Evaluation of an integrated approach to meet the physical health needs of mental health service users - The Knowsley Live Well project (evaluation)
As part of the CLAHRC NWC Partner Priority Programme, North West Boroughs NHS Foundation Trust has been evaluating The Knowsley Live Well Project (addressing health inequalities by offering physical health assessment to those attending mental health services). The aim of this project being the early identification of need or illness, the identification of previously unknown or unmet physical health need and referral to health promotion services. It is hoped that by taking this approach premature mortality, quality of life and health inequality can be improved.
Those with serious mental illness (SMI) are at greater risk of complex, physical co-morbidity and premature death compared to the general population, with life expectancy reduced by 15-20 years. Recent national reports have highlighted people with SMI die largely from treatable long term conditions associated with risk factors which are modifiable2. North West Boroughs Healthcare NHS Foundation has implemented a programme to offer mental health service users a proactive physical health assessment in conjunction with their mental health assessment, and provide advice; brief intervention and /or onward referral to health promotion or physical health services if a physical health need is identified with the aim of improving health and reducing health inequalities. This was offered in a locality ranked as being in the most deprived 10% nationally on the index of multiple deprivation at two points of service delivery. Within an assessment team facilitating initial contact with those referred to MH services and within a recovery team offering longer term intervention.
The purpose of the evaluation of the initiative was to determine the effectiveness of the physical health assessment and most effective point of delivery. Specific aims included investigating the experiences and views of service users who attended and of staff involved in the assessments to identify enablers and barriers to encourage attendance in the future. Data from the assessments provides a baseline for comparison within the organisation and to compare to national data.
The data - 185 women and 187 men attended for assessment within the two teams over a 12 month period
47% of these were smokers (42% females and 58% males) which is more than two and a half times the national average of 19%
54% of these had an abnormal BMI (47% females and 53% males) which is double the national average of 24.9%
28% of the males and 28% of females attending for assessment smoked tobacco and had an abnormal BMI.
Service users questionnaires
47 service users (28 women/19 men) returned questionnaires, 44 of these said they would recommend the PH assessment to family and friends. 18 assessments led to onward referral and 18 service users identified life style changes they made as a result of the assessment which could be seen as early evidence of intention to improve health.
Two service users were interviewed having attended for assessment and completed an questionnaire. This was from a cohort of 22 service users who were approached having expressed an interest in being interviewed via the questionnaire. This is a limitation of the evaluation.
Staff members questionnaire and interviews
22 questionnaires were returned and 12 members of staff interviewed
Staff valued the assessments and enablers identified were the availability of local services to refer to particularly NWBH services, the offer of early screening and having structures and processes within the team to support the work. Barriers identified included conflicting demands on capacity, difficulties trying to negotiate and manage priorities for those with multiple and complex health needs.
Next steps will be to:
- Interview more service users who accessed the physical health assessment and those who didn’t with the aim of identifying barriers and enablers to attendance and of making lifestyle change.
- To undertake further work to better understand the long term impact of attendance and of any onward referral with regard to any previously undiagnosed illness and/or of any resultant behaviour change.