Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 2001 Jul 28;323(7306):231.

Physical health of people with severe mental illness

Adequate staffing and shared commitment are needed

Wally Barr 1
PMCID: PMC1120844  PMID: 11496879

Editor—In their editorial Phelan et al correctly highlight the importance of general practitioners assessing the physical health of patients with severe mental illness.1 Although we share their belief that the success of this is reliant on practices identifying these patients, our research suggests that this task is far from straightforward.

Our three year study was sited in an English health district where the NHS trust and health authority had collaborated in establishing registers of cases of severe and enduring mental illness in over 60 general practices.2 The aim was to identify all practice patients with severe mental illness as a first step in raising their profile in practices. Each practice had been allocated a named community mental health nurse, and these link nurses were given a key role in developing the mental health registers in consultation with general practitioners and practice staff. During the study we carried out 42 in depth interviews with the professional staff participating in drawing up and maintaining the mental health registers in six sample practices.

The most striking finding was the difficulty encountered in achieving consistency in defining the characteristics that constitute severe mental illness. Criteria for mental health registration in all practices were drawn from the definition of severe mental illness given by the Department of Health.3 This definition is based on the dimensions of safety, informal or formal care, diagnosis, disability, and duration of illness, but we found it to be susceptible to widely varying interpretation by all participants.4 A second common feature was the impact of pressure of work and staffing shortages on establishing registers: the time consuming procedure of collating accurate and up to date patient data and establishing agreement on inclusion on the register was frequently sacrificed to more pressing matters.

Improving the physical health of severely mentally ill patients is a complex issue. The introduction of mechanisms, such as practice based mental health registers, to help in identifying needy patients is important but will be achieved only as part of an overall strategy that entails adequate staffing levels and shared commitment to the task.

References

  • 1.Phelan M, Stradins L, Morrison S. Physical health of people with severe mental illness. BMJ. 2001;322:443–444. doi: 10.1136/bmj.322.7284.443. (24 February). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Barr W. Do severe and enduring mental illness registers held in primary care make a difference? Liverpool: Health and Community Care Research Unit, University of Liverpool; 2000. . (Report no. 00/74.) [Google Scholar]
  • 3.Department of Health. The health of the nation: building bridges. London: HMSO; 1996. [Google Scholar]
  • 4.Barr W, Cotterill L. Defining severe or enduring mental illness: by principle or prescription? J Psychiatr Mental Health Nursing. 1999;6:489–491. doi: 10.1046/j.1365-2850.1999.00245.x. [DOI] [PubMed] [Google Scholar]
BMJ. 2001 Jul 28;323(7306):231.

General practitioners play a valuable part

Pamela van de Hoef 1,2,3, Ian Colls 1,2,3, Roman Scheurer 1,2,3, John McGrath 1,2,3, Harvey Whiteford 1,2,3

Editor—The editorial by Phelan et al draws attention to the need to link mental health services with primary care services in order to improve general health outcomes.1-1 The Australian national survey of mental health and wellbeing found that over the previous year 81.3% of people with psychosis had seen a general practitioner at least once, and 30.5% had seen a general practitioner on two to five occasions.1-2 These data suggest that people with psychotic disorders are at least able to access their general practitioner in a country with national health insurance that does not discriminate against persons with mental illness.

As Phelan et al suggest, however, attending a general practitioner may not be sufficient to ensure adequate attention to physical as well as mental health needs. We completed a survey of 142 patients with psychotic disorders attending a community mental health clinic. We accessed data of individual patients from the national health insurance commission to identify attendances at general practices. All subjects gave written informed consent, and the Wolston Park Hospital ethics committee approved the study. Consistent with the national data, 86% of the patients had seen a general practitioner in the previous year. While 72% were satisfied or very satisfied with this service, a third (32.4%) had five or more different general practitioners in the previous five years (people are free to attend the general practitioner of their choice in Australia). Over the previous five years, the 142 subjects had had 6151 occasions of contact with a general practitioner (4907 surgery based consultations, 1244 home or hostel visits). Of the surgery based consultations, 97% were of less than 20 minutes' duration, whereas the remaining 3% took 20-40 minutes.

It is encouraging that most patients with psychotic disorders seem able to access care from general practitioners and that there is a high level of overall satisfaction with the care that they receive. Some people with psychosis, however, seem to change general practitioners often. The reasons for this finding are not clear and are a concern to the Australian government. The data also provide empirical support for the observation that most contacts between patients with psychosis and general practitioners may be too short to undertake thorough physical assessments and mental state assessments.1-1

General practitioners have the capacity to improve outcomes for patients with psychosis. They can provide a one stop shop for many physical and mental health needs. They are accessible, and attendance is less stigmatising. The Australian government has announced that it will review the reimbursement for general practitioners' consultations with patients with mental illness and is supporting improved mental health training for general practitioners.1-3

References

  • 1-1.Phelan M, Stradins L, Morrison S. Physical health of people with severe mental illness. BMJ. 2001;322:443–444. doi: 10.1136/bmj.322.7284.443. (24 February). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Jablensky A, McGrath J, Herrman H, Castle D, Gureje O, Carr V, et al. Psychotic disorders in urban areas. Aus NZ J Psychiatry. 2000;34:221–236. doi: 10.1080/j.1440-1614.2000.00728.x. [DOI] [PubMed] [Google Scholar]
  • 1-3.Davies J. A manual of mental health care in general practice. Canberra: Commonwealth Department of Health and Aged Care; 2000. [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES