Physical health care monitoring for people with serious mental illness

People with mental health problems often have complex and long-term difficulties with their physical health such as weight gain, smoking and heart problems. They sometimes do not take care of themselves, have inactive lifestyles and may not be able to cope with daily life or work. People with mental health problems have higher rates of diabetes, lung disease, cancer, heart problems, HIV/Aids and other infectious diseases.

Physical health care monitoring can take a variety of forms from simple checks carried out by the person themselves to complex specific health checks carried out by health professionals. Monitoring helps identify current health problems and also anticipate future health problems.

In August 2006 the United Kingdom’s Department of Health issued guidance on how to provide better care for the physical health needs of people with serious mental illness. Spearhead Trusts, the Royal College of Psychiatrists, the National Institute for Clinical Excellence and other organisations all promoted the use of physical health care monitoring for people with mental health problems.

This review intended to find evidence to support this guidance. The authors’ conclude that current guidance and practice on physical health monitoring lacks a firm basis in research and there is little evidence to support this growing trend. They based their conclusions on results from a search carried out for trials in 2012 which found no relevant randomised studies. Current monitoring is mainly based on the agreement of experts, medical experience and good intentions. This does not mean that physical health monitoring is invalid, wrong or not of benefit to the physical health of people with severe mental illness, only that there is as yet no definite proof. Physical health care monitoring has the potential and promise to improve quality of life and help people with mental health problems live longer, but at this stage the information is uncertain and the research evidence unclear.

This summary has been written by a consumer, Benjamin Gray, from Rethink Mental Illness. Email: ben.gray@rethink.org

Authors' conclusions: 

There is still no evidence from randomised trials to support or refute current guidance and practice. Guidance and practice are based on expert consensus, clinical experience and good intentions rather than high quality evidence.

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Background: 

Current guidance suggests that we should monitor the physical health of people with serious mental illness, and there has been a significant financial investment over recent years to provide this.

Objectives: 

To assess the effectiveness of physical health monitoring, compared with standard care for people with serious mental illness.

Search strategy: 

We searched the Cochrane Schizophrenia Group Trials Register (October 2009, update in October 2012), which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO.

Selection criteria: 

All randomised clinical trials focusing on physical health monitoring versus standard care, or comparing i) self monitoring versus monitoring by a healthcare professional; ii) simple versus complex monitoring; iii) specific versus non-specific checks; iv) once only versus regular checks; or v) different guidance materials.

Data collection and analysis: 

Initially, review authors (GT, AC, SM) independently screened the search results and identified three studies as possibly fulfilling the review's criteria. On examination, however, all three were subsequently excluded. Forty-two additional citations were identified in October 2012 and screened by two review authors (JX and MW), 11 of which underwent full screening.

Main results: 

No relevant randomised trials which assess the effectiveness of physical health monitoring in people with serious mental illness have been completed. We identified one ongoing study.

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