Monitoring the Physical Health of Patients with Severe Mental Illness in Prison
Introduction
People experiencing Severe Mental Illness (SMI) patients die on average 15-20 years earlier than the general population due to preventable physical health problems - Coronary Heart Disease, Type II Diabetes, Chronic Kidney Disease and Stroke - and it is important to ensure that patients with SMI receive high quality health promotion and physical health care. Tackling the health inequality gap in patients with SMI is one of the 5 priority areas identified in Core20Plus5, the NHSE Health Inequalities strategy.
In order to reduce modifiable risk factors and detect physical health problems early, all patients with SMI should receive annual physical health monitoring. This is Health monitoring should include:
A Core Physical Health Check (including 6 elements) - NB Lester tool 2023 can assist person-centred tailored discussion to enable shared decision making.
Relevant national screening and immunisations
Medicines reconciliation
General physical health enquiry into sexual health, oral health and substance misuse
Identifying patients with SMI (Case Finding)
At first night or secondary screening a pre-existing diagnosis of SMI (referred to mental health team)
NHS health checks, offered to eligible patients over 35 years
Medicines reconciliation (identified by pharmacy)
Medication review clinics
Engaging patients with Care Programme Approach annual review (high rate of DNA)
Send written invitation letter – explain the purpose of the review to minimise confusion or feeling threatened
Ask key worker to bring patient to healthcare appointment
May be easier to achieve in prison than outside
Annual Review
CARE PROGRAMME APPROACH ANNUAL ASSESSMENT
References
NICE: Physical health of people in prison (2016) https://www.nice.org.uk/guidance/ng57
NICE: Mental health of adults in contact with the criminal justice system (2017) https://www.nice.org.uk/guidance/ng66
NICE: Improving physical health for people with Serious Mental Illness (SMI) (2018)
QRisk3 Calculator - https://qrisk.org/
Lester Tool UK Adaptation 2023:
https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/ncap-library/lester-tool-june-2023.pdf?sfvrsn=c08e2847_4
MHRA Guidance (2022): Valproate: reminder of current Pregnancy Prevention Programme requirements; information on new safety measures to be introduced
https://www.gov.uk/drug-safety-update/valproate-reminder-of-current-pregnancy-prevention-programme-requirements-information-on-new-safety-measures-to-be-introduced-in-the-coming-months
NICE: Co-existing severe mental illness and substance misuse QS188 (2019) https://www.nice.org.uk/guidance/qs188/chapter/Quality-statements
NICE: Psychosis and schizophrenia in adults: prevention and management CG178 (2014) https://www.nice.org.uk/guidance/CG178
NICE: Bipolar disorder: assessment and management CG185 (2014, updated 2020) https://www.nice.org.uk/guidance/cg185
NHSE Improving physical healthcare for people living with severe mental illness (SMI) in primary care
Guidance for CCGs
NICE: Technical guidance: Physical health check and follow-up interventions for people with severe mental illness
Core20PLUS5 (adults) – an approach to reducing healthcare inequalities
https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/
BMJ 2014;348:g3207 Levy, A. Interpreting raised serum prolactin results
https://doi.org/10.1136/bmj.g3207
RCPsych Standards for Prison Mental Health Services – Fifth Edition
https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/quality-networks/prison-quality-network-prison/prison-qn-standards/qnpmhs-standards-for-prison-mental-health-services-publication-5th-edition.pdf?sfvrsn=c18ba674_2
Written by Jan Rix
Edited by Marcus Bicknell and Caroline Watson for the RCGP Secure Environments online resources
Updated 2023 Caroline Watson
