This page provides recommended actions for improving physical health screening and uptake of related interventions for people with serious mental illness (SMI).
Commissioners and providers need to look to more evidence-based interventions, increasing coverage and uptake of tailored services across a number settings, including substance misuse interventions and associated physical health pathways.
Where evidence based guidance does exist on the importance of screening, brief intervention, referral and investigation of associated physical health risks, there are significant gaps in adherence to this guidance
There is suspected ‘learned helplessness’ amongst some providers regarding the ability to successfully change substance use patterns, possibly contributing to under recording and treatment gaps.
There is significant variation in approach and provision regarding:
- The degree to which routine screening for physical health risks or conditions are available to those living with serious mental illness (SMI) in substance misuse services.
- The availability of mental health and substance misuse support (through use of liaison workers) to those presenting in the acute sector with physical health co-morbidity.
- The availability of in-house medical care in substance misuse services. This ranges from no additional specialised support, to in-house sessional primary care clinicians or outreach from secondary care providers.
- Levels of reasonable adjustments, access or enhanced offers of general medical services within primary care.
- Arrangements between mental health care coordinators or substance misuse key workers to support access; standardised agreements on roles and responsibilities to support access are often inconsistent.
Actions to take
- Embed proactive physical health screening and access to interventions across substance misuse services, mental health services, primary care and acute and community trusts.
- In accordance with National Institute of Health and Care Excellence (NICE) guidance, a comprehensive physical health assessment should be delivered at minimum annually. It should more frequent if the person has a significant physical illness or there is a risk of physical illness because of substance misuse.
- Annual health checks should include additional clinical focus on areas of increased risk in those using substances. This includes, for example, nutritional status, cardiovascular disease, respiratory disease, liver disease (including transient elastography testing for excess alcohol use), blood borne viruses, neurological complications (e.g. peripheral neuropathy, cognitive impairment) and very poor oral health.
- Monitor the physical health of adults and young people with psychosis and coexisting substance misuse, as described in the guideline on schizophrenia (Psychosis and schizophrenia in adults: prevention and management: NICE clinical guideline 178). Pay attention to the impact of alcohol and drugs (prescribed and non-prescribed) on physical health. Monitoring should be conducted at least once a year or more frequently if the person has a significant physical illness or there is a risk of physical illness because of substance misuse.
Tools to help you
Psychosis and schizophrenia in adults: prevention and management (Clinical guideline 178). This NICE guideline promotes early intervention and long-term recovery, and recommends checking for coexisting health conditions. Monitoring should be conducted at least once a year or more frequently if the person has a significant physical illness or there is a risk of physical illness because of substance misuse.