Physical health care for the severely mentally ill

Mental and physical health are two sides of the same coin, each affecting the other to determine our overall health. There is long-standing evidence for the connection between the two, particularly for those with a severe mental illness (bipolar disorder, schizophrenia or psychosis), who are more likely to die up to two decades earlier than the general population because of long-term illnesses, many of which can be prevented or well managed if caught early.

NICE has had guidance on physical health monitoring for severe mental illness since 2002, but it wasn’t until 2017 that the NHS committed to put it in action. It was decided that GP surgeries would send a letter to individuals with a severe mental illness on their register, inviting them to take part in a full health check on an annual basis. This entailed an assessment of alcohol use, smoking, blood glucose, blood lipids, blood pressure and BMI. We explore how many people with a severe mental illness have received a full health check in the chart below.

Barring a fall in activity during the Covid-19 pandemic, the number receiving a full check has increased steadily from 117,932 in October-December 2018 to 273,858 in April-June this year. The proportion of individuals on the severe mental illness register receiving a full check has followed a similar pattern – reaching an all-time high of 58% in the last quarter of 2022/23 before dropping to 52% in April-June this year. The target for how many people with a severe mental illness should receive a full health check changed from a percentage to numerical terms by the second quarter of 2021/22, but the number receiving full health checks has still not met that numerical target since. It should also be noted that some individuals may be doing health checks through their community mental health teams, which could underestimate the count shown here.

The WHO has set a global objective for the integration of mental health care into community care settings like primary care, which is traditionally reserved for physical illness only. While it is good that this has not fallen on deaf ears in the NHS, uptake should be increased to meet the target. This can be achieved by using tools to aid implementation and learning from specific sites that have worked with patients who need extra support in accessing the health checks.

These checks are the first step in the right direction but hold little value if deployed alone. Guidance on the implementation of the checks specified that they would be followed by the necessary interventions, and include a comprehensive assessment on nutrition, exercise and drug use. However, since that data is not publicly reported, we do not know whether this initiative is successful in reducing the burden of physical illness on those already battling mental illness.