Challenging people’s ideas

Amanda Derbyshire’s work in improving the physical health of patients with mental illness has achieved such impressive results in Halton and Warrington that it has made her a joint winner of the RCN Health Practitioner Member Award.

A support, time and recovery worker has dramatically improved the physical health of patients being treated for mental illness by overhauling screening, monitoring and support.

Amanda Derbyshire, of Halton and Warrington Early Intervention Team at 5 Boroughs Partnership NHS Trust, established and developed a physical health and wellbeing pathway for patients after an audit showed screening was poor.

‘We know from national research about the importance of their physical health needs,’ says Amanda. ‘People with mental illness are at increased risk of physical ill-health, especially individuals with schizophrenia or bipolar disorder, who die on average 16-25 years sooner than the general population. Yet less than 30% of people with schizophrenia receive annual physical health screenings.

‘It was paramount we took action immediately to improve our service users’ physical health care and to establish and develop a system to help monitor it.’

She liaised with GP surgeries and care co-ordinators to compile service users’ physical health records. Only 6% had received a baseline comprehensive health screening, falling to just 3% at the two-year stage of their treatment.’

She used the Royal College of Psychiatrists’ Lester cardiometabolic tool – an assessment and intervention framework focusing on smoking, lifestyle, BMI, blood pressure, glucose regulation and blood lipids – for patients receiving antipsychotic medication as a template, and combined it with the trust’s own physical health assessment document.

Amanda established a steering group linked to primary care and secondary care, which included service user representatives. She also produced an educational DVD and a GP leaflet.

Amanda’s work will be replicated in other areas

Picture credit: John Houlihan

With no IT structure available to record and track screening results she created her own database. ‘It shows when service users’ screenings are due to myself and their care co-ordinator,’ says Amanda. ‘The system was submitted to NICE and has been published as an example of best practice.’

Different approach

After training to improve her clinical skills, she developed health and wellbeing clinics. ‘It had been difficult to get others to do the screenings – with the clinics I knew I could make a real difference. I also organised screenings in people’s homes with local wellbeing nurses,’ she adds.

‘GP surgeries are supposed to do the screenings but they are often missed. The clinics mean we can make sure the patient is screened and then send a letter to the GP. Some GPs don’t want us involved but I tell them that these are our patients and it matters.

‘Primary care nurses were also against us at first, yet now they see that nothing is being missed.’

Amanda signposts people for smoking cessation or gym membership and holds regular weight management and healthy lifestyle sessions for those who need support to adopt a healthy lifestyle (see case study).

A re-audit shows a big increase in adherence to screenings – from 6% to 94% overall. Follow up as well as baseline screenings are completed. Intervention plans are initiated immediately, with weekly follow up appointments and screenings.

Attitudes in the early intervention team have also changed. ‘Initially the team was not sure what I was doing. They were focused on only the mental health aspect. Now they are all on board and want the screenings for their patients.’

The Nursing Standard Nurse Awards judges were impressed by Amanda’s work and thought it could be replicated in other areas. ‘She has stepped up and gone well beyond her role,’ says NHS England senior nurse for mental health and learning disabilities Joanne McDonnell.

RCN professional lead for healthcare assistants and assistant practitioners Tanis Hand adds: ‘This is an amazing piece of work.’

Improved links

The trust plans to introduce a similar assistant practitioner role in each early intervention team. Warrington adult services matron David Hindley says: ‘She has worked tirelessly to establish and enhance the links between early intervention and primary care, and has designed an effective series of in-house wellbeing clinics, outpatient screening services and effective communication links with physical health and public health colleagues.’

Amanda already has plans for the future of her service: ‘We want to create a one-stop shop for physical screening, instead of sending people to different appointments.

‘I am also hoping to facilitate a service user-led health and wellbeing group. People will come in to talk to them and I will be there to support them, but they will take control.’

Amanda is most proud of changing people’s ideas: ‘So many were against it – even the patients, parents and carers. But their opinions are changing, which is so vital as many are on medication that will affect physical health.

‘If you are determined and work hard, eventually you will get through. I know I’ve done my job and made a change to someone’s life’.

See next week’s feature about the other joint winner Sharon Finn

Case study

A comprehensive one-year screening was carried out on a 34-year-old man with first episode psychosis. His blood results showed very high cholesterol levels. He smoked, was drinking and had a poor diet.

Picture credit: John Houlihan

Amanda saw him for six months, weekly for the first two, gradually moving to fortnightly and then monthly.

Her advice and support included:

Information on ways to reduce smoking and attending cessation services with him.

Monitoring alcohol consumption levels.

Weekly diet and nutrition monitoring through food diaries and advice on cholesterol reduction. Amanda referred him to a local authority’s diet and exercise programme, and supported gym sessions by training with him.

Home visits with a medicine management specialist to discuss current medication and the impact of any additional medication required if he did not make lifestyle changes.

Involving carers in some home visits to help them understand the plans.

‘The result was a complete change in his lifestyle,’ says Amanda. ‘He stopped smoking and greatly reduced his alcohol consumption. His diet has changed dramatically – he has lost 6.5 stone. He walks his dog twice a day, goes on daily bike rides and his cholesterol levels are low enough to avoid additional medication.’

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