Physical Health in Mental Health

1. Programme : Implementation of Minimum Standards for Physical Health in Adult, Older Adults, CAMHS and LD Mental Health Services Dr Con Kelly, Medical Director Andy Mattin, Director of Quality & Nursing

2. Physical Health in Mental Health “People with severe mental health problems are much more likely to suffer from physical illness than rest of the population, but are less likely to get the right help and support from the NHS when they do” (Rethink, 2014)

3. Why? • Side effects of antipsychotic medication Antipsychotics whilst life changing for many people also have side effects that can affect physical health. For example, weight gain, heart problems and diabetes. • Lifestyle factors People with mental health problems are 70% more likely than the rest of the population to smoke. Despite this, they are less likely than others to be given support to quit. People who have severe mental illness are also less likely to exercise and are more likely to develop problems with drugs and alcohol.

4. Why? • Poor health monitoring Everyone should receive regular health checks, to monitor things like blood pressure and weight. People with severe mental illness are less likely to receive health checks than the rest of the population. Figures show that fewer than 30% of people with schizophrenia are getting a basic annual physical health check. • Access to healthcare People with mental illness can find it very difficult to go to the GP. They might be anxious about it or may struggle with the early-morning booking system because medication can make it difficult to wake up early. Another problem is that when they do see their GP, sometimes their concerns are dismissed or seen as a manifestation of their mental illness, rather than as a health issue in its own right. (Rethink, 2014)

5. CNWL Currently Recent audits show that we are not performing as well as we would like to ensure that our patients have physical health checks whilst in our care. Three main contributory factors to this have been identified following our POMH-UK audits: • Inconsistent and poor access to equipment and services to undertake tests (e.g. limited access to phlebotomy for our community MH teams and insufficient access to and training in the use of ECG machines) • Inconsistent access to timely results of physical health investigations (e.g. limited access to electronic access of pathology results) • Lack of functionality on JADE to record results in a manner which is easy to retrieve (physical health checks are either scanned or written into progress notes)

6. Physical Health Programme • A year long programme started in May 2016 • Senior Responsible Officer for the Programme is Andy Mattin, Director of Quality and Nursing • A Senior Responsible Clinician will be identified • The programme is supported by the Service Redesign team • The scope of the programme is Adult, Older Adults, CAMHS and LD Mental Health Services (100+ teams/wards)

7. What will the programme aim to achieve? Define, document and implement a set of minimum standards for physical health monitoring in our Mental Health Services in North West London and Milton Keynes. Undertake a gap analysis of current provision of physical health checks. Build on existing areas of good practice and share learning through a physical health training programme. Change in culture of teams to always consider the patients whole health needs (mental and physical health). Develop a costed options paper for equipment and extension of the Trust’s pathology contract (currently excludes CAMHS, LD, EIS, Older Adults and Mental Health Community).

8. How will this programme address the three main contributing factors? • Inconsistent and poor access to equipment and services to undertake tests The programme will develop a costed options paper for extending the Trust’s pathology contract. It will ensure that all services have access to the necessary equipment to undertake physical health checks. The training programme will ensure that our staff are trained to do the tests. • Inconsistent access to timely results of physical health investigations • A dependent workstream is being undertaken by IT to establish access for CNWL Mental Health Services to the diagnostic cloud in North West London. This will enable “real-time” access to diagnostic results where patient’s have provided consent for shared information. • Lack of functionality on JADE to record results • The programme will develop a standardised form for recording physical health tests. This will be implemented on SystmOne for go live of the new clinical system.

9. Establish T & F (May) Develop & Agree Minimum Standards (May, June) CQUIN - Training plan developed (May, June) Scoping of current devices (Apr – June) Business Case & Training plan developed (July - August) Clinical System Form (July – Sept) Procurement of Equipment (July – Sept) Develop patient information (July – Sept) Q1 17/18 Q1 16/17 Q2 16/17 High Level Timeframes Apr - June July – Sept Embedding into local operational procedures Close programme report (Jan) Handover to BAU (Feb) Implementation of the Standards commences (Oct) Training commences (Oct – ongoing to BAU) Integration into local Ops Policies (Oct – Nov) 2016/17 2016/17 2016/17 Q3 16/17 Q4 16/17 2016/17 Jan – Mar Oct - Dec 2016/17 Programme Evaluation (June) Apr - June 2016/17 Timeframes have been aligned to achieving the requirements of the National 2016/17 CQUIN on physical health.

10. Discussion