Colloborative Approach to Improve Life Exepectancy of Severely Mentally Ill
In an era where most of us can expect to live into our late 70s or even 80s, the life expectancy of people living with severe mental illness (SMI) can be dramatically shorter.
The average schizophrenia sufferer, for example, may die up to 10 years younger – their truncated lifespan the result of common and largely preventable illnesses, poorly treated because of their lifestyle and neglect by the community.
In an effort to relieve this dreadful toll, a ground-breaking integrated approach to caring for the physical health of SMI sufferers is being trialled in clinics at Sydney Local Health District.
It is hoped the program – the Collaborative Centre for Cardiometabolic Health in Psychosis (ccCHiP) - can be rolled-out to other local health districts in the Sydney Health Partners network.
Stream leader and Professor of Psychiatry at Concord Clinical School, Tim Lambert, explains how cutting-edge information technology and what he describes as “common sense” in service delivery models are combining to improve health outcomes for Australians battling severe mental illness.
- Who are you trying to help?
The most vulnerable psychiatric populations – those with complex and enduring disorders such as schizophrenia or bipolar disorder– who typically carry multiple cardio-metabolic risks such as obesity, high blood pressure, high cholesterol, gum disease, diabetes, high smoking rates, sedentary lifestyles and so on.
The best estimate we have is that these SMI people represent up to 3.5 per cent of the population. In a country of 25 million, that is a lot of people who are potentially living in poor health and dying much too young.
- Why are you undertaking this research?
The traditional approach to public health care doesn’t work for the severely mentally ill. They have a poor record of attending clinical appointments and may not be able to remember what they are there for, what treatments they have had elsewhere, or what instructions or lifestyle advice they were given by clinicians. We believe there is a need for a clinical approach that spans the gap between traditional psychiatry and general medicine.
- What are you working on?
Recognising the difficulty SMI patients experience in attending multiple, serial and geographically dislocated assessments, we are taking the common sense approach of providing assessment by up to eight disciplines in a single session. These comprise dietetics, exercise physiology, oral health (dental), nursing, cardiology, endocrinology, sleep medicine, general medical psychiatry, and pharmacology.
At the end of the session, the whole team discusses each patient in order to provide an interdisciplinary synthesis of the issues presented during the assessment (and incorporating relevant clinical materials assessed prior to the clinic).
Our patients have the services of a community nurse who will take them to visit their GP within four weeks of attending our clinic.
- What information systems are you developing to support this integrated approach?
To help clinicians and GPs work with a lot of information, the program is also innovating in the IT space. The workflow incorporates a bespoke web application that incorporates the functions of relational database, an adherence promotional tool to assist patients (using a variety of graphics-rich tools), an e-learning tool for multidisciplinary students, and a reporting tool that automates the development of reports for all relevant clinicians involved in the patient’s care. Clinicians can login to the tool anywhere in the LHD network using any device that can access the internet.
We are also working on the final developmental phase of an integrated referral and reporting system that integrates eMR, GP databases, private and public pathology providers, and prescribing databases.
- How does being part of a collaborative partnership like Sydney Health Partners help you to achieve more than you would be able to individually?
ccCHiP is being pioneered by Sydney Local Health District and now has the support of the leadership of the other two LHDs in the Partnership - Northern and Western Sydney local health districts. SHP is now facilitating the introduction of this novel clinical model across the network. The message: that every clinician, in any branch of medicine and health, now needs to be master of the “three Cs” – Chronicity, Complexity and Co-morbidity.
- What potential do you see for scaling-up the results of your research? How can it reach more people in the health system?
ccCHiP has demonstrated through its year-on-year growth (in partnership with LHD and GPs) that the barriers to providing integrated health care to the SMI, engendered by traditional disciplinary silos, can be overcome. Implementation across the SHP network will give the program greater scale, generate more data and, I believe, provide clear evidence that this approach translates into better global health outcomes for the severely mentally ill.