The featured paper is a Department of Health document on the health needs of people with severe mental illness entitled ‘Supporting the Physical Health Needs of People with Severe Mental Illness’ and freely available here. In the Executive Summary, the White Paper, Choosing Health: Making Healthy Choices Easier is referred to when it was announced that a pilot in 8 centres in England would examine models of healthcare for people with ‘mental health problems’. Indeed later in the document the Choosing Health White Paper is described as the key document relating to treating physical illness in people with severe mental illness.
The document is divided into four sections together with an appendix outlining job plans and details of pilot projects as well as other models of practice. The four sections are the introduction, background, establishing physical health programmes and managerial considerations. The document is further divided into numbered paragraphs some of which focus on relevant points from other DOH documents.
In the introduction the article emphasises the founding principles of the NHS in particular the prevention as well as treatment of disease. The article goes on to say that there are moves to
‘transform the NHS into a health, rather than a sickness service’
‘There is now a focus on bringing mental health and physical health, rather than a sickness service’.
The White Paper identified those with ‘mental health problems’ as having worse physical health than the general population and that from 2006 NHS health trainers would support those with the highest need. There are then references to the National Service Framework for Mental Health and the National Service Framework for Mental Health: Five Years On with mention of ‘integration, recovery and social inclusion’. The document also mentions the Chief Nursing Officer’s review of mental health nursing ‘From Values to Action’ which also makes recommendations which should contribute towards improving physical health in people with severe mental illness.
In the Background, there are some disturbing statistics about physical illness in people with mental illness. Thus
‘New analysis of records of 1.7 million primary care patients found that people with a diagnosis of schizophrenia or bipolar disorder are more than twice as likely to have diabetes than other patients and also more likely to experience ischaemic heart disease, stroke, hypertension and epilepsy’
In this section a number of other factors which may influence management of physical illnesses are discussed including diagnostic overshadowing, discrepancies between service user and carers views of interest in physical health as well as a summary of the results of a 2005 Disability Rights Commission consultation questionnaire. A number of other documents including the General Medical Services Contract for GP’s, the Quality and Outcomes Framework, NICE guidelines and the Public Service Agreement are discussed later in the section.
The third section is on establishing physical health programmes. In the initial part of this section there is a discussion of research which shows the benefits of integrative health programmes for people with severe mental illness although citations aren’t given. There is also a discussion of various initiatives to improve lifestyle although the report comments on the relative lack of research data in this area.
The third section of the document focuses on the establishment of a health programme moving through the steps from the aims of the programme through to the establishment of the programme, consultation with relevant groups, communication, setting up registers as well as the consultations themselves. The fourth and final section looks at managerial issues. Here the discussion focuses in particular on the nurse practitioner with the roles and responsibilites of the practitioner as well as training and supervision and the need for measuring outcome.
While this document is specifically useful for the purposes of commissioning, in the process it gives a useful outline of DOH strategic objectives in the area of improving physical health in people with severe mental illness and should therefore be of interest to professionals working in this area as well. The document is clearly structured and information dense with abundant references and additional resources for further reading.
Steps To Treatment 2 (This is a DOH Commissioning Framework and therefore informs commissioning of services).
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