Still 'being bothered about Billy': managing the physical health of people with severe mental illness.

Abstract

People with severe mental illness (SMI) face a future not only limited by stigmatising psychiatric illness, but also a life shortened by 15–20 years through physical comorbidities. Social and behavioural determinants help explain why many of these comorbidities cluster together. Moreover, the experience of multiple conditions, sometimes with conflicting management requirements and multiple healthcare providers, creates a disproportionate treatment burden accompanied by often poorer individual disease outcomes, a situation compounded by discriminatory health care.1 The late Professor Helen Lester called upon GP colleagues to make the care of people with SMI core business in her 2012 James Mackenzie Lecture, ‘Being Bothered about Billy’, to the Royal College of General Practitioners (RCGP) Annual General Meeting. Recognising the particular contribution of cardiovascular disease (CVD) and diabetes to reduced life expectancy, Professor Lester urged GPs to ‘Don’t just screen, intervene’ for cardiometabolic risks. This advice was seemingly unheeded when GP contract negotiators retired three key cardiometabolic indicators from the 2014/2015 Quality and Outcomes Framework (QOF),2 with the predictable detrimental impact of this decision.3 While CVD remains the commonest cause of a still widening mortality gap,4 this population also experiences elevated rates of other physical comorbidities compared with the general population.5 We will argue that tackling this health inequality should remain core business for GPs. ### Why this matters to primary care In the UK, the lifetime prevalence of psychotic disorders such as schizophrenia and bipolar disorder are 0.72%6 and 1–2%7 respectively. A GP with an average list size can expect about one patient per year to present with a new psychotic illness, characterised by changes in perception, thinking, mood, and behaviour. Stigma and social isolation compound disrupted education and employment, and financial and accommodation uncertainties. About 20% of individuals will fully recover following a single episode. However, most continue to experience psychological and …