Mental Health in Scotland: Improving the Physical Health and Well Being of those Experiencing Mental Illness

Management and Treatment of Physical Health and Wellbeing

Everyone potentially will benefit from access to relevant health promotion advice and information.

Improving the management of physical health and wellbeing for people with a mental illness should be embedded within existing health improvement policies and practice, and health promotion, screening, self management and recovery initiatives must be equally available to all. ( See here).

Of the guidance available there are a number of core good practice elements common to each including:

General health and wellbeing:

• A review should take account of lifestyle choices such as smoking, diet, physical activity, and risk behaviours such as alcohol and drugs, with appropriate health promotion advice and interventions offered;

Additional health promotion activity:

• Attention to immunisation needs, sexual and reproductive health, or dental and eye checks;

Medication management:

• A review of any side effects with action where appropriate;

Physical screening:

• Primarily for cardiovascular risk factors such as weight and blood pressure; and

Investigations:

• primarily for cardiovascular risk factors such as glucose and cholesterol.

Keep Well

Ultimately there are many factors which can affect physical health, including: poverty, inequalities, disability, deprivation, unemployment and childhood trauma. There are a range of initiatives addressing these factors within Scotland.

Keep Well is a 3 year anticipatory care programme that focuses on tackling the main risk factors associated with the early onset of cardiovascular disease within areas of multiple deprivation. ⁴¹ The programme represents a key component of the Scottish Government's drive to reduce health inequalities. The initiative is already piloted across 7 NHS Board areas with a stated aim to increase the rate of health improvement, with a particular focus on early intervention for those at a high risk of coronary heart disease and its main risk factors in the age group 45-64 years.

Communities selected for the initial stage involve Community Health Partnership ( CHP) populations in North Glasgow, East Glasgow, Edinburgh, Dundee and North Lanarkshire.

Currently 166 practices are proposed for Wave 2. This would provide the opportunity for up to 44,000 individuals to go through the Keep Well process. Health Checks commenced in November 2007.

The Keep Well Health Check includes 3 main assessment areas; clinical (e.g. Height, Weight, Blood Glucose and Cholesterol), lifestyle (e.g. Smoking, Physical Activity and Diet) and life circumstance (Learning, Employability and Income Maximisation). Based on assessed need a range of NHS and non- NHS treatments, services and supports are offered thereafter.

There are clear overlaps between the clinical and lifestyle content of the Keep Well check and the Quality and Outcomes Framework ( QOF) based review for people on general practice based mental health registers.

(See example in Annex C of QOF related guidance for GP's).

In developing planned and tailored interventions for individuals, the Keep Well approach takes account of the importance of co-morbidity, which often involves both physical, wellbeing and mental health elements, and therefore the need to take account of the mental health issues in tackling risk factors for physical diseases.

To support the objective of improving the physical health of those with mental illness it is proposed that a logical set of actions are considered between national representatives, Keep Well Wave 1 & 2 areas and local Mental Health services. This consultative process would be facilitated via the Keep Well Delivery Infrastructure.

This process would not only inform health check plans for individuals with an enduring mental illness within the Keep Well target populations, but might also assist in establishing a way forward for this work for the population served by Community Mental Health Services as a whole.

It is important to ensure that referral pathways are clear, and that areas without "Keep well" are still inclusive of people with mental health problems.