots across four mental health trusts and external evaluation by the Royal College of Psychiatrists.[27]

Examples report measurable service improvements, including a clozapine service reducing non-attendance from 22% to less than 1% and increasing physical-health and side-effect monitoring to 96%.[25][37]However, beyond these specified tools, targets and local mechanisms, the material does not define a unified indicator set, reporting timetable, surveillance system, sanctions or named document-wide accountability body.[2][4][24][34]

Costing & Financing

Financial information is limited. The material identifies quality-payment mechanisms, workforce and service-resource needs, and the economic burden of falls, but does not set out a dedicated implementation budget, funding allocation, funding source, funding gap, resource-mobilisation plan or economic model for the wider programme.[3][23][33]

• Use the Commissioning for Quality and Innovation payment framework to reward providers for quality improvement, including cardiometabolic assessment and treatment for patients with psychoses; no payment value or provider allocation is specified.[3]
• Resource workforce development through continuing professional development, locally supported training, specialist support, pharmacy collaboration and multidisciplinary staffing, without associated monetary values.[3][5]
• Recognise practical non-monetary requirements, including assessment tools, laboratory testing, smoking-cessation medicines and support, lifestyle programmes, oral-hygiene equipment, dental access, mobility aids, environmental modifications and specialist referrals.[11][29][23][26]
• Note that falls account for over 4 million hospital bed days annually and an estimated annual cost of 2 billion pounds sterling, while fragility fractures have an estimated combined social and healthcare cost of 4.4 billion pounds sterling in the United Kingdom.[23]
• Identify coordinated dental treatment alongside other specialty appointments as intended to reduce time in hospital services and support cost-effective care, without providing a monetary estimate.[38]

No other explicit programme costings, expenditure figures, unit costs, financial assumptions or quantified funding requirements are provided.[7][18][8]