Mental Health Strategy 2017-2027

The physical wellbeing of people with mental health problems

Ambitions:

• That premature mortality of people with severe and enduring mental illness is tackled.
• That the rate of smoking amongst people with a diagnosed mental health problem should decline at the same rate as the rate for the general population.
• That the uptake of screening for cancers, amongst people with a diagnosed severe and enduring mental illness, should be the same as the rate for the general population.
• That side effects of psychiatric medication are appropriately monitored and, where possible, reduced.

It is unacceptable that people with severe and enduring mental illness may have their lives shortened by 15 to 20 years because of physical ill-health. This is a significant health inequality. Tackling it will help support parity and accessibility to - and availability of - services, as well as supporting prevention and earlier interventions work. Tackling it will also help to ensure non-discrimination in a human rights-based approach.

There must be actions that improve the physical health of people with mental health problems and that improve the mental health of people with physical health problems. Actions need to happen at population community levels, in primary care services, in specialist mental health services and in specialist acute services. There should be holistic services around the individual. Addressing inequalities needs to be built in. People who have a mental health condition are considered as having a disability if it has a long-term effect on normal day-to-day activity, as defined under the Equality Act 2010, where 'long term' is if the condition lasts, or is likely to last, 12 months. Disabled people are therefore intrinsic to this Strategy. Adults with learning disabilities also have higher rates of mental ill-health than any other group in the population, so services for this population must be accessible.

Primary care

Integration Authorities will want to consider how they can maximise the role of clinical and non-clinical workers in primary care who provide problem-solving, listening and signposting for physical, mental and social problems, who work with people to optimise their own health and who monitor some chronic condition care plans. As part of its Workforce Planning, the Scottish Government will also consider this.

Liaison psychiatry

Liaison psychiatry is a type of multidisciplinary, mental health specialist service. Such a service can provide advice, assessment, treatment and training, which spans emergency departments, inpatients and some outpatient acute services. This is for people with physical health problems who also have a mental health issue, as well as treating people whose primary diagnosis is a mental health one.

Such services can help to ensure that people need only ask once to get help fast. Health and financial benefits come from reduced lengths of stay, reduced re-admissions and investigations and improved care of medically unexplained symptoms, dementia and long term conditions. ^[21]

These services should be funded and provided by acute services as part of the range of services needed in an acute setting. As part of its Workforce Planning, the Scottish Government will work with NHS Boards on their liaison psychiatry provision and specialist mental health provision for acute patients.

Alcohol and drug misuse

People who have problems with alcohol and/or drug misuse, and who also have a mental health problem, may sometimes fall through the gaps where services are not joined up. Substance misuse can also affect families and carers. Integration Authorities will therefore wish to ensure that alcohol, drugs, mental health services and social services work jointly and in a holistic way, so that people receive help with substance misuse and any underlying mental health issues.

Problem substance use and mental health issues are included in the Distress Brief Intervention design but work must be wider, addressing needs in primary care and in other parts of healthcare.

• Action 27 : Test and learn from better assessment and referral arrangements in a range of settings for dual diagnosis for people with problem substance use and mental health diagnosis.
• Action 28: Offer opportunities to pilot improved arrangements for dual diagnosis for people with problem substance use and mental health diagnosis.

Smoking

While the general smoking rate is declining, smoking rates among those with mental health problems have changed little during the past 20 years. One in three people with mental health problems in the UK smoke, as compared with one in five of the general population. ^[22]

Smoking can negatively affect the efficacy of medication taken for mental health problems, thereby increasing pharmaceutical costs. Stopping smoking can reduce depression, anxiety and stress and can reduce the long term risk of cancer - all of which can have a positive impact on the individual and a reduction in healthcare costs. Making a difference to smoking rates can help tackle premature mortality.

• Action 29: Work with partners who provide smoking cessation programmes to target those programmes towards people with mental health problems.

Physical health screening

As the Mental Welfare Commission for Scotland has highlighted, smoking is not the only factor contributing to early deaths of people with a mental illness. Other contributing factors may include: poorer access to physical healthcare and diagnostic overshadowing (where physical problems are under-treated or wrongly attributed to mental health issues), inadequate diet, lack of exercise, the effects of long-term use of psychiatric medication, higher rates of suicide (compared to the general population), and accidental and violent deaths. ^[23] Public health is failing this population.

To begin to address the often poorer physical health of people with more severe mental health problems, issues with medication and screening are areas to start.

• Action 30: Ensure equitable provision of screening programmes, so that the take up of physical health screening amongst people with a mental illness diagnosis is as good as the take up by people without a mental illness diagnosis.

The National Confidential Inquiry into Suicides and Homicides by people with Mental Illness has identified the organisational existence of a local comorbidity policy as a protective risk factor ^[24] . The Scottish Government has communicated this through Healthcare Improvement Scotland.

Physical activity

Medication can have side effects on weight. Keeping physically active can help with some of the impacts of weight gain as well as having an effect on mood. Our vision is of a Scotland where more people are more active, more often, in part because being active is good for mental wellbeing. With Active Scotland, the Scottish Government will support the development of a programme on physical activity by the Scottish Association for Mental Health ( SAMH). The programme will improve the physical and mental health of people experiencing physical and mental health challenges, enabling them to live longer and healthier lives through increased levels of physical activity. Initiatives such as Our Natural Health Service are welcome for the differences they may make to people's mental wellbeing. ^[25]

• Action 31: Support the physical activity programme developed by SAMH.

Dying well

The Scottish Government has published a Strategic Framework for Action on Palliative and End of Life Care, 2016-21. ^[26] We expect the vision, aims and outcomes of the Strategic framework to apply to those who are dying and who also have severe and enduring mental illness, as well as those who are dying and who need mental health support to enable them to die well.