Improving management of schizophrenia and severe mental illnesses in general practice

UCL research has led to major changes in the management of people with severe mental illness in general practice through its impact on policy and the NHS Quality Outcomes Framework in England and Scotland.

Schizophrenia is one of the most common serious mental health conditions, and around 1 in 100 people will experience schizophrenia in their lifetime. Many people will continue to live normal lives, with their condition managed primarily by their GP.

In the mid-1990s to date, Professor Irwin Nazareth (UCL Primary Care & Population Health) and colleagues, later including Professor David Osborn, began a programme of research to learn more about how this care is offered, and how it could be improved. They found that although people with schizophrenia would frequently consult their GP, their management was typically unstructured with little attention given to their physical health, compared to the care offered to people with other chronic diseases - despite a willingness on the part of these patients to have their physical and psychological health needs managed by their GP.

Further research showed that people with severe mental illnesses have poorer than average physical health, including a higher risk of death from cardiovascular disease.

As a result of these findings, the National Institute for Health and Clinical Excellence (NICE) updated its guidance on schizophrenia in 2009 to recommend that patients should have an annual physical review focussing on cardiovascular risk factors including blood pressure, cholesterol, HDL cholesterol, smoking and diabetes.

Following on from this recommendation, the national GP contract (the Quality Outcomes Framework) was amended to encourage the implementation of this guidance. GPs are now remunerated for ensuring that people with SMI have had specific cardiovascular risk factors measured within the last 15 months.

Many national organisations have also incorporated the research findings into their guidance on mental health conditions, including: the European Psychiatric Association, the European Society of Cardiology, the British Association of Psychopharmacologists, and many of the Royal Colleges. In 2011, Professor Osborn advised the Department of Health on this topic in relation to their new strategy No health without mental health. As a result, the guidance includes a number of recommendations regarding the interface between physical and mental health. This included six main objectives, including "that more people with mental health problems will have good physical health".

This research has directly impacted on the day-to-day care provided for people with severe mental illnesses in general practices across the country, leading to a reduction in the inequalities of care that occur in people with schizophrenia and severe mental illnesses.