In this excerpt from the May/June edition of Mental Health Today Magazine, Brian Semple looks at how new resources are helping mental health professionals to reduce the number of people with severe mental illness who die 20 years younger than average. To read the article in full click here to subscribe

Clare Gill, who is 41 and has schizo-affective disorder, first began to develop serious pains in her joints after being prescribed the antipsychotic Stelazine (trifluoperazine). “It got to the stage where my parents had to tie my shoe laces for me because I could hardly use my fingers. I went to my psychiatrist, but she didn’t seem in the slightest bit interested. She ruled out point blank that it was anything to do with the Stelazine, and wouldn’t discuss the side effects. She just said that because it was something physical, I had to see my doctor, who wasn’t interested either. You get knocked back and forth from psychiatrist to GP. It’s like a really stressful ping-pong game.”

Eventually her parents paid for an appointment with a private rheumatologist, who diagnosed Gill with systemic lupus erythematosus (SLE), an autoimmune disease that attacks the body’s cells and tissue. “It seemed obvious to me that it was related to the Stelazine and the rheumatologist confirmed that it was the side effects that caused the SLE. It’s a condition that can affect you for life, or even kill you, so I was lucky.”

Unfortunately, Gill’s experiences are all too common among people affected by mental illness, who die on average 20 years younger than the general population, mostly as a result of preventable physical health conditions. For example, they are two to three times more likely to develop type 2 diabetes and twice as likely to die from heart disease.

Taking physical health seriously

Gill’s story points to a number of the key factors that contribute to these alarming statistics: poor monitoring of physical health, inadequate explanation of medication side effects and failure by health professionals to take people with mental illness seriously when they raise concerns about their physical health.

Medication is a huge issue here, with antipsychotics in particular often causing dramatic weight gain, which in turn can lead to heart disease, diabetes, raised cholesterol and blood pressure, stroke, colon cancer and sexual dysfunction. Yet, as in Gill’s case, people are often not given comprehensive information about the potential side effects that could result from the medication prescribed to them. The Care Quality Commission’s survey of community mental health services 2011 showed that more than half of people taking medication for mental illness felt that they could have been given more information about side effects and 28% were not given any information at all. This leaves people less equipped to notice side effects, and less empowered to raise concerns about them.

Check it out

In a bid to tackle these problems, Rethink Mental Illness has launched a range of resources designed to give mental health professionals the confidence and tools to address the physical health needs of the people they support.

These include the Physical Health Check (PHC), a tool designed to improve the monitoring of physical health by encouraging a conversation between the practitioner and the patient about their physical health, identifying any unmet health needs or problems, and deciding together what action to take.

Vanessa Pinfold is a research fellow at Rethink Mental Illness and was closely involved in the development of the PHC. She says that what sets it apart from other systems for monitoring physical health is the philosophy and vision underlying it: “The aim is to encourage an empowering dialogue between the practitioner and the person being treated, which enhances the therapeutic relationship. In that way it’s very different to a lot of standardised assessment systems – it’s not a screening questionnaire, and it’s not meant to be a box-ticking exercise. Instead, we want the PHC to enable clinicians to have a conversation with the people they support about their physical health needs, and to decide on a joint action plan together.”

Key health risks advice

Another resource being used in Lancashire is free e-learning training, developed by Rethink Mental Illness, which offers information and advice on some of the key health risks affecting people with mental illness.

Rhett Pomfret, a support time and recovery worker in Lancashire with a particular focus on physical health, says that information contained in the e-learning package about ethnicity and sexual health was particularly useful. “We’re already used to talking to people about their diet and drinking and so on, but you might have tended to avoid the sexual health issues, because you might think ‘what if they tell me something and I don’t know the answer,’ or ‘how do I approach that issue?’. The training package is pitched at the right level, it brings all the relevant issues together in the right detail and points people in the right direction to approach it.”

Pierce believes that the value of using these resources cannot be underestimated and he points to a number of cases in which physical problems identified using the PHC would have otherwise developed into fatal conditions. “Because we’d asked the right questions, we’d identified people who developed breast lumps or testicular lumps and we were able to get them seen by their GPs and get treatment. It’s very likely that without having done that, those conditions would have developed to the stage where they weren’t treatable. I think it’s not hyperbole to say that having done this for a year, it has probably saved one or two people’s lives.” 

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