Thread by @Mental_Elf

Hello, good evening and welcome to our third Mental Health Question Time of 2019

WATCH LIVE from 6pm elfi.sh/mhqt-physical

TWEET your questions/comments to #MHQT

QUESTION: Fit for purpose: how can mental health care professionals support physical health?

Our Chair this evening is Prof David Osborn @osborn_ucl from @UCLPsychiatry

Our panelists are:
@CoProNorfolk @NSFTtweets
@FGaughran @MaudsleyNHS
@SimonGilbody @MHARG_york
@Andy__Bell__ @CentreforMH
@simranNMHIN & Cam Lugton @PHE_uk
#MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk People living with mental illnesses have an increased risk of developing a physical illness compared with the general population, AND when they experience ill-health, they have poorer access to adequate medical services #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk This inequity results in worse health and shorter lives for individuals with diagnoses ranging from schizophrenia to depression #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk There is increasing interest in preventing and managing physical health problems in people with mental illnesses. But are changes in clinical practice, or even mental health services, enough? #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk What exactly is driving the mortality and morbidity gap, and do we need to think bigger by addressing its societal and economic drivers? #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk You can watch this #MHQT public discussion live elfi.sh/mhqt-physical & join in with the conversation on the hashtag #MHQT Each of our speakers will speak for 5 mins in response to a question from the Chair. We’ll then open it up for comments and questions from the floor

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk We'll be starting in 5 mins at 6pm.

Grab a cuppa!

Two browser tabs:

1. YouTube video in one
elfi.sh/mhqt-physical

2. #MHQT tweets in the other
twitter.com/hashtag/MHQT?s…

Give us a wave if you're watching 👋

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk Welcome to our Physical Health & Severe Mental Illness #MHQT elfi.sh/mhqt-physical

Chair: David Osborn @osborn_ucl
Panel @CoProNorfolk @FGaughran @SimonGilbody @Andy__Bell_ @simranNMHIN

Unfortunately @DianaRose160 is not able to join us tonight. Get well soon Diana!

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 Our first speaker is Kevin James @CoProNorfolk a "peer consultant and change agent". He is a governor of @NSFTtweets, a trustee of the charity @equallives_org which is "dedicated to making the voices of those who face disabling barriers heard" #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org Our chair @osborn_ucl is asking @CoProNorfolk

❓Do you think people get offered the kind of help with their physical health that they would like and need? #MHQT

Kevin, unsurprisingly, begins by saying "The quick answer is NO, but people are starting to do this"

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org WE ARE LIVE and discussing:

Physical Health and Severe Mental Illness
#MHQT

elfi.sh/mhqt-physical

Join us!

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org One of my friends was told she could be "skinny and psychotic or fat and healthy". This is unacceptable @CoProNorfolk #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org Our next #MHQT panelist is Dr Fiona Gaughran @FGaughran lead consultant in the National Psychosis Service and director of research and development @MaudsleyNHS. She is also a reader in psychopharmacology and physical health in the department of psychosis studies @KingsIoPPN

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN .@osborn_ucl asks @FGaughran

❓A lot of strategies to improve physical health that have been in research trials up to now have not shown very much evidence of effectiveness. How could we do better, or what can we learn from existing research that would improve practice? #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN Westman et al (2019) Taking part in research studies helps, but are we including the wrong people in research? says @FGaughran researchgate.net/publication/33…

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN "Research studies don't always reach the people who are most ill and most need our help" @FGaughran at #MHQT

Lally et al (2018) The Representativeness of Participants With Severe Mental Illness in a Psychosocial Clinical Trial frontiersin.org/articles/10.33…

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN Next up at #MHQT it’s Prof @SimonGilbody Director of @MHARG_york & lead of the #ClosingTheGapSMI mental health research network @CTGNetworkUK which aims to understand why ppl w severe mental illness have some of worst physical health issues in our society york.ac.uk/healthsciences…

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK Our chair @osborn_ucl is now asking @SimonGilbody

❓What should be the number one priority in improving the physical health of people with severe mental illness?

(It’s almost as if he’s written his own question) #MHQT #drumroll

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK At #MHQT @SimonGilbody is saying we should help people stop smoking york.ac.uk/healthsciences…

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK “It’s time for the V-compromise: varenicline & vaping. Partnership with service users means resources for peer support workers.”

#SCIMITAR trial in @TheLancetPsych led by @SimonGilbody

We blogged about it here nationalelfservice.net/mental-health/…

Tx @Davidiris1 @pubmentalhealth #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth Health professionals! Are YOU prescribing varenicline and vaping (electronic cigarettes) to patients with severe mental illness? Check out this 2018 position statement from @RCPsych @Davidiris1 @pubmentalhealth #MHQT rcpsych.ac.uk/docs/default-s…

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych Next up is @Andy__Bell__ Deputy CEO @CentreforMH. Andy is a member of the Mental Health Policy Group & chaired the Mental Health Alliance 2006-08. He’s also carried out research on implementation of national mental health policies & on local mental health needs assessments #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych Our #MHQT chair @osborn_ucl is asking @Andy__Bell__

❓Should poor physical health outcomes among people with severe mental health problems be seen as a problem of equality?

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych At #MHQT @Andy__Bell__ is talking about @EquallyWellUK A “collaborative formed by @CentreforMH @kscopehealth @Rethink_ & Royal Colleges to bring about equal physical health for people with severe mental illness. equallywell.co.uk

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ Check out the @EquallyWellUK podcast I recorded for their launch in 2018 if you want a broad overview of their work #MHQT

soundcloud.com/national-elf-s…

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ At #MHQT @Andy__Bell__ is stressing that we need to address social deprivation, health inequalities and many kinds of discrimination. Helping people improve their physical health is not a "problem to fix", it requires a joined up systemic solution centreformentalhealth.org.uk/campaigns/equa…

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ Our final panelists are Simran Sandhu @simranNMHIN & Cam Lugton who both work for @PHE_uk. Simran is the Programme Manager of the National Mental Health Intelligence Network, and Cam is the Programme Lead for the same network #MHQT fingertips.phe.org.uk/profile-group/…

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ Our #MHQT chair @osborn_ucl is asking @simranNMHIN & Cam Lugton @PHE_uk

❓How can we change the care system as a whole to manage physical health among people with severe mental health problems better?

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ We are LIVE NOW at #MHQT discussing physical health in mental illness

Watch elfi.sh/mhqt-physical

Tweet #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ The LIVE #MHQT discussion on physical health in mental illness is now hotting up as @osborn_ucl asks for comments & questions from the floor.

That includes YOU tweeps! Send us your thoughts and don’t forget the hashtag

⭐️ #MHQT ⭐️

elfi.sh/mhqt-physical

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ Our first comment from the floor is about #Austerity

Well @Andy__Bell__ jumps in to answer this one:
"It's important that we call this out, difficult economic conditions cause mental ill-health, we've seen massive cuts in public health budgets, the loss of SureStart etc."
#MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ It's incredibly complex this physical health and severe mental illness question.

BUT we can start by heating people's houses, making sure they have enough food, and ditching our existing adversarial benefits system
- @Andy__Bell__ #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ Question from the floor:

❓How can we close the #MortalityGap when we don't have enough NHS staff on the ground to deliver the service?

The Mortality Gap is 15 years. People with severe mental illness die younger #MHQT elfi.sh/mortality-gap

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ We need to prevent physical illness from developing in the first place, says @FGaughran but we need an integrated care system to do this. This DOES require money and sufficient staffing #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ There’s half an hour left in our LIVE #MHQT discussion on physical health in mental illness.

Do YOU have any thoughts or questions that I can put to our expert panel?

elfi.sh/mhqt-physical

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ Now @soniajohnson asks how we can improve prescribing of antipsychotics to minimise the physical health harm they may cause. #MHQT

@FGaughran says patients/prescribers have choice and the mortality gap is largest for people NOT on antipsychotics.

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ @soniajohnson Shared decision making is really crucial when it comes to antipsychotics, says @Andy__Bell__ at #MHQT

"Why didn't they tell me about the side-effects?" is a question that we still hear too often.

Let's bring mental health pharmacists into this!

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ @soniajohnson From the floor Nicola Morant says we need primary and secondary care to work much better together. Providing GPs with more time and skill to discuss psychiatric medication with patients #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ @soniajohnson Comment from floor: People often aren't well informed about WHEN and HOW to take their psychiatric medication.

These are often simple problems that can be solved #MHQT

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ @soniajohnson Question from floor: What about team-sport? With such a light-touch intervention we can improve physical health, improve social connectedness etc. #MHQT

Are we overlooking social prescribing (e.g. playing football) for people with severe mental illness?

@osborn_ucl @UCLPsychiatry @CoProNorfolk @NSFTtweets @FGaughran @MaudsleyNHS @SimonGilbody @MHARG_york @Andy__Bell__ @CentreforMH @simranNMHIN @PHE_uk @DianaRose160 @equallives_org @KingsIoPPN @CTGNetworkUK @TheLancetPsych @Davidiris1 @pubmentalhealth @rcpsych @EquallyWellUK @kscopehealth @Rethink_ @soniajohnson Cam Lugton from @PHE_uk answers by saying we need to improve the evidence-base for these kinds of interventions (cost-effectiveness especially) #MHQT Then we can roll-out wider implementation