Quality statement 6: Physical health checks for people with serious mental illness

Quality statement

People from black, Asian and other minority ethnic groups with a serious mental illness have a physical health assessment at least annually.

Rationale

Life expectancy for adults with a serious mental illness is significantly lower than for people in the general population. People from some black, Asian and other minority ethnic groups are at an increased risk of cardiovascular disease and type 2 diabetes and these conditions can be exacerbated by the use of antipsychotics. An annual health check helps to pick up on early signs of physical health conditions and enables action to be taken to prevent worsening health.

Quality measures

Structure

a) Evidence of local arrangements to ensure that people from black, Asian and other minority ethnic groups with a serious mental illness have a physical health assessment at least annually.

Data source: Local data collection, for example, using NHS England's practical toolkit for mental health trusts and commissioners.

b) Evidence of local primary and secondary care services working together to monitor and address the physical health needs of people affected by serious mental illness as part of the Rethink Mental Health Integrated Physical Health Pathway.

Data source: Local data collection, for example, using NHS England's practical toolkit for mental health trusts and commissioners.

Process

Proportion of people from black, Asian and other minority ethnic groups with a serious mental illness who have had a physical health assessment within the past 12 months.

Numerator – the number in the denominator who have had a physical health assessment within the past 12 months.

Denominator – the number of people from black, Asian and other minority ethnic groups with a serious mental illness.

Data source: Local data collection, for example, from practice risk registers.

Outcome

a) Premature mortality rates among people from black, Asian and other minority ethnic groups with a serious mental illness.

Data source: Local data collection, for example, from practice risk registers.

b) Prevalence of type 2 diabetes among people from black, Asian and other minority ethnic groups with a serious mental illness.

Data source: Local data collection, for example, GP patient records or data providers such as Commissioning Support Units (CSUs).

What the quality statement means for different audiences

Service providers (such as GPs or mental health services) have systems in place to ensure that physical health assessments are carried out at least annually for people from black, Asian and other minority ethnic groups with a serious mental illness. The results are shared (under shared care arrangements) when the service user is in the care of both primary and secondary services. Service providers may involve people in peer and lay roles to support raising awareness of the increased risks and importance of physical health checks among people from black, Asian and other ethnic minority groups with a serious mental illness.

Healthcare professionals (such as GPs or nurses) carry out physical health assessments at least annually for people from black, Asian and other minority ethnic groups with a serious mental illness. They share the results (under shared care arrangements) when the service user is in the care of both primary and secondary services. They also highlight the increased risks and importance of physical health checks to people from black, Asian and other ethnic minority groups with a serious mental illness.

Commissioners (such as NHS England local area teams) ensure that they commission services that can demonstrate they are carrying out physical health assessments at least annually in people from black, Asian and other minority ethnic groups with a serious mental illness, and include this requirement in continuous training programmes. They also ensure that shared care arrangements are in place when the service user is in the care of both primary and secondary services, to ensure that the results of assessments are shared.

People from black, Asian and other minority ethnic groups with serious mental health problems have regular health checks (at least once a year). This is to check for problems that are common in people being treated for a serious mental illness, such as weight gain, diabetes, and heart, lung and breathing problems. The results are shared between their GP surgery and mental health team.

Source guidance

Definitions of terms used in this quality statement

Serious mental illness

Schizophrenia, bipolar affective disorder and other psychoses.

[NICE single menu of indicators, 2018]

Physical health assessment

A comprehensive health check focused on physical health problems such as cardiovascular disease, diabetes, obesity and respiratory disease. The annual check should include:

  • weight or BMI, diet, nutritional status and level of physical activity

  • cardiovascular status, including pulse and blood pressure

  • metabolic status, including fasting blood glucose, glycosylated haemoglobin (HbA1c) and blood lipid profile

  • liver function

  • renal and thyroid function, and calcium levels, for people taking long-term lithium.

[Adapted from NICE's guideline on bipolar disorder, recommendations 1.2.11 and 1.2.12]