Richard Armitage is a GP and Clinical Lead affiliated with the Division of Epidemiology & Public Health at the University of Nottingham. He is on Twitter: @drricharmitage
People living with severe and prolonged mental illness in England die 15-20 years earlier than the general population.1 This premature mortality is mostly explained by preventable and controllable non-communicable diseases such as cardiovascular disease and cancer. Accordingly, NHS England’s 2016 Five Year Forward View for Mental Health aimed to address this inequity by increasing early detection and treatment of physical ill-health in people living with severe mental illness (SMI) through annual full and comprehensive physical health checks. The vast majority of these take place in primary care and necessitate face-to-face clinician-patient interactions.1
People with severe mental illness die 15-20 years earlier….
NHS England publishes quarterly data on the number of people on the General Practice SMI register and how many of those received a physical health check in the previous 12-months.2 On 31 March 2020 (end of 2019-2020 Q4), 35.8% (159,312 of 444,972) of eligible patients had undergone a full physical health check in the preceding year, a comparable figure to the previous quarter (32.3%).
Cases of SARS-CoV-2 infection in England began to rapidly increase in March 2020, leading to the first national lockdown beginning 23 March 2020. On 30 June 2020, only 28.6% (136,416 of 476,616) eligible patients had undergone a full physical health check in the preceding 12 months. This fell to 23.7% (119,980 of 506,716) eligible patients on 30th September 2020.
NHS England also publishes monthly data on the number of appointments in primary care.3 To reduce the risk of viral transmission there was a 47.2% decrease in the number of face-to-face appointments between 01 April 2020 and 30 September 2020 (61,643,671) compared with the corresponding figure in 2019 (116,722,482).
There was a 33.8% decrease in the proportion of patients … who had undergone a physical health check …. following the first COVID-19 lockdown.
In summary, there was a 33.8% decrease in the proportion of patients living with SMI who had undergone a full physical health check in the preceding year in the six-months following the first COVID-19 lockdown in England, alongside a substantial decrease in face-to-face appointments in primary care. Since these physical health checks cannot be conducted remotely, their decrease is partially explained by this decrease in face-to-face appointments.
While the consequences of viral transmission are significant, so too are those of unidentified and uncontrolled non-communicable diseases in people living with SMI. The well-recognised risk of premature mortality must be weighed against the threat of COVID-19 transmission during physical health checks.
The decrease in physical health checks amongst this cohort must be urgently addressed.
COVID-19 has disproportionately impacted on those living with SMI in multiple ways, including higher risks of infection, severe clinical outcomes, and declining mental health.4,5 The decrease in physical health checks amongst this cohort must be urgently addressed to prevent greater burdens of physical ill-health being added to this list.
- The Mental Health Taskforce. Five Year Forward View for Mental Health. https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf [accessed 27 January 2021]
- NHS England. Physical Health Checks for people with Severe Mental Illness. https://www.england.nhs.uk/statistics/statistical-work-areas/serious-mental-illness-smi/ [accessed 27 January 2021]
- NHS Digital. Appointments in General Practice Report. https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/general-practice-data-hub/appointments-in-general-practice [accessed 27 January 2021]
- SW Lee, JM Yang, SY Moon, et al. Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort study. The Lancet Psychiatry 01 December 2020; 7(12): 1025-1031. DOI: 10.1016/S2215-0366(20)30421-1
- K-Y Pan, AAL Kok, M Eikelenboom, et al. The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts. The Lancet Psychiatry 08 December 2020. DOI: 10.1016/S2215-0366(20)30491-0