People with SMI can die up to 20 years younger than the general population due to preventable physical health issues like cardiovascular disease and diabetes. SMI cases are an opportunity to show you understand the issues and how to intervene.
Core checks:
🌟Tips🌟
Start with Compassion: To get engagement you need trust. Start off well by listening and acknowledging the psychological and physical health challenges. Messages of empathy should be personal and genuine, "I am sorry to hear the anxiety has been bad… ,
Emphasise Holistic Care: Highlight your commitment to looking at the whole picture. " …and you’ve been struggling with your landlord. I might be able to help you with those issues”
Integrate Risk Management: Raise awareness . "Its my job to help keep you healthy by looking after your heart and preventing diabetes." And collect the data you need for Qrisk and diabetes assessment (weight, lipids, HBA1c, family history).
Personalised Plans: “We need to figure out what will work best for you” Help the patient to make a plan they can enact: Can they exercise?, what exercise do they enjoy?, Can they join an exercise program specifically for those with mental illness e.g. the SHAPE program?, Would they engage with dietary support (dietetics).
Teach and Educate: Help the patient understand medication impacts and preventive measures. Give clear, messages in digestible chunks. "Antipsychotics can lead to weight changes, so it’s important we make a plan so you can eat well and keep active"
Smoking: It is important to keep the patient onside. A non-confrontational technique taken from motivational interviewing is to start the conversation by asking about feelings. “How do you feel about your smoking”
Interventions & Support: Critical to being effective is continuity and follow up. So, remember to agree a target goal and a follow up date to see them again.It often takes a few goes to get your phrasing and timing right so don't let SCA be your first try.
Why not do a role play a case and listen back on Clinitalk with your role play buddies.
How about Julie a 22 year old with Schizophrenia, smoker, BMI 32 on olanzapine.
Ref: NICE CG178 / NHS England
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