Improving the quality of life for people with severe and enduring mental illnesses has been the focus of a partnership in Bolton, writes Alan Jones

People with severe mental illnesses have a higher level of physical illness than the rest of the population, including coronary heart disease, diabetes and respiratory disorders. Also, due to their mental health problems they are less likely than others to seek help for their physical problems, which can also affect their quality of life.

Bolton primary care trust set out to help people with severe mental health problems by creating practice-based registers for these patients to ensure they received a full annual physical health check.

Clearing hurdles

The implementation of practice-based registers in GP practices in the area proved to be a challenge, but the tide turned whenhealthcare development managers from pharmaceutical companies AstraZeneca and Janssen-Cila approached the PCT to offer assistance.

Initially, there was a fair degree of scepticism about working jointly with pharmaceutical companies and although the proposal was approved by the board, the project took a year to get going.

When it did get off the ground, the first task was to appoint project manager Rachel Steedman, who set about forming a steering group with key stakeholders from across the local health economy, including the PCT,Bolton,Salfordand Trafford Mental Health trust, Bolton patients' council for mental health and the voluntary sector.

To ensure the effectiveness of the annual health check, training was provided for practice nurses. Some funding was also provided for equipment in GP practices and hospital wards (for physical reviews) and for the education of community psychiatric nurses and PCT pharmaceutical advisers. A key part of the project was to encourage closer working relationships between community mental health teams and primary care.

Key achievements

The project has brought more people into the registers and allowed many more patients' poor physical health to be recognised at an earlier stage. Other benefits of the annual health check have included the opportunity to give lifestyle advice on diet, exercise, smoking and alcohol, other physical health checks such as blood pressure and blood glucose monitoring and a review of prescribed medication.

Apart from funding support, both industry managers also used skills in project management, networking and facilitation. They provided an interface enabling healthcare professionals to network with other PCTs (Salford and Trafford) who had implemented severe mental illness registers and could share ideas and outcomes. They provided expertise, guidance and direction in the education of primary care nurses and community psychiatric nurses. They also helped the community psychiatric nurses engage better with primary care.

This project has contributed to the healthcare of more than 500 patients with severe and enduring mental illness.Full implementation of the registers is now forecast and many useful recommendations have come from the project. Good practice guidelines to support the implementation of severe mental illness and learning disability practice-based registers have also been produced.

It has also opened the door to further partnership work with Trafford and Salford PCTs and proved to be a springboard for other joint collaborations in the PCT and the local mental health trust.

For Bolton PCT, these registers are only the start of a process of developing more systematic ways of treating patients with severe mental illness.The project is an excellent example of joint working and has not only helped Bolton PCT to implement key mental health policies and protocols but enabled patients to enjoy a better quality of life.