Physical health of people with severe mental illness: Don't just screen… intervene!

Introduction: A growing number of studies suggest a causal relationship between antipsychotic treatment and metabolic disturbances. The most frequent problems linked to antipsychotic drugs have been abnormalities of glucose metabolism such as insulin resistance, hyperglycaemia or new onset diabetes mellitus and dyslipidemia, including increased levels of total cholesterol, LDL-cholesterol and triglycerides. The study was aimed at reviewing the practice regarding the routine monitoring of physical health of service users on antipsychotic treatment. The study set out to reduce the cardio-metabolic effect of antipsychotic medication in service users. The study was also aimed at contributing to a reduction in the mortality rates in people with severe mental illness as well as testing out approaches to improve the physical health of people with serious mental illness who are receiving care from the Early Intervention in Psychosis Teams. The promotion of a more integrated approach to the physical health care of people with a SMI was also targeted. Methods: In November 2012, the Warrington and Halton Early Intervention in Psychosis service (EIP) conducted the initial audit, designed by AQuA as a baseline measure of the current standard of physical health screening amongst the Early Intervention patients in the two boroughs. The recommendations from the National Institute for Health and Care Excellence (NICE) and Maudsley prescribing guidelines were the frameworks for the AQuA design. The Research and Audit Governance Group in the 5 Boroughs Partnership NHS Foundation Trust approved the audit. A retrospective review of the clinical records of all patients opens to the EIP, who were prescribed antipsychotics, was undertaken. Six physical health parameters were examined and these include; serum lipid profile and blood glucose levels. Others measures were body weight, height, Body Mass Index (BMI) and blood pressure. These parameters were entered into the survey monkey audit tool developed by AQuA. Recommendations were made following the initial audit. A re-audit was carried out in May 2013. Results: The re-audit in May 2013 showed an increase in the number of service users being screened and monitoring for the six identified parameters A robust and comprehensive recording system has been developed, resulting in more service users receiving appropriate screening and physical health monitoring. Better links and working relationships have been established with primary care services and there is increased awareness of the need for physical health monitoring in professionals and service users. Regular and well-equipped physical health clinics with well-trained staff have beenestablished acrossboth localities. Other secondary care agencies within the Trust are now more aware of the requirements for physical health screenings.