Cervical cancer screening resources aimed at addressing mental health disparities

Support for women service users with severe mental illness to access screening

• Leaflet and video explain what women can expect during a smear test, as well as advice on how to prepare for it
• Cancer mortality rate is 30% higher in people experiencing serious mental health conditions than in the general population 
• Community mental health and enhanced primary care teams report significant benefits since the leaflet’s launch in autumn 2019

A new cervical cancer resource to support women with serious mental health issues access screening has been successful across a range of services.

The leaflet, Support Available for Your Cervical Screening (Smear Test), explains what cervical screening is and what women can expect during an examination, and offers tips on how to prepare for it. A video about the leaflet is also available on YouTube. 

• RELATED: Cervical cancer: how nurses can dispel myths and offer support around HPV

There is also a two-page list of statements that service users can tick to highlight issues that can affect their experience. These include:

• I hear voices.
• My medication makes me shake.
• I don’t like to feel exposed or naked.
• I am afraid it will hurt.
• I am a survivor of sexual violence.

Service users can also write down words that may trigger anxiety attacks or flashbacks to help describe the mental health condition they have.

Read more articles on cervical cancer

Community mental health teams, enhanced primary care, trauma and forensic staff, and those working on inpatient wards and in sexual health clinics have already seen the benefit since the leaflet’s launch last autumn.

Sensitively engaging with service users who avoid cervical smears

The Berkshire Traumatic Stress Service has recently started to use the leaflet about cervical cancer screening with its clients.

The service, part of the Berkshire Healthcare NHS Foundation Trust, specialises in treating adult survivors of sexual abuse, military veterans and people struggling with feelings of shame.

Consultant nurse therapist Jacqueline Sin says the leaflet is helping to make the care she provides more holistic.

After discussing the resource with colleagues, the whole team is now using it.

‘I was eagerly waiting for this leaflet to come out, because our clients find this topic to be a very sensitive issue,’ says Dr Sin. ‘It’s so important that women need to be getting that check.’

She says the leaflet helps support women to take responsibility for their own health, and has already helped her to engage with women who may have been avoiding cervical cancer checks.

‘Primary care is busy and they don’t always have time to think about mental health patients and how to engage them,’ Dr Sin adds. ‘It helps our clients to have someone they know and trust, like a mental health nurse, to communicate this sensitive stuff.

‘I would like to see more cross-working with primary care.’

Overseas interest gathering pace

Interest has also come from overseas.

Two mental health charities are using the leaflet in New Zealand while in France the regional public health agency is looking to translate and adapt it to use in its own health system, says creator Frederique Lamontagne-Godwin, who interviewed mental health nurses, screening professionals and service users to inform the leaflet design as part of her doctoral studies at the University of West London.

Ms Lamontagne-Godwin is being supervised by University of Surrey professor of mental health sciences and nursing Elizabeth Barley, who leads ongoing work on developing mental health-friendly health check resources for health and social care professionals. As part of this work, Professor Barley and three co-authors have published Interventions to Encourage Cancer Screening Uptake in Severe Mental Illness because there was so little research evidence in this area.

What evidence is available indicates that cancer mortality is 30% higher in people with serious mental health conditions than in the general population, partly attributable to women with serious mental health issues being less likely to access cervical or breast cancer screening.

Watch: Support for your cervical screening (smear test)

Professor Barley says women experiencing serious mental health conditions may have had bad past experiences with cervical smears, which puts them off attending again, or service users who hear voices may find it hard to be in a busy waiting room.

Tested on service users who have experienced trauma and genital mutilation

‘We felt people were missing out on screening because they didn’t have full facts or support so Ms Lamontagne-Godwin was appointed to do the PhD.

‘She developed the leaflet and tested it, not just with people with mental illness, but with people who have experienced trauma and female genital mutilation.’

‘Cancer is the second leading cause of death in this group. We need to be thinking about cancer and cancer screenings’

Frederique Lamontagne-Godwin, creator of the cervical screening leaflet for mental health service users

Professor Barley points out the huge inequality of mental health service users missing out on essential health checks and having worse physical health outcomes than the general population.

‘They are coming into contact with services which are not used to dealing with people with severe mental illness, and there is a lot of stigma around.’

Ms Lamontagne-Godwin urges mental health nurses and other healthcare professionals to take appropriate opportunities to talk about physical health checks with people experiencing serious mental health issues.

• RELATED: Our cancer experience: health professionals share their stories and offer advice

‘Cancer is the second leading cause of death in this group,’ she says. ‘We need to be thinking about cancer and cancer screenings.’

Help for service users who struggle with intimate screening

During the course of the leaflet's development, Ms Lamontagne-Godwin also heard from women who have experienced trauma, such as rape, and might struggle with intimate screening.

‘Initially, the target was women who have schizophrenia or bipolar disorder but, when I started talking to so many different organisations, this was widened to anyone who has experienced trauma or mental illness. It touches so many people.’

It will be hard to measure how effective the leaflet is but, as Ms Lamontagne-Godwin points out, ‘if we help even one woman go for screening, then that’s fantastic’.

Find out more

• Barley EA et al (2016) Interventions to encourage uptake of cancer screening for people with severe mental illness 
• Kisley S, Crowe E, Lawrence D (2013) Cancer-related mortality in people with mental illness
• Woodhead et al (2016) Cervical and breast cancer screening uptake among women with serious mental illness: a data linkage study