Making a difference - physical healthcare for people with severe mental illness

 

UCLH BRC research identified that people with severe mental illness (SMI) are more likely to develop heart disease than those without SMI. To close this health gap the research team developed better risk prediction tools and management strategies.

These are now in use throughout the NHS and internationally to screen and monitor patients with SMI for heart (cardiovascular) disease (CVD).

People with SMIs such as schizophrenia and bipolar disorder disproportionately have additional physical health problems that affect their quality of life and life expectancy. UCL Psychiatry researchers, led by Dr Hayes and Professor Osborn and funded by the BRC, have shown that the risk of people under 50 with SMI dying from CVD is three times higher than people without SMI, and that the numbers continue to rise1. Their team identified the risk factors responsible for why people with SMI are more prone to CVD, including higher rates of smoking, high cholesterol and obesity.

Their work also showed that the CVD screening tools for the general population were not suitable for people with SMI2. The team went on to develop and test the world’s first CVD risk assessment tool that includes SMI diagnosis and prescriptions for antidepressants and antipsychotics.

By revealing the scale of preventable deaths from CVD in people with SMI, Dr Hayes and Professor Osborn’s research raised awareness in doctors and policy makers about these patients’ special needs. Public Health England’s 2018 briefing on Severe Mental Illness and Physical Health Inequalities cites the research and recommends NHS and care providers target services to reduce illness and early death among people with SMI.

To ensure these services choose the right tools to support physical health in people with SMI, Professor Osborn worked with NHS experts to produce the RightCare toolkit for NHS managers3. The team’s research has also informed national and international guidelines for doctors and pharmacists on how various medicines (statins, antipsychotics) affect physical health in people with SMI. As a result, annual cardiovascular screening has been introduced for all patients with SMI as a core element of the NHS Plan for the next decade, and more people with SMI are receiving statins to lower their cholesterol, leading to better physical and mental health outcomes.

1. Hayes, J. British Journal of Psychiatry, 2018; 2. Osborn DP, JAMA Psychiatry, 2015; 3. Osborn, D., The Lancet Psychiatry, 2018