Scope and method
access services for help with their physical health and when they do it is suggested that clinicians are less likely to address issues as they would with other service users ( Lawrence and Kisely , 2010 ).
Healthy Lives Healthy People ( DoH , 2010 ) was the first paper released by the UK government that promoted parity of esteem between physical and mental health . In 2011 the Coalition government produced the No Health Without Mental Health ( DoH , 2011 ) strategy which set out the aim for people with mental health problems to have good physical health . However , there is not only a disparity between funding for physical and mental health there is also a significant discrepancy in how much consideration their prognosis is given ( Millard and Wessley , 2014 ).
Antipsychotic medications used to treat severe mental illnesses such as schizophrenia can have significant side effects and are associated with ECG changes . Prolonged QT interval is thought to occur due to the effect that antipsychotic medication can have on ion channels ( Pacher and Kecskemeti , 2004 ). Although a prolonged QT interval itself can be a symptomless condition , it is associated with increased risk of Torsades de pointes which is a life-threatening heart arrhythmia which can cause sudden cardiac death .
It is thought that newer atypical antipsychotic drugs are less cardiotoxic than the older typical drugs ( Glassman , 2005 ), but it can be argued that patients prescribed atypical antipsychotics are often younger and therefore less at risk of prolonged QT interval . Ray et al . ( 2009 ), however , established that although the risk is of sudden death is higher for patients prescribed typical antipsychotics the risk is increased for all patients prescribed antipsychotic medication . NICE guidelines ( NICE 2014 ) describe the importance of physical health monitoring for patients prescribed these medications , and suggest that baseline checks should be carried out including blood lipid and glucose levels and an ECG to establish the QT Interval . These checks should be repeated at three months and annually after that .
Some improvements have been made to physical health monitoring for patients with psychotic illnesses in recent years ; however , monitoring still falls below the acceptable standards ( Ramanuj , 2013 ). Commissioning for Quality and Innovation ( CQUINs ) have been introduced which require that all patients in secondary mental health care that are diagnosed with a psychotic illness and are being treated with antipsychotics have a cardiometabolic risk screening tool , called a Lester Tool completed every year ( NHS England , 2016 ). The Lester tool provides a sound basis for cardiac-metabolic risk monitoring but does not include ECG monitoring . Therefore , it falls to individual clinicians to recognise the need for this and to take action , but this does not seem to be routinely done and ECG monitoring still falls below required standards . There are several reasons for this including lack of access to equipment , lack of trained staff and difficulty accessing services for patients who may be required to attend additional appointments at a different hospital for an ECG to be completed . Relying on patients who often show reduced attendance rates to participate in extra appointments in an environment they are unfamiliar with and where they do not know the staff is unlikely to be a reliable system .
Scope and method
There is a need to look at strategies to improve the physical healthcare of patients with SMI . The Commissioning for Quality and Innovation ( CQUIN ) framework uses financial incentives , screening tools and audits that have been put in place but there is still the need to do more to improve physical healthcare and avoid the preventable deaths of patients with SMI . An area that seems to be under-utilised is the use of new technology to improve access to screening ( Castle-Clarke , 2018 ). In the past new technologies in healthcare would have been costly and may have required additional staff and training to be able to utilise them but some recent advancements have included the development of a range of portable devices capable of taking ECG ’ s ( Cheung et al . 2018 ).
The Alivecor Kardia is one of the most widely researched of these devices ( Bansal and Joshi , 2018 ). It is a portable device that connects to a