Closing the medical mortality gap in patients with major psychiatric conditions

Abstract

This article discusses options for closing the mortality gap between the general population and people with major psychiatric conditions such as psychosis, autism, learning disability and dementia. Most of the mortality (85%) involves physical disease, with most deaths occurring in general hospitals or care homes, so is relevant to all doctors. The main focus of psychiatric treatments has been to reduce suicide, although there is no evidence that they achieve this. This article calls for psychiatrists to collaborate with medical colleagues to help reduce excess deaths from physical causes. The practicalities of combined physical and mental health monitoring and prescribing clinics are discussed, based on experience in Whitby. Potential national solutions are summarized including options for smoking cessation, sugar restriction, nutritional supplementation and flu vaccination.

Practicalities of care closer to home: seven key questions for community psychiatrists

“…Clearly, viewing SMI, intellectual disability and autism as palliative conditions is controversial; however, this view fits the available evidence and dovetails with the Gold Standards Framework method of oversight (model 2 above) – which secondary mental health services cannot provide owing to their move to episodic care, typically a specialist assessment and two follow-up contacts. Primary care SMI management has been piloted in Whitby (the Whitby SMI monitoring project; de Silva 2018b), with a CPN rotating between 6 GP practices (population 26 000), working with practice nurses responsible for cardiovascular screening to cover all patients on antipsychotic medication (including clozapine). This approach had widespread staff and patient approval, leading to all patients on long-term depot antipsychotics being discharged from the CMHT, as well as pick up of previously undiagnosed hypertension, dyslipidaemia and glucose intolerance.…”