Physical health monitoring in severe mental illness has settled into a metabolic routine — weight, blood pressure, lipids, glucose, prolactin — and immunisation is almost never on the form. It should be, because the same barriers that produce the metabolic gap produce the vaccination gap: disengagement, disorganisation, transport, stigma at the point of access, and a primary care list that has lost contact with the patient.
So ask, and record. Which vaccines, when, and whether the patient knows how to get the next one. Then close the loop yourself rather than referring the question back — a message to the general practice naming the patient and what is due achieves more than advice given to a patient who will not attend.
Where your service has a depot clinic, a community team visit, or any regular contact the patient reliably keeps, that contact is the most reliable place in the system to deliver or arrange a vaccine. Use it.
- Add immunisation status to the physical health review template alongside metabolic monitoring
- Record which vaccines, when given, and what is due next
- Send a named message to the general practice rather than advising the patient to arrange it
- Use depot clinics and community visits as the delivery or booking point — they are the contacts patients keep
- Treat disengagement from primary care, not vaccine refusal, as the usual reason coverage is missing
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