Physical health in mental illness: psychiatry's shared responsibility

I have recently completed the evaluation of responses to a postal questionnaire sent to consultants in adult general psychiatry in the UK. The aim was to study their understanding, recognition and management of ill health in patients with severe mental illness. The 300 responses (72% response rate) received have been helpful in revealing the present state of practice in recognising the problems and addressing the unmet health needs of this patient group.

Only 72% of the consultants who responded thought that patients have a complete physical examination on admission to an acute psychiatric ward; 28% believed that patients do not have a full physical examination within 72 h of admission.

As regards out-patients, 26% of consultants believed that the medical needs of their patients are managed by general practitioners (GPs) via care coordinators. Only 45 % reported that their patients had been asked to have physical check-ups at GP surgeries in the previous 3 years. The rest did not know whether their patients have any medical needs nor whether their needs are addressed at primary care level.

Fifty-six per cent of respondents felt that the physical health of out-patients, albeit important, is the responsibility of primary care. As psychiatrists, they did not get involved in investigating possible medical conditions of their patients and they did not expect to receive information from primary care. Of the 44% who thought they should be involved in their patients’ well-being, 51% reported that they have minimal time or resources to deal with physical health questions; 45% said that they have moderate resources and could mobilise these if the need arose; only 4% reported that they have provisions to address the physical needs of their patients.

I therefore welcome recent articles in APT focusing on the physical health and lifestyle of people with severe mental illness and problems of their management (Connolly & Kelly, 2005; Garden, 2005; Lester, 2005). It is important to draw colleagues’ attention to (belated) protocols of shared care for people with long-standing mental health problems.

Training for all mental health professionals working with people with severe mental illness and the increased drug-related risk of weight gain, hypercholesterolaemia, hyperprolactinaemia, diabetes, metabolic syndrome and other conditions affecting patients will need to come to the forefront of concerns when assessing the quality of mental health provision for this patient group.