‘Promoting the physical

health of people with mental

health problems’ Gregor Henderson, Public Health England

@Gregorwell

Public Mental Health Methodology

Everyone, irrespective of where they live, has the opportunity to achieve good mental health and

wellbeing…especially communities facing the greatest barriers and those people who have to

overcome the most disadvantages. This includes those living with and recovering from mental

illness.

Mental health Promotion

Improving lives,

supporting recovery and

inclusion

Mental illness

prevention and suicide prevention

Informed by the WHO approach

Key themes:

• Reducing health inequalities

• Community centred approaches

• Embedding and integrating mental health

• Improving workforce capacity and competency

2

Context

Physical

• people with severe mental illness die 15 - 20 yrs earlier

• same health and life expectancy as the general population in the

1950s

• die from the 5 big killers

• have up to 3 times more modifiable risks

• have less access to population healthcare

Social

• higher levels of unemployment

• higher levels of poor housing and homelessness

• experience stigma and discrimination

3 Prevention Concordat for Better Mental Health Programme

Five Year Forward View for Mental Health

Premature Mortality

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Rec 43: Clear plan to develop and support the Mental Health

Intelligence Network over 5yrs, so that it supports data linkage across

public agencies, effective commissioning & implementation of new clinical pathways and standards

as they come online.

Lead NHSE

Lead PHE

Lead PHE

NHSESupport

Align NHSE –led Recommendation 22 improve physical health for people with SMI

280,000 more people with SMI will have access to evidence based physical health checks and interventions

)

Rec 20: Ensure that people with mental health problems at greater risk of poor physical health get access to prevention

and screening programmes. All mh inpatient units and facilities to be

smoke-free by 2018.

Improving lives – PHE activity

• promoting equal access to cancer, non cancer screening

and health check programmes

• promoting physical health care (CQuINs and QoFs)

• smoking cessation (access to smoking cessation services,

smoke free mental health units)

• addressing wider determinants (employment and housing)

• providing system support

5 PHE’s approach to improving the public’s mental health and wellbeing

NHS Health Check• NHS Health Check is a whole population prevention programme that is

universally targeted at people aged 40 - 74 years. The focus is reducing risk

of heart disease, diabetes, kidney disease and stroke.

• Establishing and understanding the level of offer and take up by people with

a mental health problem is complex as mental health status is not routinely

recorded at offer or take up. unprecedented. Plans have four strands:

1. Systematic comparison of access to universal NHS Health Check vs

other population groups

2. Systematic review of primary care access to the seven defined health

measurements within the NHS Health Check

3. Identifying opportunities to streamline and consolidate delivery for the

NHS Health Check and the Annual Physical Health Check for people with

SMI

4. Identifying opportunities to capitalise on other NHS Health Check and CVD

initiatives

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7

Primary care commissioning guidance

Improving physical healthcare for people living with SMI

(New resource expected Autumn 2017)

• Introduction

• Purpose (context, case for change, definition, development of guidance)

• CCG roles and responsibilities (Monitoring progress)

• Evidence based PH checks/follow up looks like

• Primary/secondary care interoperability and communication

• Primary care workforce

• Supporting implementation

• Annex (case studies, checklist, trajectories)

• Appendix (definitions, tools/resources, templates)

Stakeholder engagement:

CCGs, NHSE colleagues (primary care), NICE, PHE, NIHR, CQC, Rethink, Mind,

service users, clinical ERG, providers, RCGPs, NHS Clinical Commissioners network

Main audience:

Commissioners, CCGs, GPs (as well as providers)

Alcohol and Drugs

Work to prevent the health harms caused by alcohol and substance misuse has increasing focussed on comorbidities.

Success requires action across the health system so delivery support has included:

New coexisting conditions guidance

Target workforce commissioners and providers. High attention to mental health, alcohol and substance misuse.

CQUIN Preventing ill health by risky behaviours (alcohol and tobacco)

For all inpatients incl MH Trusts. Focused on screening, VBA/IBA and evidence based interventions. (2017/18 - 2018/19).

New tool for non-clinicians working with vulnerable and complex clients

Target workforce includes services, housing/homelessness, probation, social care, substance misuse. Provides practical guidance on the problems caused by very heavy drinking and how to help this population to receive earlier medical advice and treatment. (due Sept 2017).

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TobaccoPeople with a mental health problem die on average 10 to 20 years earlier than the general population. Smoking is the largest cause of this inequality.

Prevalence of smoking in the general population in England is 15.5% but among people with a SMI is 40% (up to 60% for those with probable psychosis and up to 70% among people in psychiatric units).

Action to reduce smoking levels is recognised as a key way to reduce premature mortality and health inequalities.

Work has focussed on supporting delivery the FYFVMH ambition for all MH Trusts to be smoke free by 2018. This has been through: improving the intelligence on ‘what works’; disseminating effective practice; and developing an approach to audit. Examples

• Publishing a series of tailored guidance relevant to both adults and young people. Particular

emphasis on supporting implementation of NICE PH48 and PH45 by MH settings and

others responding to unmet needs of underserved groups. This complements PHE and

NHSE support to the system through the Leading Change Adding Value programme.

• With support of NICE, CQC RCP, RCN, RCPsych and NHSE, dissemination of practice

examples to share the lessons of what has works from Trusts who are already smoke free.

• Next steps include: measuring implementation of smoke free NICE guidance in MH Trusts

and improving the how the prevalence of smoking of people with a mental health problem is

measured in secondary care settings

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Leading Change Adding Value:

Smoking and Mental Health Programme

Action focussed on reducing unwarranted variation so that all Trusts

improve their consistency in complying with NICE guidance

1. Comprehensive policies in place and ratified

2. Referral and arrangements with community providers

3. Use of IT systems to record smoking cessation interventions and smoking

related incidents

4. Staff and service user engagement processes

5. Smoking shelters

6. Provision of stop smoking aids for staff who want to quit or temporarily

abstain while working

7. Sharing of communications strategies

8. Sharing of literature including leaflets, banners, poster, letter footers

9. Directing to most up to date smoking cessation and prescribing guidelines

Opportunities

Learning from other places – ‘Equally Well’ New Zealand

Collaborative Programme. Centre for Mental Health,

Rethink and others (underway). Shared consensus and

agreed actions.

Improving Data and its Use – PHE and NHSE

National Audits:

• Transparency on smoking cessation – Atlas of Variation,

• Physical Health Cquins (reduce variation – Right Care

focus),

• Primary Care Physical Health Check QUOF.

12 Prevention Concordat for Better Mental Health Programme