mental health

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Bringing together physical and mental health

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Priority 4: Strengthening primary care for the physical health needs

of people with severe mental illnesses

The problem

Compared to the general population, people with severe mental illnesses are

less likely to have their physical health needs identified or to receive appropriate

treatment for these. Despite a policy commitment to reducing these inequalities,

monitoring of physical health among people with severe mental illnesses remains

inconsistent in both primary and secondary care. For example, only a minority

are screened for cardiovascular disease (Hardy et al 2013), and other tests such

as cholesterol checks and cervical smears are performed at lower rates than for

the general population (RSA Open Public Service Network 2015). Part of the problem

historically has been a lack of clarity over whether responsibility for providing

primary health care to this group of people lies principally with GPs, mental health

teams, or both (Lawrence and Kisely 2010). There are skills gaps in general practice –

for example, most practice nurses do not receive training in how to perform physical

health checks for people with severe mental illnesses, and there is evidence of

‘diagnostic overshadowing’ in which physical symptoms can be overlooked as a result

of an existing diagnosis (Jones et al 2008). Barriers to accessing primary care for

physical health may be further exacerbated by stigma and socioeconomic inequalities

among people with severe mental illnesses (Park et al 2013).

Impact on people

Poor detection and treatment of physical ill health contributes to the threefold

increase in mortality rates among people with schizophrenia (Brown et al 2010).

A review of the evidence found that people with severe mental illnesses receive

a poorer standard of care for a range of conditions including diabetes and heart

failure, and are less likely to receive medical treatments for arthritis (Lawrence and

Kisely 2010). Primary care can play an important role in ensuring that people with

mental illnesses receive equitable access to care across the system.

The case for change: 10 areas where integration is needed most 28

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