Health providers should use the available system levers to reduce obesity and increase physical activity levels. Health promotion programmes that support people to manage their weight and increase activity levels are now well established and highly effective. However, the system needs to increase awareness of this higher risk for people living with serious mental illness (SMI), particularly those starting anti-psychotic medication, and be prepared to react faster to intervene and reduce these side effects.
Recommended actions to take
1. Increase access, uptake and benefit from health promotion programmes Evidence based successful approaches include:
- Strategies directed at both fitness and weight parameters.
- Ensuring the availability of a full range of community-based resources that support improved wellbeing, social contact, and meaningful day to day activity including vocational activities, and respond to individual needs and preferences
- Using a combination of education and activity based interventions.
- Providing more structured, tailored health promotion programmes delivering a full suite of components (diet, exercise, education on weight and healthy living, motivational counselling). Use face-to-face contact and adequately trained treatment providers
- Consideration of reasons for unhealthy lifestyles in the context of the wider determinants that drive them, and the barriers (e.g. money, access to green or ‘safe’ space to try out exercise, sedation from medication, loss of confidence) that can hinder behaviour change.
2. Assist people with SMI to reduce weight gain associated with anti-psychotic medication:
- Ensure broader health and wellbeing resources are accessible to all individuals, including information regarding side effects of medication and how to maintain a healthy weight, incorporating physical health interventions
- Work with diabetes prevention programmes to apply reasonable adjustments in line with the evidence base to improve uptake by those living with SMI
3. Increase the quality and availability of health promotion, prevention, screening and National Institute for Health and Care Excellence (NICE) guideline treatment/medication monitoring, for overweight, obesity and sedentary behaviour:
- In mental health Trusts, use the physical health SMI Commissioning for Quality and Innovation (CQUIN) and body mass index (BMI) outcome indicator alongside safe prescribing and health promotion initiatives.
- To improve NICE guideline medication monitoring, prevention, screening and NICE guideline treatment for overweight and obesity.
- In primary care use the Quality and Outcomes Framework (QOF), NHS England Clinical Commissioning Group (CCG) guidance on annual health checks and development of enhanced models of primary care to improve screening and delivery of NICE guideline treatment for overweight, obesity and sedentary behaviour.
- Use the NHS health checks to improve identification, engagement and the range of entry points to interventions for individuals over 40 living with SMI.
- In secondary care bariatric services, ensure access to mental health liaison expertise and reasonable adjustments to service delivery.
Tools to help you
- Positive Cardiometabolic Health Resource. National Audit of Schizophrenia: a clinical resource aiming to support the implementation of the physical health CQUIN to improve the physical health monitoring of people living with SMI.
- Improving Physical Health for people experiencing Serious Mental Illness (SMI). Bradford Case Study.
- Rethink Mental Health – Physical health resources for health professionals. This website provides resources for primary and secondary care professionals such as resources such as CQUIN toolkit, information leaflets and good health guides, and a physical health check flyer and e-learning package.
- Public Health England Data and Analysis tools. “A single point of access to data and analysis tools from across Public Health England (previously known as the ‘Data and knowledge gateway’)”.