Supporting the physical health of people with severe mental illness
They are also more likely to have multiple physical health conditions alongside their mental illness, and this increases the complexity of their care.
But poor outcomes are not inevitable. Physical health can be improved, and many early deaths avoided, if people receive the support they need, when they need it.
This Collection brings together recent examples of published and ongoing research, funded or supported by the NIHR. It provides evidence to support the physical health of people with severe mental illness. Much of the research has been highlighted in accessible summaries – NIHR Alerts – over the last 3 years.
The information included is intended for healthcare professionals involved in the physical and mental healthcare of people with severe mental illness, as well as for those managing and commissioning services.
Key messages
Personalised support – Coping with severe mental illness and multiple physical health conditions can be overwhelming. People prioritise dealing with their mental illness. They need support to self-manage their physical health in a way that is personalised and recognises and addresses the challenges they face.
Improved physical healthcare – Suggestions include care that combines the management of both physical and mental health conditions, good social support, sharing of patient records across different services, and longer consultations to discuss physical and mental health needs.
Annual Physical Health Checks – People with severe mental illness who have their annual physical health check have fewer A&E attendances and unplanned hospital admissions. Only about half of those eligible have them.
Increased uptake of health checks – Telephone invitations, text message reminders and opportunistic invitations improve uptake in the general population and may help this vulnerable group.
A healthy lifestyle – A healthy lifestyle is associated with a longer life in people with multiple mental and physical health conditions, as much as for people without.
Targeting single versus multiple health behaviours – Smoking may be better targeted alone rather than with other behaviours for people with severe mental illness. By contrast, interventions targeting diet alone, physical activity alone or both together can all promote weight loss.
Addressing clusters of multiple health conditions – People with severe mental illness are more likely to have multiple physical health conditions than their peers, and at a younger age. It is now known that these conditions tend to group together in similar clusters, whether or not people have severe mental illness. Services could focus on these disease clusters for both groups, but with intervention starting earlier for people with mental illness.
Extra support after an inpatient stay – People with severe mental illness who have been recently discharged from inpatient mental healthcare need extra support for their physical and mental health. They are more likely to die of natural causes and by suicide than those who have not recently been in hospital. More deaths from natural causes occur in the first year after discharge, especially in the first 3 months.
End of life care – Barriers exist to good end of life care for people with severe mental illness. The relevant services – and the practice of professionals within them – are different. Collaborative working across mental health and end of life care systems, training, and proactive physical health care could improve care.
"Poor physical health for people with severe mental illness is not inevitable, but a coordinated approach between primary care and secondary mental health care providers is required to make improvements. The introduction of Integrated Care systems in England in 2022, should be a catalyst, but barriers still exist.
Over the last few years, the NIHR has published a considerable amount of research on how this inequality could be addressed.
Support for patients must be personalised, the reasons for non-attendance at annual health checks must be discussed with individual patients, and ways found to provide support to enable them to attend appointments. Separate appointments for separate conditions should cease. These appointments should also focus on providing healthy lifestyle advice.
Aftercare for people discharged from in-patient mental health care should be intensive for the first three months, and tail off over the first year. This should help reduce the number of deaths through natural causes and suicides."
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