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Nurses tackle physical health to reduce mortality gap

Claire Johnston
8 February 2017
Mental health nurses at Camden and Islington NHS Foundation Trust (C&I) are at the forefront of a pioneering five-year programme* to save the equivalent of more than 10,000 years* lost to premature death, through tackling the poor physical health of people with severe mental health conditions.
They are undergoing targeted training to enhance their knowledge of physical health issues to help narrow the, on average, 20 year mortality gap between people with serious mental illness (SMI) and the rest of the population. 
Innovative “Physical Health Skills Passports” document the specific training the Trust’s nurses now undergo in assessing and treating physical health conditions such as diabetes and lung disease, which are significantly more prevalent in serious mental health conditions. 
Claire Johnston, Director of Nursing, said: “By monitoring and assessing the physical health needs of our service users, at the same time as treating their mental health condition, our nursing staff are pivotal in enabling them to live, longer, healthier and happier lives.”
The move is a key element of an innovative approach by C&I to tackle together the physical and mental health needs of people with SMI in order to reduce premature death.
C&I acknowledges that there are likely to be different levels of experience and confidence in carrying out physical health screening and assessments among its nursing staff. The aim of the “passport” is to assess and then build on nurses’ existing skills, as well as to support them with professional revalidation, appraisal and supervision.
The skills will enable staff at community-based anti-psychotic drugs depots and wellbeing clinics* to undertake physical health screening and assessments alongside their other duties in relation to mental health care. 
The skills and training outcomes in the passport are matched against the outcomes of the Trust’s five-year programme* and physical health CQUIN framework.
There are two elements – the first covering physical health skills assessment and the second offering specific training packages. 
The physical health self-assessment element for diabetes reduction includes, for example, demonstration of checks and intervention on smoking, giving lifestyle advice and use of the Malnutrition Universal Screening Tool (MUST), and undertaking clinical checks such as blood pressure and use of a National Early Warning Score (NEWS). A similar approach has been adopted within the passport to address Chronic Obstructive Pulmonary Disease (COPD).
The training element of the passport includes three separate levels of training to support smoking cessation, and programmes increasing awareness and screening assessment for diabetes and COPD.    
Claire Johnston said: “For too long, people with mental illness have struggled to get proper advice and support for their physical health concerns, including diabetes, COPD and smoking – and they have died too early from these preventable diseases.  With our new tools and training for nursing staff we will be able to make a crucial difference to the quality of life for our service users and their families.”
The Trust aims to:
  • reduce the suicide rate among psychosis patients by 20% by 2022
  • cut the percentage of those smoking by two per cent per year by 2020
  • carry out widespread screening for diabetes to determine full prevalence up to 2020, before then reducing to stabilise at 18% or lower by 2022, reversing  the national trend  
These aims are at the heart of its “Integrated Practice Unit for Psychosis” (IPU)* which covers service users at C&I with diagnosed psychosis and those registered with local GPs. It is being funded by Camden and Islington Clinical Commissioning Groups and reflects C&I’s key strategic priorities* in delivering mental health care. 
Hannah PerrymanHannah Perryman, a return to practice nurse with previous acute psychiatric and community mental health experience, strongly supports the integration of physical and mental health. She has recently complemented her existing physical health skills with training in blood testing service users attending community wellbeing clinics.  
She said: “We have an obligation to ensure the overall welfare of our service users and with the right approach and structure we are in a strong position to make a major contribution to their physical health care.”
Nayo Jobson, an assistant practitioner with one of the Trust’s Assertive Outreach Teams, has undertaken training recently in phlebotomy, diabetes screening and smoking cessation. Sheik Tafajoul
Nayo, who knows of four service users who have recently died due to physical health complications, said: “The extra knowledge and training gives mental health practitioners greater awareness of when someone is not well and what physical health interventions to push for.”
Sheik Tafajoul, a community mental health nurse, has had training in smoking cessation, taking blood pressure and blood tests, and wider COPD and diabetes awareness.
He said: “This is an excellent approach, particularly in view of the demographic of our service users within our Trust.  This helps our own set of skills and means that we can further ensure the safety of those we are trying to help.”

Notes to Editors:

* The Trust’s five year programme is also known as its Integrated Practice Unit for Psychosis
It entails working in partnership with Camden and Islington local authorities, GPs, acute trusts and community health services, to target 18 specific improvement outcomes addressing both mental and physical health, as well as wellbeing and quality of life. 
For physical health outcomes the focus particularly is on diabetes and Chronic Obstructive Pulmonary Disease (COPD), and an emphasis on encouraging people to quit smoking.
* Strategic priorities
Our three strategic priorities are:
  • Early intervention and prevention;
  • Helping people to improve their health and wellbeing
  • Research and innovation 
*10,000 lost years: This figure has been calculated on the basis of C&I’s 15% target reduction of the gap between average mortality in people with serious mental illness (SMI) and that of the general population – for the SMI population it is on average 15 to 25 years earlier.  A 15% reduction of this gap is equivalent to 1.5 years, and for the estimated 7,000 potential SMI group in Camden and Islington this would be a total 10,500 hours.
*Wellbeing clinics: Wellbeing clinics provide expertise and help for people to improve their physical and mental health, and consequently their sense of wellbeing.
The aim is to build people’s sense of enjoyment, contentment and engagement with others and boost their self-confidence and self-esteem.
Support is provided on a range of different issues that can impact on physical and mental health such as sleep, alcohol intake, healthy diet, activities, building relationships, learning and “mindfulness” – being aware of the present moment, including your thoughts and feelings.

About Camden and Islington NHS Foundation Trust 

We provide mental health and substance misuse services to people living in Camden and Islington, and a substance misuse and psychological therapies service to residents in Kingston. 
We have two inpatient facilities, at Highgate Mental Health Centre and St Pancras Hospital, as well as community based services throughout the London boroughs of Camden and Islington. Our Trust is also a member of University College London Partners (UCLP), one of the world’s leading academic health science partnerships.
We provide services for adults of working age, adults with learning difficulties, and older people in the London area either in a community or inpatient setting.
Our income for 2015/16 was £138million and we have approximately 1,700 staff. Our staff work in multi-disciplinary teams providing a holistic approach to recovery. This means that we often work with partner agencies and the voluntary sector. Camden and Islington Mental Health and Social Care Trust was established in 2002. In March 2008 we became the first Care Trust to achieve Foundation Trust status and are licensed by NHS Improvement.

Sheik Tafajoul

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