This case study is an example of the collaborative work taking place to deliver physical health support services for people living with severe mental illness (SMI). It is one of a collection of case studies that support our guidance for integrated care systems on Improving the physical health of people living with severe mental illness, published in January 2024.
Organisations: Rethink Mental Illness, Somerset ICS and Somerset NHS Foundation Trust
Aim and rationale
In 2019, Somerset was selected as an early implementer site for community mental health services transformation. It brought together the NHS, local authority, the voluntary, community and social enterprise (VCSE) sector and those with lived experience to develop a model for the county – Open Mental Health, which provides 24/7 support to adults experiencing mental health issues. Improving the physical health of those living with a severe mental illness (SMI) is a key component of this model.
Development and implementation
- Peer mentors have been introduced as SMI physical health check (SMI PHC) practitioners, each of whom is linked to a primary care network (PCN). A key aspect of their role is to increase engagement with SMI physical health checks by those living with SMI, including by supporting them during a check, and helping them to understand the process and results and to take sustainable actions in response. Open Mental Health is piloting a phone line to give people a dedicated ‘safe space’ to chat to SMI PHC practitioners about the check, including any concerns or barriers they may have and support available to attend a check if needed.
- Open Mental Health’s expert by experience leaders have helped co-produce a new localised information leaflet that has been circulated across the ICS, as well as the letters sent to individuals about their SMI physical health check, ensuring these are more inviting and less instructive.
- Experts by experience have also co-designed and facilitated training for SMI PHC practitioners around engaging people living with SMI, and following positive feedback this has been rolled out more broadly across Somerset PCNs.
Overcoming challenges
- Engagement from GP practices in the county was variable, and GP capacity to engage and complete the physical health checks was challenging at times. To overcome this, Somerset NHS Foundation Trust created four dedicated roles to deliver SMI physical health checks for people who historically had not engaged in the process.
- Data collection has proved challenging and relies on GP practices supplying the data to the ICS or trust. ICSs now communicate more with GPs to request regular data about the number of people on their SMI register, while SMI PHC practitioners have built relationships with GP practices to raise awareness of the register and the physical health checks among GPs and those living with SMI. By taking this approach, the SMI register in Somerset increased by 27% between March and September 2022.
- It takes time for a SMI PHC practitioner to build relationships and trust with a person living with SMI, and to achieve sustainable engagement between the person and health professionals. This can be challenging when organisations are also looking for quick results. Developing an understanding of peer support among these partners is crucial.
Outcomes
- More SMI physical health checks are being delivered: a 23% increase between the end of 2018/19 (1,392; 29% of the SMI register) to 2,007 by the end of 2022/23 (49% of the SMI register).
- Discussions with services and service users identified a need for dedicated follow-on support for people living with SMI. Further money has been secured to recruit two physical health navigators to link people living with SMI to services in their community. A directory of services will be developed to give partners comprehensive information in one place.
- Feedback indicated that the previous letter inviting people to an SMI physical health check caused anxiety and lack of engagement. People find the new letter and information reassuring and this is encouraging them to book a check.
Recommendations
- It is crucial for ICSs to form good relationships with their partners.
- Do not have pre-conceived ideas about what a project should be – be flexible and listen to other professionals.
- Be open to introducing peer support.
- Be outcome focused when identifying needs and commissioning services but design the process together with partners.
Contact
Kirsten Taylor-Scarff, Rethink Mental Illness, Kirsten.TaylorScarff@rethink.org
Open Mental Health – co-produced Physical health check information leaflet