Meeting the physical healthcare needs of people with serious mental illness in primary care

Problem

People with serious mental illness (SMI) – predominantly schizophrenia or bipolar disorder – die on average 15-20 years earlier than the general population, largely from the same potentially preventable physical conditions such as heart and lung disease. This mortality gap may still be widening and is a major injustice that represents one of the biggest health inequalities in England. As stated, by the late Professor Helen Lester, primary care is the cornerstone of healthcare for people with SMI as it is where most of their physical health needs are met. Consequently this study focuses on exploring what is happening in primary care.

Approach

Semi-structured interviews were conducted with people living with schizophrenia and bipolar disorder and health professionals (GPs and practice nurses) in the Yorkshire and Humber region, to explore patient and provider perspectives regarding the barriers and enablers of meeting the physical health needs of people with SMI in primary care. Maximum variation was used to purposively select a sample which would include a range of respondents (age, gender, level of deprivation), as well as snowball sampling to engage those who proved hardest-to-reach, younger people with schizophrenia. Interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis methodology.

Findings

Health professionals openly acknowledged that not enough is being done for this group. The main challenges identified included engagement of SMI patients, frequent missed appointments and difficulties following up when problems had been identified, providing sufficient time for adequate consultation, lack of continuity of care due to growing pressure on routine appointment systems, lack of training about mental health for doctors and nurses in primary care and a widening disconnect between primary and secondary care in relation to sharing information and communication. In contrast, nearly all respondents viewed the Quality and Outcomes Framework (QOF) positively, reporting that it had raised awareness and encouraged GPs to conduct physical health checks for this patient group, an example of good practice that has sustained, even after the removal of QOF indicators. Analysis of patient interviews to follow.

Consequences

This research study will provide new evidence about what is happening in practice by exploring views and perspectives from patients and health professionals. It will offer insider insight and innovative ideas on how to improve practice and inform policy. For example, a number of health professionals identified a missed opportunity in the role of practice nurses in relation to SMI patients. It was recognised that practice nurses could make a valuable contribution to the physical health management and monitoring of SMI patients, yet currently they have little direct contact with them and no mental health training, in stark contrast to their work with groups who have LTCs such as diabetes, COPD, asthma and CVD.