The physical health of people with mental health problems.
Promoting the wellbeing of the entire population including those with mental
health problems which had been prioritised by the public in consultation.
The Department of Health has been working on pilots with Eli Lilly to
look at how to improve the physical health of those with mental health problems and
guidance is being drawn up by Mentality. Guidance will be aimed at PCTs in their role as
commissioners of services. The pilots have provided special training for nurses to detect
physical problems including Body Mass Index (BMI), smoking and healthy eating as well as
recognising the side effects of drug treatments. The role of mental health nurses has been
reviewed by the Chief Nursing Officer was has recommended that they focus on physical,
social and psychological needs as well as psychiatric.
Within NIMHE the Let’s Get Physical programme is being used to
map all current work on promoting healthy lifestyles. It is known that employment is good
for wellbeing and there is work going on to help people off Incapacity Benefit into work
through the Pathways pilots. However there are problems amongst employers who may
discriminate against people with mental health problems or fail to give them adequate
support in the workplace. The Health Bill, which bans smoking in public places is to be
extended to short stay mental health facilities and patients will be given greater support
in giving up smoking.
Lynne Burling spoke from personal experience about
her son Alex who has schizophrenia and serious physical health problems. She explained the
side-effects of clozapine that he had suffered and that his doctors had failed to act
until she had insisted on a blood test. Mrs Burling looked into the side-effects of the
drug herself as well as the symptoms of diabetes. Alex’s GP was unaware of the link
between the drug and diabetes and the risk of liver damage. Alex was finally prescribed
insulin but his psychiatrist took him off clozapine over one week and Alex was admitted to
hospital with a psychotic episode. Mrs Burling’s complaint about his care is with the
Healthcare Commission. Alex was then seen by another psychiatrist who helped him to reduce
the clozapine gradually and regain a better quality of life. Mrs Burling is speaking at a
conference in February 2007 to call for improvements to the care people on psychiatric
drugs are given.
Dr Shubulade Smith began by recalling the case of a
woman who had collapsed and been taken to hospital and as she had schizophrenia it was
assumed that her collapse was related to that. In fact she was anaemic with very low
haemoglobin. She hadn’t seen her Community Mental Health Team for a long time and her
health had suffered. The woman died, she was 36. She died because there wasn’t enough
recognition of the physical health of people who have mental health problems.
Respiratory and cardiovascular problems are much more common amongst
people with mental health problems as are diabetes and obesity. If they have cancer they
are also more likely to die from it due to poor access to healthcare. May mental health
patients also have gastrointestinal disorders. Consultant psychiatrists are often very
busy and focus too much on mental health and risk and do not spend enough time thinking
about the patient’s physical health needs. All anti-psychotic drugs lead to weight
gain and this can trigger diabetes.
Dr Smith has worked with Lilly on the pilots, which have used nurse
advisers to work closely with patients and ensure that they receive health checks, blood
tests and lifestyle assessments. Health problems are then identified and help offered.
Much of the work included encouraging people to become more active, through sport or more
gentle exercise. The pilots produced good results but it was clear that health
professionals need to broaden their role in looking after a person’s physical and
mental health.
Q&A
Miranda Morland noted that more training is needed to enable people
to move from incapacity benefits into work. She also noted that people with mental health
problems are often on low incomes and therefore cannot afford to go to the gym or eat
organic food. Jenny Bywaters responded that it can be hard to have a good quality of life
on incapacity benefit, supported employment can help the transition into work for some
people.
Nick Bosanquet asked how these pilots could be rolled out without
extra funding for GPs and PCTs. Jenny Bywaters said that the guidance will give a strong
message to services about best practice and some funding would be provided though not ring
fenced and this will be given to the most deprived areas. Rob Holmes noted that he had
been talking to mental health trusts and there was interest in taking forward the work of
the pilots including from directors of nursing.
Another speaker from the floor spoke about her work with Smoke Free
Minds and had found a lot of resistance to giving up as smoking is used as a coping
mechanism by some people with mental health problems. Dr Smith agreed that it was not easy
but that the pilot schemes had had some success.
Lynne Jones MP reported on a pilot in Birmingham where nurses had
gone out to people’s homes and taken them out to the park or to the gym. She noted
that it is essential for health professionals to be concerned with all aspects of their
patients’ health.
Margaret Edwards noted that though health checks are now in place for
people with serious illnesses they don’t happen enough and aren’t made a
priority. Lynne Burling noted that carers can play an important role in supporting people
and pushing for services but it is very hard for people who are on their own to get access
to health care. Jenny Bywaters said that advocates can play an important role in
supporting patients.
Lynne Burling stated that her son had found work in a horticulture
centre where he had been supported but that it would have been better if he had made
therapeutic earnings as some reward for the work. There is a need for better understanding
of the transition back into work. Lynne Jones MP mentioned that
according to the Department of Work and Pensions, people doing voluntary work are no
longer allowed to have a free lunch at their work without it affecting their benefits,
which seemed very unfair. Jenny Bywaters agreed to take this back to the Department of
Health and ask for it to be raised with the Department for Work and Pensions.
Lynne Jones thanked the speakers.
Members:
Dr Lynne Jones MP
Tim Loughton MP
Sandra Gidley MP
Lord Turnberg
Dr Ian Gibson MP
Observers:
Jo Loughran – Rethink
D. Burling – Carer
Lisa McNally – Wandsworth PCT
Shazia Ghani – Tower Hamlets Social Services
Mary Burul – ELCMHT/THPCT/BPS
Julia Redhead
Miranda Morland – Bruised UK
Eric Lynch – Sanofi-Aventis
Margaret Edwards – SANE
Rob Holmes – Lilly
Nick Bosanquet
Agnes Wheatcroft – Royal
College of Psychiatrists
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