Improving somatic health of outpatients with severe mental illness

Background: Patients with severe mental illness (SMI) experience a 13-to 30-year reduction in life expectancy compared with the general population. The majority of these deaths can be attributed to somatic health problems. The risk on somatic health problems is partly increased due to a reduced ability to request care and the fact that the current health care organisation is unable to fulfil the needs of these patients. Our previous work shows that a health check intervention can bypass the inability to request help of patients with SMI by detecting somatic health problems that were not detected previously [1]. The aim of this research project is to develop a policy recommendation on how to improve physical health based on consensus by the major stakeholders: patients, family carers, general practitioners, and mental health care staff. Methods: We used a three round Delphi method. The first round consisted of an inventory of potential policy recommendations, in two consecutive rounds consensus was sought on a selection of recommendations. Results: The policy recommendations described improvement in collaboration among health care professionals; the need to educate involved professionals regarding the specific medical risks associated with patients with SMI; and defining the differences between GPs and mental health care professionals regarding their responsibilities to provide adequate care for the physical health of SMI patients. Examples of consensus based policy recommendations on colloboration are: The GP is the professional with overview and direction of the complete (general and specialist) treatment of patients. The professional (MHP or GP) who diagnoses a new somatic complication should notify the other professional (MHP or GP) providing them with relevant medical information.-o The results from cardiovascular risk screening need to be known by the GP and MHP. The performer of the screening should inform the other party in writing. For the policy on new physical symptoms, MHP should always consult the GP. Consultation with the GP is necessary before referral to a medical specialist by MHP. Changes in medication should always be reported in writing between MHP and GP. The psychiatrist can delegate the performance of the necessary screening required for some medications used in the treatment of psychiatric disease to the GP, if the patient agrees. Direct personal contact between MHP and GP is an important prerequisite for improving cooperation. Sharing of direct (cell)phone numbers can contribute in facilitating direct contact. Discussion: Currently there are multiple barriers to optimal health care which can be overcome by implementing the suggested policy recommendations. Part of these recommendations can be implemented directly in current health care.