Improving physical healthcare for people with serious mental illness (SHINE Project)
People with serious mental illness, such as schizophrenia and bipolar disorder, have a significantly reduced life expectancy and a higher prevalence of physical health disorders than the general population.
Assessing the physical health of patients when they are in hospital offers an opportunity to identify risk factors for developing conditions such as cardiovascular disease or diabetes and provide advice and support on services that can be accessed on discharge. Unfortunately this is rarely done for patients with serious mental illness when they are in hospital, despite numerous national guidelines recommending such an approach.
Central North West London NHS Foundation Trust (CNWL), one of the largest providers of acute and community mental and physical healthcare has been working with NIHR CLAHRC Northwest London on a Health Foundation funded project to use quality improvement methods to develop and implement a tool to ensure all patients admitted to hospital have their physical healthcare needs met based on the use of the JBS3 Score as a calculator, which estimates an individual’s lifetime risk of a developing cardio-vascular disease and provide a basis for discussing with patients how their risk can be reduced. The systematic approach to quality improvement developed by CLAHRC Northwest London has been used by healthcare professionals, managers and patients to better understand care processes, develop and test interventions and engage with stakeholders.
Process Mapping the care pathways associated with admission were developed to analyse current practice and identify where improvements could be made and interventions introduced. An initial audit of recording of physical healthcare parameters identified the need for a more robust and streamlined assessment and recording system.
Ensuring people with a lived experience of serious mental illness are involved as full members of the Project Team and the Advisory Board to ensure all perspectives are considered and has led to the co-production of a patient held physical health booklet as a tool for shared decision-making around physical health. The booklet uses a traffic light system to explain risks and enable patients to take some responsibility for improving their physical wellbeing. Finally the project team have been provided with the ‘Long Term Success’ tool, designed by CLAHRC Northwest London to support the team to reflect on progress and identify challenges to sustaining improvements in the clinical setting.