Sue Bailey RCPsychChanges are needed to improve the physical health of people with severe mental illness (SMI) across the NHS, as they often die 10-20 years earlier than the general population due to physical illness, a report has said.

The joint report, published by the Royal College of Psychiatrists and the Academy of Medical Royal Colleges, sets out essential actions to improve the physical health of adults with SMI across the NHS. 

While the health of the general population in the UK has improved significantly over the past 50 years, the life expectancy of adults with SMI is lagging behind. Nearly half (46%) of people with SMI have a long-term physical health condition and are at risk of losing on average 10-20 years of their lifespan due to physical ill-health. 

The report, ‘Improving the physical health of adults with severe mental illness: essential actions’ was written in partnership with the Academy of Medical Royal Colleges and the Royal Colleges of General Practitioners, Nursing, Pathologists, Physicians, the Royal Pharmaceutical Society and Public Health England. The report makes practical recommendations for changes that will help adults with SMI to receive the same standards of physical healthcare as the general population and reduce the risk of premature death.

The report makes 8 recommendations to key bodies and inspectorates, including:

• Creating a new national steering group to lead and link key stakeholders with experts from the professions so that important aspects of physical healthcare are addressed and monitored at a national level

• Each mental health service, acute hospital, general medical practice or GP federation should develop a physical health strategy for patients with SMI which is approved by the board and reviewed annually; they should also appoint a lead clinician at board level to be responsible for its implementation

• Training for healthcare staff should be reviewed to ensure healthcare professionals are equipped to fulfil the physical health needs of people with SMI, such as being able to recognise physical illness and take appropriate action

• Infrastructure should be improved; e.g. systems for recognising acute illness; improved IT to help with meeting current health-needs; better access to investigation results to help to improve standards of both physical and mental healthcare.

Chair of the Academy of Medical Royal Colleges, Professor Dame Sue Bailey (pictured), said: “Health professionals should have the same ambitions for the physical health of people with severe mental illness as for the general population. The ambition of this report is to provide a focused programme of actions that can be taken across the system, from training to leadership and best practice in care provision, to reduce preventable premature mortality in this vulnerable group.”

Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, added: “The recommendations in this report takes us a step beyond what we already know – that physical illness is the biggest single cause of death in severe mental illness. This is now a major priority for us, NHS England and anyone who cares about severe mental illness.”

Lance Sandle, vice-president of the Royal College of Pathologists, said: “People with severe mental illness are not getting the right tests at the right time to diagnose, manage and monitor their physical health. This leads to poorer health and exacerbates existing conditions. 

This can be improved by better IT connectivity across healthcare organisations and by providing patients with a unique number which is recognised by all IT systems.

“This will make it easier for healthcare staff to flag when a person with severe mental illness needs a vital pathology test to manage their physical health, leading to better diagnosis and swifter and more effective treatment.”

David Branford, English Pharmacy board member, Royal Pharmaceutical Society, said: “We urgently need to see better integration of mental and physical health services, so that people are treated as a whole. The majority of premature deaths in people with severe mental illness are caused by potentially changeable health-risk behaviours, such as smoking, alcohol and addictions, lack of exercise and obesity. Targeted intervention to support people with mental health problems with smoking cessation, weight management; addiction, advice about physical activity and medicine optimisation are all necessary and can be delivered by pharmacists. Pharmacists should work closely with the healthcare team to optimise the use of medicines and to be able to monitor the physical side effects of the medicines prescribed for physical and mental conditions.”

Professor Maureen Baker, chair of the Royal College of General Practitioners, said: “This report drives home the need for more mental health services in the community, and for GPs and our teams to have better, easier and quicker access to these.

“One of the pledges made in NHS England’s GP Forward View is for every GP practice to have access to a dedicated mental health therapist – and this will be essential in making sure our patients with serious mental illness receive optimal physical and mental health care.

“Mental health is an enduring priority for the RCGP and we have developed a number of practical resources to support GPs and other healthcare professionals to deliver the best possible care to our patients with mental health conditions. Promoting physical activity and lifestyle is also a priority, and we are working to support GPs to do this, in the best interests of all our patients.”