Improving the physical health of people with mental health ...

1 Improving the physical health of people with mental health problems:Actions for mental health nursesEnglandYou may re-use the text of this document (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit Crown copyright Published to , in PDF format only. : Improving the physical health of people with mental health problems: Actions for mental health nursesAuthor: Nursing, Midwifery and Allied health Professions Policy Unit, Quality Division, Strategy and External Relations Directorate 32400 Document purpose: PolicyPublication date: May 2016 Target audience: Registered mental health nurses; Directors of mental health nursing; Staff working in mental health and social care services; Lecturers and those who deliver professional training. Contact details: Dr Ben Thomas mental health , Learning Disability and Dementia Care Professional Officer Nursing, Midwifery and Allied health Professions Policy Unit Strategy and External Relations Directorate Department of health 79 Whitehall, London, SW1A 2NS Email: NHS England Publications Gateway Reference 046033 Improving the physical health of people with mental health problems: Actions for mental health nursesContentsForeword 5 Improving physical health and wellbeing.

2 A new resource 6A holistic approach to physical and mental healthA commitment to actionImproving outcomes for people living with mental health problems 10 Metabolic syndrome and people with mental health problems 12 Cardiovascular diseaseDiabetesRegular physical health checksHealth screeningTaking action: the role of mental health nurses 14 Working in partnershipKnowledge and skillsRightCare progammeCare planning1. Action on .. support to quit smoking 182. Action on .. Tackling obesity 223. Action on .. Improving physical activity levels 264. Action on .. Reducing alcohol and substance use 305. Action on .. Sexual and reproductive health 346. Action on .. Medicine optimisation 387. Action on .. Dental and oral health 428. Action on .. Reducing falls 46 Appendix 1 Assessment tools 501. The Lester tool2. Integrated physical health Pathway3. NHS Screening4. physical Activity Benefits for Adults and Older AdultsAppendix 2 References 564 Improving the physical health of people with mental health problems: Actions for mental health nursesAcknowledgements The Department of health would like to thank the many stakeholders who contributed their expertise and time to this particular thanks go to colleagues at:Central and North West London NHS Foundation TrustCity University LondonHealth Education EnglandLondon South Bank University South London and Maudsley NHS Foundation TrustEndorsements This resource is supported by the following organisations:British Heart FoundationQueen s Nursing InstituteRoyal College of NursingRoyal Pharmaceutical SocietyUNITE - mental health Nurses Association5 Improving the physical health of people with mental health problems.

3 Actions for mental health nursesForewordThe Five Year Forward View for mental health (2016) has once again highlighted that people with mental health problems have poorer physical health than the general population, often they are unable to access the physical healthcare they need and experience unnecessary health with severe mental illness are particularly at risk and die on average 15-20 years earlier than the general population. Being in contact with mental health services does not necessarily mean that people will have a physical health assessment, have their physical health monitored, or receive the information and support they need to adopt a healthier health nurses have unparalleled opportunities to help people improve their physical health alongside their mental health , both in inpatient settings and in the community. Building on their skills and knowledge this resource will assist mental health nurses to identify the key risk factors that are known to adversely affect the physical health of people with mental health problems.

4 By following the activities to achieve change, and learning from the good practice examples in this resource, they can build up their confidence and expertise and make improvements to people s health Government is committed to putting healthcare for people with mental health problems, including people with co-existing learning disabilities, on an equal footing with people with physical problems. This means reducing unwarranted variation, so that individuals are supported to live healthy lives, and are empowered to make real progress towards bringing their life expectancy in line with the rest of the England has agreed that by 2020/21 at least 280,000 more people living with severe mental health problems should have their physical health needs met. mental health nurses are crucial to making these improvements, and to the Government s goal of parity of esteem. Nurses must capitalise on the opportunities they have and make sure that people with whom they have the most contact have their physical health needs met by early detection and access to evidence based care and resource is a significant step forward encouraging mental health nurses to take an active role to ensure people s physical health needs are assessed and responded to.

5 Drawing on the available evidence it will improve the monitoring of and reduction of the risk factors that have a detrimental effect on people s physical health and ultimately reduce health BurtMinister of State for Community and Social CareDepartment of Health6 Improving the physical health of people with mental health problems: Actions for mental health nursesImproving physical health and wellbeing .. a new resourceThis resource is for mental health nurses, wherever they work, to take positive action to improve the physical health of people living with mental health problems. It builds on work to ensure parity of esteem between mental and physical health by giving equal attention to the physical health of people with mental health problems as is given to the general population. people with mental health problems should be supported to live healthy lives, and should be empowered to make real progress towards bringing their life expectancy in line with the rest of the resource supports the Government s commitment to ensure that people living with mental health problems have the same access to health checks and healthcare as the general population.

6 It provides evidence based information about ways in which mental health nurses can improve the physical health and wellbeing of people living with mental health problems by tackling some of the key risk factors for physical health problems. It complements other programmes of work underway to address the physical health needs of people with mental health problems within health Education England (HEE), NHS England, Public health England (PHE), Royal Colleges of Nursing, Midwifery, Physicians, Psychiatrists and Pharmacology and within national this resource focuses primarily on adults with mental health problems including common mental illnesses, severe mental illness (SMI) and personality disorder, it is important to recognise that over half of all mental ill health starts before the age of 14 and 75% (excluding dementia) develops by the age of 181. Children with mental health problems are at greater risk of physical health problems, just like adults they are more likely to smoke, drink alcohol and take drugs, undertake little physical activity and have poor diets, which contributes to poor physical health .

7 The life chances of these individuals are significantly reduced in terms of their physical health , educational and work prospects and life expectancy. A holistic approach to physical and mental healthA holistic approach to managing mental and physical health is needed. physical and mental health are inextricably linked and it is detrimental to a person s overall wellbeing to regard these as two separate entities. There is strong evidence that having a long term mental health condition can be a significant risk factor for the development of physical ill health2. Conversely long term physical health conditions can lead to people suffering poor mental health . people with SMI die on average 15 to 20 years earlier than other people3. This is mostly due to physical health problems which are often not diagnosed or managed efficiently and lifestyle factors which negatively affect physical the physical health of people with mental health problems: Actions for mental health nursesChallenges across the system have contributed to the unacceptably large premature mortality gap 7,8.

8 It is therefore imperative that people with mental health problems receive the physical healthcare that they require and have help in accessing support to have more healthy Government has identified a national priority to join up services across primary, secondary and crisis care in order to promote equal access, early intervention, choice, and recovery based on NICE quality standards of access for people with mental health partnership between primary and secondary care can help share expertise, instil confidence and also help overcome barriers to high quality care. Good communication between all healthcare professionals involved in the care of those with mental health problems helps to avoid duplication or fragmentation of care. While many NHS mental health and independent providers have already begun to implement programmes to improve the physical health of people living with mental health problems, there is still unwarranted variation across the facts Mortality among mental health service users aged 19 and over in England was times the rate of the general population in 2010/11.

9 people in contact with specialist mental health services per 100,000 service users, compared with 100,000 in the general population, had a higher death rate for most causes of death, in particular: nearly four times the rate of deaths from diseases of the respiratory system at , compared with the general population at just over four times the rate of deaths from diseases of the digestive system at , compared with the general population at nearly three times the rate of deaths from diseases of the circulatory system at 254, compared with the general population at Within these disease areas specific conditions that accounted for a high proportion of deaths among service users (under the age of 75) were: diseases of the liver at of deaths (1,430 in total) ischaemic heart diseases at of all deaths (1,880 in total)4. The relative difference in mortality rates was largest among people aged 30 to 39: almost five times that of the general population5.

10 people with severe and enduring mental health problems have the lowest employment rate of all groups of people with a disability at just 7%. There were 198 deaths of people detained under the mental health Act in 2013/14, the majority of which were due to natural causes, including preventable physical ill the physical health of people with mental health problems: Actions for mental health nursesA commitment to actionThis resource is part of the Government s commitment to a wider programme of work to improve the physical health of people living with mental health problems. The NHS Five Year Forward View5 commits the NHS to take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health , between health and social care. It recognises that: over the next five years the NHS must drive towards an equal response to mental and physical health , and towards the two being treated together.