Why people with severe mental illness miss their annual health checks

Design

Systematic review and qualitative evidence synthesis

Population

8 studies, 375 participants including 239 people with severe mental illness

Primary outcome

Experiences of and barriers to annual physical health checks

Effect

Five themes, from unclear purpose to service-level design

A BJGP qualitative evidence synthesis pooled eight studies from five countries, covering 239 people with severe mental illness, 15 carers and 121 primary care staff.

Five themes explained low uptake: unclear understanding of what the check was for; individual, relational and service barriers; the quality of the clinical encounter; difficulty acting on advice afterwards; and how services and staff were organised.

People with schizophrenia and bipolar disorder die years earlier than others, largely from cardiovascular and metabolic disease. The synthesis suggests the check is more likely to happen, and to matter, when its purpose is explained, the same trusted person delivers it and there is practical help afterwards.

• Explain the purpose of the physical health check in plain terms when inviting someone with severe mental illness.
• Offer flexible appointments and, where possible, the same clinician each time.
• Check weight, blood pressure, glucose or HbA1c, lipids and smoking status at each check.
• Link findings to concrete support, such as smoking cessation or review of antipsychotic metabolic effects.

Why it matters

A health check that people with severe mental illness do not attend cannot close their mortality gap.

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