The average life expectancy of people with severe mental illness is 15–20 years shorter than those without and, to change this, “we need to do things differently”.
“We need to be here in these forums talking about it. We need to engage with the wider health fraternity”. These were the words of Asif Zia, a consultant psychiatrist at Hertfordshire Partnership NHS Foundation Trust (HPFT), speaking at a Royal Pharmaceutical Society (RPS) Bedfordshire and Hertfordshire event held in Hatfield, Hertfordshire, on 26 March 2019.
Hosted in conjunction with HPFT and the Centre for Postgraduate Pharmacy Education (CPPE), the evening — organised by Chetan Shah, chief pharmacist at HPFT — was intended to get community pharmacists thinking about how to best support the physical health of patients with severe mental illness. Zia estimated that around 10,000 people in Hertfordshire are living with schizophrenia, but said that many do not engage with GPs or other primary care services. Such patients are, he said, more likely to walk into a community pharmacy. “Getting you, as a workforce, ready will go some way towards supporting patients with severe mental illness around their physical health,” Zia said.
The physical health of those with severe mental illnesses, such as schizophrenia and bipolar disorder, can be affected by multiple factors, attendees heard. “[Patients] will actually drift down the social tier … because of not being able to concentrate, not doing a lot of exercise, not going out, not making friends.”
This “social drift”, Zia said, inevitably has an impact on physical health: it leads to a lack of physical activity and, hence, an increased risk of diabetes, stroke and heart failure.
But Zia warned against “diagnostic overshadowing” — assuming physical symptoms are always related to a patient’s mental health condition, rather than being problems in their own right.
The issues flagged by Zia were brought to life in an interactive case study session led by Shah, in which attendees discussed how to support ‘James’ — a patient taking the antipsychotic clozapine to manage his schizophrenia. Shah emphasised that long-term use of antipsychotics can contribute to poor physical health outcomes, including weight gain and metabolic syndrome. Attendees considered how to advise James on his weight, and on the interactions between tobacco smoke and clozapine. The importance of building trust with the patient was emphasised, and Shah directed attendees to the RPS campaign to involve pharmacists more in mental health care: pointing out that patients were part of the roundtable group that helped develop the policy.
Zara Mehra, regional tutor for the East of England at the CPPE, pointed attendees to CPPE’s mental health gateway, which contains e-learning modules and case studies to develop pharmacists’ skills. It is crucial to strive for parity of esteem between mental and physical health, Mehra said, adding that “our aim should be to normalise discussions about mental health conditions”.
Feedback from the event, Shah told The Pharmaceutical Journal, showed that the “vast majority” of attendees would like further education and training to better support patients with serious mental illnesses.
Ultimately, Shah said, he would like to see community pharmacies commissioned to undertake physical health checks of people with severe mental illness.
“Irrespective of which sector we work in, we have a significant opportunity to help — particularly if we stop working in our silos.”