To receive a presentation addressing mental health and physical health monitoring in relation to the prescription of anti-psychotic medication and the current issues, achievements and pathways available.

(Note: to be presented by Dr Colm Owen, Consultant Psychiatrist and Medical Director for Devon Mental Health, Learning Disability and Neurodiversity Provider Collaborative and Dr Emma Sircar, GP and NHS Devon Primary Care Lead for Mental Health).

Dr Colm Owens Consultant Psychiatrist and Dr Emma Sircar, General Practitioner and NHS Devon Primary Care Lead for Mental Health provided Members with an update and presentation in relation to Devon’s approach to physical health monitoring in mental health.

Members were informed that the main aim was to address health inequality for people with severe mental illness by increasing the number of annual physical health checks delivered for people with serious mental illness; to design a safe and commissioned pathway for initiation, monitoring and review of anti-psychotics and to design a safe and commissioned pathway for the physical health monitoring of people with eating disorders.  The reasons for this were:

·         to attempt to reduce early mortality of patients with serious mental illness by completing health checks and offering appropriate interventions;

·         to review anti-psychotic prescribing to ensure that it was still appropriate and to pick up any physical health concerns and intervene;

·         to address the current low rates of completion of cardio-metabolic physical health checks for people with severe mental illness and those prescribed with anti-psychotics across the whole system;

·         to enable access to checks for all eating disorder/disordered eating patients requiring physical health monitoring.

It was explained that to achieve success, it was essential to include the right people in the work such as experienced experts, acute mental health trusts; primary care, the voluntary sector and commissioners.  Taking a collaborative approach was important as well as building good relationships between local teams across the sectors and exploring opportunities and community team engagement.  Effective communication was also key, delivered through patient information leaflets; an available video tracking a patient’s primary healthcare journey; a system level resource pack and patient passports which enabled people to hold their own information, empowering them to take ownership over health together with information as to why the health checks were so important.

In terms of primary care, the aim was to complete the majority of annual physical health checks for those on the serious mental illness register and to explore how to extend primary care funding to include anti-psychotic monitoring and measures for those with eating disorders and to put in place measures for the physical health monitoring team to review and act upon.  In relation to secondary care the focus was on anti-psychotic initiation and stabilisation monitoring with clear guidance to primary care on initiation of anti-psychotics; consideration as to the length of time for medication, how it should be reduced and when.  It was important to provide advice and guidance to primary care in relation to anti-psychotics and to ensure annual health checks for those not attending primary care.

Members were informed that the One Devon documents were progressing to sign off and that the test of change could be measured when the results of the North Devon rollout were available, which tested and refined pathways and communications.  The North Devon rollout had commenced in November/December 2023 and a rollout in Torbay and Plymouth was envisaged for early 2024 with the rest of Devon likely to follow during the next financial year.

Members received responses to the following questions:

·         Could community pharmacists help with the rollout?

·         What is the process for reaching out to individuals who are homeless with mental health issues?

·         How many people in Torbay are currently prescribed anti-psychotic medication?

·         Do those figures include individuals where there may be a post-natal cause?

·         When patients attend for review, they might fear that medication may be withdrawn – did that create a barrier for review and how was that currently addressed?

·         How would extra funding be obtained in direct relation to those individuals with eating disorders?

·         What was the comparison in numbers of individuals with serious mental illness pre-Covid-19 pandemic compared with numbers post Covid-19 pandemic?

·         When would the results of the rollout in North Devon be available?