The Core Study


Item 18

Physical health


a) Service users' physical health problems are asked about and documented in initial assessments (at least 80% of service users).

b) There is all source agreement that the CRT facilitates access to physical health investigations and treatments during CRT care for those with identified physical health problems.

c) The CRT provides or arranges (or confirms provision during the last 12 months) screening for cardiovascular risk factors for at risk service users who consent to this (at least 80% of service users). 

d) The CRT has working equipment and facilities and appropriately skilled personnel to carry out weight and blood pressure checks, urine testing for glucose levels.

Why this is important

Where a physical health problem is impacting on a service user's mental health or contributing to a crisis, there is a clear rationale for CRT involvement in ensuring access to investigations or treatment.  For many people with severe and enduring mental health problems, admission to an acute ward may provide the only guarantee of important physical health checks, including screening for increased risk factors for cardiovascular disease. If the CRT is providing a comprehensive alternative to admission, it should be able to provide these too where needed.

In the video below, carers and service users discuss the importance of addressing physical health issues. 

Ways of doing this well

The audio clip below is of Dr David Osborne, a consultant psychiatrist, talking about the importance of CRTs being aware of physical health issues.

Speaker button

Paying attention to physical health 

The Royal College of General Practitioners website on physical health for mental health is very good:

Physical Health Assessment 

Examples of good practice

In our fidelity review survey of 75 crisis teams in 2014, the following team achieved excellent model fidelity, and can be contacted for advice about how they achieved this:

  • Barking, Dagenham, Havering HTT, North East London NHS Foundation Trust

Case study: Ealing Crisis Resolution Home Treatment Team, West London Mental Health Trust

The Ealing Crisis Resolution Home Treatment Team (West London Mental Health Trust), conduct weekly physical health clinics.  Four appointments are arranged for the morning, and all patients are invited to attend by booking an appointment. In addition to this, there are four appointments allocated for the evening, where physical health checks are conducted in the service user's home. These appointments are particularly offered to those clients who have difficulty leaving their homes.

The team use Rethink's 'Physical Health Check', which is completed collaboratively with the client. The investigation also includes an ECG and bloods. The results are summarised in a letter to the client, GP, and care coordinator if appropriate, with any health needs identified and action points agreed.

The team's physical health check programme includes close working relationships with relevant external services, to ensure that any issues identified are addressed promptly. For example, the team have established good working relationship with the local diabetic clinic and the Trust's gym manager and team to facilitate quick access to these services. The team have presented to GP surgeries in their area to highlight the work they are doing and to engage GPs in the process. 

Click here to download an example GP letter

Click here to download Rethink's Physical Health Check

Click here to download the team's physical health appointment sheet

Relevant reading

Healthcare Commission (2008) The Pathway to Recovery

All mental health providers should take steps to ensure that the physical health of people with mental illness is not overlooked, and that provision of healthcare is implemented and managed effectively. Appropriate access to healthcare and health promotion services should be available.30, 49 (p.37)

The standardised mortality ratio for people with severe ongoing mental illnesses is two and a half times greater than the national population average.71 People with conditions such as schizophrenia and bi-polar disorder are at increased risk of physical conditions such as heart disease, diabetes, obesity, respiratory conditions, and infections.35,49 Guidance from the National Institute for Health and Clinical Excellence (NICE) on depression and schizophrenia recommends that services make regular full assessments of service users' physical health.72, 73 These checks should be carried out when medication is prescribed, when it is being changed and to monitor any side effects. Once in hospital, the admission may be a good opportunity to reassess a person's physical health (especially in light of a treatment plan) and to reconcile the prescription of medication at the point of admission and discharge. On the day of their admission or as soon as they are well enough, the patient should receive a structured standard medical assessment that matches the assessment undertaken in the Quality and Outcomes Framework in the General Medical Services contract.36 In 2008, the Royal College of Psychiatrists' scoping group on physical health in mental health will be publishing service standards that will detail the range of physical health checks that should be conducted. (p.51)