Blog by SPHR transdisciplinary placement holder Jane Welch
What is severe mental illness?
Only a few short decades ago, not many people talked openly about their mental health. As recently as the 1950s, people experiencing mental health issues were labelled ‘defective’ (or worse) and sent away to lunatic asylums. Fast forward to 2023, and attitudes towards mental health are changing. As we emerge from the acute phase of the COVID-19 pandemic, people are increasingly aware of common mental health issues like depression and anxiety and are more willing to open up about how they feel. There’s still a lot of work to do to normalise conversations about mental health, but it’s a step in the right direction.
While attitudes towards mental health are slowly shifting, people living with severe mental illness have been left behind by the public conversation about mental health. More than half a million people in England are living with severe mental illness, which means they experience psychological problems which are so debilitating that they affect a person’s day-to-day functioning and ability to work. Schizophrenia, bipolar disorder, and psychosis (seeing and hearing things that other people don’t) are all types of severe mental illness. Only a small minority of people experiencing severe mental illness are cared for in psychiatric hospitals. The majority live in our communities. The people you see every day – the neighbour you talk to over the garden fence or the colleague sitting next to you in a meeting – could be living with severe mental illness.
Physical health and severe mental illness
People who experience severe mental illness die on average 15 to 20 years earlier than others in the general population. Their lives are not being cut short by mental illness – severe mental illness is often not even included on death certificates as a contributing factor. 2 in 3 deaths among people living with severe mental illness are caused by physical illnesses which can be prevented and treated, including heart disease, respiratory disease, diabetes and high blood pressure. More research is needed to fully understand why this happens, though the experience of severe mental illness may affect someone’s lifestyle, increase their risk of developing physical health problems, and make accessing health services and managing physical health conditions more difficult.
If we’re serious about addressing health inequalities and preventing early deaths, we must take action to improve the physical health of people with severe mental illness. The NHS in England aims to deliver an annual physical health check and follow-up care to 60% of people with a diagnosis of severe mental illness. This approach is positive, but is it ambitious enough to deliver big improvements in health outcomes for people living with severe mental illness?
Over the summer I completed a Transdisciplinary Placement funded through the NIHR School for Public Health Research and hosted by Fuse, the Centre for Translational Research in Public Health. I was involved in WHOLE-SMI (Wellbeing and HOListic health promotion for people with Severe Mental Illness), a research project that focuses on the delivery of holistic health support for people with severe mental illness. The project builds on PRIMROSE (Prediction and management of cardiovascular disease risk for people with severe mental illnesses), a study led by colleagues at University College London which supported people living with severe mental illness to reduce their risk of heart disease using personalised health checks, goal setting, and coaching to support lifestyle change. Patients involved in the PRIMROSE study were less likely to be admitted to psychiatric care, and the PRIMROSE approach generated savings for the health and care system of around £895 per patient per year.
WHOLE-SMI focuses on the rollout of a new version of the PRIMROSE model adapted to meet the needs of patients in North East England and the way health and care services are delivered locally. It’s an implementation study, so understanding how the health and care system in our region manages change is as important to the research team as evaluating the clinical or financial benefits of delivering care in a new way. In health and care systems grappling with staffing and financial pressures change can be difficult – but not impossible. Projects like WHOLE-SMI are a huge asset to systems because they can help us build on learning from other regions and understand what works (and what doesn’t) when it comes to delivering the transformational change we need to improve physical health outcomes for people with severe mental illness.
Looking ahead, the publication of results from the first phase of the WHOLE-SMI project will explore the physical health support needs of patients living with severe mental illness in the North East, the physical health support currently available to them, and any gaps. These findings from this phase of the project are based on interviews with experts by experience and health and care system stakeholders.
If you’d like to know more about the WHOLE-SMI project, please get in touch! You can contact Dan Steward, WHOLE-SMI Research Assistant (firstname.lastname@example.org) or Jane Welch, Policy Advisor to the Chief Executive at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (email@example.com).