Process and outcomes of care for patients with severe mental illness at a general practice in Lambeth.

A study was conducted in July/August 2010 that looked at the process and outcomes of care for patients with severe mental illness at a general practice in Lambeth.

Below are the conclustions and recommendation from the study. To read the full report click here

Conclusions and Recommendations

  • With increasing numbers of patients being managed in primary care, it is recommended that the Mental Health Register and Annual Health Check is expanded to include more detailed evaluation of psychological wellbeing and mental state, more detailed assessment of medication including adherence and side effects, and review of risk.    This could contribute to relapse prevention and longer term wellbeing of mental health service users.
  • Although the MH Register was originally defined as a register for people with severe psychotic and bipolar illnesses, it may be more appropriate to define such a register in terms of level of need rather than diagnosis.
  • From a clinician’s perspective, the concept of a lifelong MH Register is attractive because risks such as suicide risk and cardiovascular risk persist for decades after recovery from a first psychotic episode.  This would seem especially important if care is delivered by an increasingly diverse range of statutory and non-statutory agencies i.e. primary care have an over-view of the individual’s care plan and can “keep track” of individuals who have disengaged from services.
  • However, the idea of being on such a register may not be acceptable to all service users and this would need further exploration.
  • In a model in which it is envisaged that patients move between primary and secondary care, good communication is essential to ensure seamless transfer of care (to minimise risk and to ensure the least disruptive patient experience).
  • Links between secondary care and primary care could be strengthened so that primary care clinicians can access expert advice easily and quickly (without the patient having to be referred back to secondary care) and so that patients can benefit from new research developments in relation to the long term management of their condition (rather than just at times of crisis).
  • There is a group of patients who develop progressively negative symptoms of schizophrenia such as reduced motivation and social withdrawal.   Such patients may be less likely to come to the attention of services compared to those with behavioural disturbance associated with positive psychosis, but may have chronic elevated levels of need and risk (e.g. of neglect) and represent a particularly vulnerable group.    The MH Register may be a mechanism whereby the needs of such patients can be monitored in the longer term.
  • Further research could look at the views of service users and carers about the MH Register. Do individuals find it helpful to remain on such a register indefinitely?  What should be the process for individuals ceasing to be on the register?

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