The big picture
When, in 2014, the NHS published its strategy in the form of the Five Year Forward View, a special emphasis was placed on mapping out a future that “dissolves the classic divide… between physical and mental health”. Despite having been “set in stone almost since 1948”, a wave of recent evidence has shown that breaking down this divide is not only appropriate and advisable, it is fundamentally necessary for the health of the NHS itself. This article is concerned with the interface been mental and physical health, as well as an ambitious initiative that is a torch bearer the integration called for in the 5YFV.
So in what ways are these two domains of health – one relating to mind, the other to body – closely interrelated? As is summarised by the Mental Health Foundation, “poor physical health can lead to an increased risk of developing mental health problems. Similarly, poor mental health can negatively impact on physical health, leading to an increased risk of some conditions.” The extent of this increase in risk is profound; according to a recent Government report on the issue, people with severe mental illness “die on average 15-20 years earlier than the general population”.
There are a variety of complex drivers influencing these levels of premature mortality. The rate of smoking, for example, amongst people with certain severe mental illness is two to three times what it is in the general population. In terms of nutrition, evidence suggests that people who report daily mental health problems consume significantly less fruit and vegetables than those who do not report such problems. Similar trends may be observed in relation to physical activity levels and other healthy lifestyle behaviours.
Not only are risk factors for cardiometabolic conditions more frequently pronounced amongst those with mental health difficulties, there is also an inverse care law at play which means this vulnerable group are in fact less likely to receive the checks and management they require. It is for these reasons and more besides that the issue is regarded by many as representing one of the most poignant health inequalities currently facing the country and its health authorities.
However, despite the aforementioned emphasis on ‘poor’ health, the effects run in both directions; there is an increasing body of research showing that improved physical heath can have a substantially beneficial impact on mental wellbeing, and vice versa. As such, the rationale behind treating both mental and physical health as part of the same conversation and with parity of esteem is not only commonsensical, it is supported by a robust evidence base and carries with it significant opportunities to reduce inequity in the public’s health.
One of the key ways in which this issue is being tackled is through the introduction of a health check programme aimed at improving the monitoring and reduction of key cardiometabolic risk factors amongst mental health patients. Whilst a similar initiative is offered to the general population in the form of the NHS Health Check – a cardiovascular risk assessment for those between the ages of 40 and 74 – a unique set of considerations presents itself when engaging with people experiencing mental health difficulties. At the same time however, if these considerations can be successfully negotiated, there are huge opportunities to help these vulnerable individuals embark on a journey to improved health and wellbeing.
So what are these considerations? Bearing in mind the prevalence of feelings of anxiety and depression amongst those suffering with mental illness, the potential for the individual having the health check to experience restlessness and worry or helplessness and low mood – particularly if they were to find out that they’re at high risk of having a heart attack or stroke – is something that it would be important to be able to effectively support. In this respect, key considerations would be ensuring that the appropriate skills and consultation support tools are in place to allow for health checkers to convey clear information and to help develop meaningful change plans. In other words, a set of skills and systems that are duly able to contain the consultation and sow seeds for the possible next steps.
What’s more, when working with people experiencing severe mental illness and for whom the world may have the potential to become a frightening and persecutory place, being closely sensitive to the needs of the individual is crucial. A collaborative and respectful working relationship between both people constitutes a vital foundation for being able to respond in this way. To this end, if a system is capable of translating the data inputted into the relevant colour-coded risk thresholds, it simultaneously assists in the maintenance and growth of such a relationship; allowing the system to convey potentially difficult facts in relation to, for example, a person’s weight, means the health checker is better able to retain the kind ‘non-judgemental attitude’ that represents such a corner-stone of good counselling technique. When both parties share a screen and are privy to the same information, a fundamental implication is that both individuals are able to be on the same side of whatever is being addressed.
Health Options® – the software that is used across the UK to deliver patient-focused health and wellbeing checks – has been developed with precisely these principles in mind. Moreover, building on the understanding that “patients, like everyone else, profit most from a truth they, themselves, discover”, a core principle behind the software’s design is that it facilitates consultations in which the person having their health checked is encouraged both to acknowledge their current health status and determine their own future direction, with dynamic risk results conveying the likely results of any lifestyle change. A full suite of training videos on precisely how Health Options® software can be used in conjunction with such counselling techniques is available through our e-learning hub.
New developments soon to be released will also mean that individuals will be able to access their health check results online via a secure website and to continue to track their progress. My well record, as it will be called, represents a further crucial step towards encouraging individuals in adverse circumstances to improve their health prospects in their own time and on their own terms. The electronic data transfer capabilities of the software and its seamless referral processor represent additional areas of functionality that ensure the health check functions as it should: as the first step in a person’s journey to better wellbeing. Nowhere is it more vital that this first step is taken in a mindful way with the appropriate tools for the job than when offering health checks to people suffering with mental illness.