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Table 1 Views on the importance of CHD risk factor screening and obstacles to its success
| View expressed by * | ||||
|---|---|---|---|---|
| Reasons cited for the importance of CHD screening in SMI | CMHT | GP | SU | N |
| • There is a high prevalence of smoking and weight problems among their own caseload with SMI |
|
| 23 | |
| • Physical health is often neglected by services due to their focus on clients' mental health problems |
|
|
| 20 |
| • Side effects of antipsychotics, e.g. weight gain and metabolic |
|
|
| 14 |
| • Physical health can be neglected due to clients' poor motivation and social isolation – they need extra help and encouragement with this |
|
|
| 13 |
| • Research evidence indicates people with SMI are a high risk group for CHD |
|
| 9 | |
| • Knowing about one's personal risk for CHD would enable clients to take timely preventative action (e.g. to make lifestyle changes) |
| 8 | ||
| • Regular screening would allay client's fears about their physical health |
| 7 | ||
| • Clients are aware of their own risk factors for CHD, especially smoking, family history, diet and weight |
| 6 | ||
| • Screening should be offered to everyone, regardless of SMI diagnosis |
|
|
| 3 |
| • Recent experience of clients with SMI dying due to undetected CHD |
| 2 | ||
| • The stress of having SMI may adversely affect the heart |
|
| 2 | |
| • People with SMI are harder to engage and so need more assertive screening |
| 2 | ||
| • It is important for staff to recognise risk and be able to interpret any new physical symptoms as organic rather than psychological in nature |
| 1 | ||
| Perceived obstacles to/negative views of CHD screening | ||||
| • Lack of appropriate resources in existing services – e.g. time, trained staff |
|
| 18 | |
| • Anticipation of low uptake rates by patients with SMI |
|
| 17 | |
| • Perceived difficulty in making lifestyle changes amongst people with SMI, even if risk CHD factors are identified |
|
|
| 15 |
| • Patients dislike having blood tests |
| 12 | ||
| • Lack of funding for CHD screening services or it not being seen as a priority by Trust management |
|
|
| 12 |
| • A screening offer might be viewed as interference in patients' lives – they may feel defensive, anxious or paranoid |
|
| 7 | |
| • Stigma: a perception that services such as smoking cessation can't deal with people with SMI |
|
|
| 4 |
| • CMHT services already "squeezed" |
| 4 | ||
| • Staff resistance to more changes in their role – CHD screening would be moving too far away from their mental health role |
| 4 | ||
| • Poor communication of results between primary and secondary care |
|
| 3 | |
| • Lack of appropriate services to refer patients to if risk factors are identified – e.g. long waiting lists, narrow referral criteria, group sessions |
| 3 | ||
| • It would not be cost effective to screen all SMI patients, only those in high risk groups e.g. overweight |
|
| 2 | |
| • Prior experience of low attendance when routine screening appointments were offered to people with SMI in line with the new GP contract |
| 1 | ||
