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Physical health handbook Patient information Contents Foreword 2 Do you have a choice? 4-5 What checks do I need for my medicines? 6-7 If you take antipsychotic medication completing this form before your health check may be useful 8-9 Taking control of side effects 10 - 12 Managing long term health conditions (diabetes, obesity, CHD, COPD) 13 -18 Smoking Cessation (Stopping Smoking) 19 - 21 Exercise therapy 22 - 23 Healthy Eating24 Useful resources26 Foreword At South West London and St George’s Mental Health NHS Trust, we are committed to providing the best care and support for you not only for your mental health but your physical wellbeing too. People with mental health problems and learning disabilities are at increased risk of developing physical illness, especially heart disease and diabetes. This is due to a combination of factors including the effects of medication, smoking and lack of exercise. Physical health problems can often affect your mental health so that is why we want to ensure we offer you the right support and help in order for a speedy recovery. This booklet will provide you with information on the types of checks we carry out and on common physical health conditions which may have an impact on you and your recovery. 2 Physical health handbook About us We are committed to the provision of consistent, personalised, high quality services, a journey of continuous quality improvement. We also have an on-going commitment to being a learning organisation. Our approach focuses on three components of quality: safety, effectiveness and patient experience to assure our stakeholders on the quality of our services. Why are physical health checks needed? We aim to provide excellent care that not only looks after your mental health and wellbeing but will support you with any physical health care needs. The national mental health strategy ‘No health without Mental Health’ (2011) outlined good physical health as one of six key objectives to improve outcomes for people with mental health problems. Whether on the ward or in the community, the team need to get a good idea of how healthy you are when you first come into hospital and may need to monitor your physical health throughout your stay. This is important, as sometimes physical health conditions may be causing or contributing to your mental health symptoms. Therefore assessing your physical health is just as important as assessing your mental health. Why do we do this? • It helps us to identify and treat any early signs of physical health problems you may have • It helps us to prevent or treat any physical health problems associated with medicines you take for your mental health condition. Please ask your nurse for a copy of the physical health checks for those taking medicines for your mental health • We may need to continue with any care and treatment you may have been getting from your family doctor or another hospital service before you came into hospital • We can help by putting you in touch with a GP if you do not already have one www.swlstg-tr.nhs.uk3 Do you have a choice? Staff will offer physical health tests and checks and you can choose whether or not to have them. However, we feel that it may be in your best interest to have the test done so we may offer them to you again, even if you have previously refused. If we see your health getting worse and you refuse any of the tests we offer you, we’ll talk to you to make sure you understand the consequences of refusing. A ‘best interest meeting’ may be set up with you, your care team, your family or someone else you’d like with you to discuss how best to care for you. When do these physical health checks happen? Everyone admitted to an inpatient ward should have a comprehensive physical health care assessment within 48 hours of admission. Also, we will offer daily physical checks which will include, taking your blood pressure, temperature and pulse along with regular weight checks. 4 Physical health handbook What physical health checks are included? Physical health care assessment include the following: • Questions about any pre-existing medical conditions you may have • Questions about lifestyle e.g. smoking/ diet / nutrition / exercise / alcohol / drugs/ sleep • Asking about allergies • Asking about side effects of medication • Measuring your pulse, blood pressure, breathing and temperature • Measuring weight and height • Testing urine • Routine blood tests www.swlstg-tr.nhs.uk5 What checks do I need for my medicines? If you are prescribed medication to treat your mental illness we will need to complete various physical tests including an ECG (electro-cardiogram records the electrical activity of the heart and detect abnormal heart rhythms), blood pressure, pulse, height and weight measurements. We also carry out blood tests that include checks for diabetes, cholesterol and other conditions that may impact on your wellbeing. The blood test will also measure levels of certain medications you may be taking. Some tests are repeated after three months, six months or annually depending on the type of medication to monitor the impact of the treatment on your physical health. If there are any negative impacts or side effects, your doctor will review and change the medication if necessary. Information on different medications Printed information on the different medications is available, including the types of physical checks you should expect. You can request this information from your named nurse, psychiatrist or ward pharmacist who can also advise you on the types and frequency of any physical examinations. 6 Physical health handbook When you are in the community An annual physical health check is available to people with a diagnosed mental illness, not only for people who are taking psychiatric medication. You should be sent a reminder about a physical health check if you are on the GP practice’s register for people with a mental health diagnosis. The check-up will be similar to the one you had when you were admitted to hospital and should include taking your blood pressure, blood tests to check for cholesterol levels; checking weight and blood sugar levels, and a discussion about lifestyle e.g. exercise, healthy eating and smoking. If any problems are found, the GP should refer you for specialist assessment and support. The GP, practice nurse or community mental health team (CMHT) should share the test results with other people involved in your care for example your GP, care coordinator and/or psychiatrist. You should also get a copy of the results. www.swlstg-tr.nhs.uk7 If you take antipsychotic medication completing this form before your health check may be useful Glasgow Antipsychotic Side effect Scale (GASS-C) This questionnaire is used to see if you have any side effects of newer antipsychotic medicines. Put a tick in the box that describes if you get the side effects and a tick if that side effect distresses you. Health professionals can help with the results and management of side effects. Over the past week: Never Once A few times Everyday Distressing? 1. I felt sleepy during the day 2. I felt drugged or like a zombie 3. I felt dizzy when I stood up and / or have fainted 4. I have felt my heart beating irregularly or unusually fast 5. My muscles have been tense or jerky 6. My hands or arms have been shaky 7. My legs have felt restless and / or I couldn’t sit still 8. I have been drooling 9. My movements or walking have been slower than usual 8 Physical health handbook Over the past week: Never Once A few times Everyday Distressing? 10. I have had, or people have noticed, uncontrollable movements of my face or body 11. My vision has been blurry 12. My mouth has been dry 13. I have had difficulty passing urine 14. I have felt like I am going to be sick or have vomited 15. I have wet the bed 16. I have been very thirsty and / or passing urine frequently 17. The areas around my nipples has been sore or swollen 18. I have noticed fluid coming from my nipples 19. I have had problems enjoying sex 20. Men: I have had problems getting an erection 21. I have been constipated or had difficulty passing stools Over the past three months: Yes No 22. I have been constipated or had difficulty passing stools 23. Women: I have noticed a change in my periods 24. I have been gaining weight www.swlstg-tr.nhs.uk9 Taking control of side effects These are a few suggestions you may want to think about for dealing with unwanted side effects Nausea/sickness • Take medication with food, unless told otherwise. • Eat smaller, more frequent meals. Sip water. • Talk to your prescriber about changing the dose or medicine. Movement problems such as shakiness or stiffness • These types of side effects are best treated by reducing the dose or switching to a different medication. • You can have an additional type of medication to treat any shakiness or stiffness but this is not recommended in the long term. • No one should have to tolerate this type of side effect as there are plenty of other choices of medicines available that cause little or no movement problems. Dry mouth, constipation • A high fibre diet that includes plenty of fruit and vegetables is helpful. Water rather than fizzy drinks and sugar free gum for a dry mouth might help. • It is important to look after your oral hygiene. It is helpful to brush your teeth twice a day and have regular dental check ups as a dry mouth can lead to tooth pain and tooth loss. 10 Physical health handbook Weight gain • It is helpful for you and your care team to take a proactive approach to prevent weight gain. • You should weigh yourself regularly and measure your waist size. • Take into account your appetite may be much stronger and you might crave foods that relieve hunger quickly such as chocolate, sweets, cakes, fizzy drinks and fast food. • Try and plan ahead, learn how to read food labels and how to make healthy snacks and meals. • Speak to your team about getting support to increase your activity. • If you are unhappy with the effects of your medicine on your weight, speak to your prescriber and ask for an alternative medicine. Low blood pressure (dizziness, feeling faint and light headed) • Have your blood pressure taken regularly. Make sure you are not dehydrated, avoid alcohol, heavy meals, long periods of lying down, long periods of standing still and very hot baths or showers. • If it persists, discuss the possibility of switching to a drug that does not cause low blood pressure with your prescriber. www.swlstg-tr.nhs.uk11 Raised blood sugar, diabetes • Just like with weight gain, a proactive approach is needed to prevent changes in blood sugar and the onset of diabetes. • The level of sugar in your blood should be tested before a medicine is prescribed, then every three months and every six months, when stable. • A healthy lifestyle - a good diet, keeping active and not smoking all help to maintain stable blood sugar levels. • Report symptoms such as frequently passing water, increased thirst and abdominal pain to your care coordinator. Sexual side effects • Report any changes in your interest, performance and satisfaction with sex, as well as swollen, leaking breasts (men and women) and erratic periods (women). • Discuss with your prescriber either reducing the dose or switching to a drug that does not cause these side effects. • Make sure you follow health promotion advice e.g. breast self-examination and contraceptive advice. 12 Physical health handbook Managing long term health conditions Diabetes What is diabetes? Diabetes is a condition where there is too much glucose (sugar) in the blood stream. This happens either because the body does not produce enough insulin or stops responding to it. For those who have diabetes, it is a condition for life. However, it can be well managed to avoid complications developing. It is important for someone with diabetes to monitor their blood glucose levels regularly to ensure they have good control. Being on medication for your mental health may affect your diabetes control, so close monitoring is very important. Do you have diabetes? If you have diabetes there is a wide range of help and support available: • If you are an inpatient staff can help you monitor your blood for glucose and understand your medication • The dietician can help you with healthy eating and weight management • Exercise therapy, gym sessions and occupational therapy are available to you In the community your GP and practice nurse will offer monitoring and support. www.swlstg-tr.nhs.uk13 Obesity What is obesity? Obesity or being very overweight is a condition described by an abnormal or excessive amount of body fat that presents a risk to your health. One of the ways to check for obesity is to calculate something called the Body Mass Index (BMI) by measuring your height and weight. Another useful method is to measure around your waist. People with large waists (94cm or more in men and 80cm or more in women) are more likely to develop obesity-related health problems. Medications and obesity Many medications prescribed for psychiatric conditions, like antidepressants and antipsychotics, can also cause weight gain as a side effect. Your doctor will discuss this with you, before starting treatment and will suggest methods how to address this. Management of obesity • The ward staff can help you with developing a plan to manage weight gain and can referral to a dietitian for more specialist advice. • The ward menu has healthy choices marked with a red healthy heart. • We recommend that you take part in regular activities. These may be arranged on the ward or a gym referral can be made. • We recommend that you avoid snacks, takeaway meals and sugary drinks. 14 Physical health handbook Hypertension (High blood pressure) What is hypertension? Hypertension is abnormally high blood pressure. What causes hypertension? In the majority of cases, no clear cause is found for raised blood pressure. In some cases, it may be due to a underlying illness, for example, a kidney disease or a thyroid problem and this would need to be ruled out. You have a higher risk of developing high blood pressure if you lead an unhealthy or stressful lifestyle or there is a family history of high blood pressure, heart disease or stroke. What are the complications of hypertension? The main problem with hypertension is that there are almost no symptoms until serious problems develop. You can have raised blood pressure for a long time without noticing, until you develop complications. High blood pressure increases the risk of heart attacks and stroke. That is why it is important to check your blood pressure regularly if you are at risk. Next steps If you are admitted to the ward, the nurses will check your blood pressure and the doctor will perform a physical health examination. Your team will discuss any concerns with you and can advise and support you should you need further tests or treatment. They will also liaise with your GP as they will take over your monitoring once you leave the ward. www.swlstg-tr.nhs.uk15 COPD What is COPD? COPD stands for Chronic Obstructive Pulmonary Disease. It is also known as chronic bronchitis and emphysema. Typical symptoms of COPD are: • Increasing shortness of breath when physically active • A persistent cough with phlegm • Frequent chest infections. What causes COPD? The main cause of COPD is smoking. The more you smoke and the longer you have been smoking, the more likely you are to develop COPD. Smoking irritates and inflames the lungs, which causes scarring of the lung tissue. Over many years, the inflammation leads to permanent changes in the lungs. Prevention of COPD The best way to prevent developing COPD is to stop smoking. Next steps If you are admitted to the ward, the nurses will check your blood pressure and the doctor will perform a physical health examination. Your ward team will discuss any concerns with you and can advise and support you should you need further tests or treatment. They will also liaise with your GP as they will take over your monitoring once you leave the ward. If you wish to stop smoking, your team will be able to support you and refer you to a smoking cessation advisor. 16 Physical health handbook Cardiovascular disease (CVD) What is CVD? CVD is a narrowing of your heart arteries due to fatty deposits in the artery walls. It is more common in smokers and in people with high blood pressure, diabetes or high cholesterol. How common is it? CVD is the most common cause of death in the UK. One in five men and one in seven women die from CVD. There are over 2.5 million people in the UK living with cardiovascular disease. Symptoms of cardiovascular disease These develop slowly over many years. Breathlessness when exercising may be your only symptom. You may not know anything is wrong until you develop chest pains (angina) or have a heart attack. What increases your of cardiovascular disease? A risk factor is something that increases your likelihood of getting a disease. There are several risk factors for CVD, including: • Smoking • High blood pressure • High blood cholesterol • Being physically inactive • Being overweight or obese • Diabetes www.swlstg-tr.nhs.uk17 • Family history of heart disease. • Ethnic background - for Bangladeshis, Indians and Pakistanis, and people with an African Caribbean background, cardiovascular risk can be higher than for the rest of the UK population • Gender - men are more likely to develop CVD at an earlier age than women • Age - the older you are, the more likely you are to develop CVD How you deal with stress, the amount of alcohol you drink, as well as the type of job you do may also influence your risk of developing CVD. The more risk factors you have, the higher your riskof developing CVD. Even though you can’t change all your risk factors, there is plenty you can do to reduce your risk and help to protect your heart. On admission to the ward a number of tests will be carried out. This includes having your pulse and blood pressure taken as well as having a Electro Cardiogram (ECG). The doctor will also ask about your family history, any heart disease and life style questions. (British Heart Foundation 2015) 18 Physical health handbook Smoking Cessation (Stopping smoking) Smoking and medicines Smoking interacts with some psychiatric medications (e.g. Clozapine, Olanzapine) making it less effective, resulting in increased dosages and more side effects associated with these drugs. Please note that if you stop or reduce smoking, your mental health medication may need to be reduced or adjusted. If you have questions about your medicines ask your Mental Health Team or contact Medicines Information on: 020 3513 6829 Smokers are four times more likely to quit successfully with NHS Stop Smoking support. Benefits of quitting / stopping smoking can: • Improve mood • Decrease anxiety and depression • Increase energy levels • Reduce chances of heart disease, lung cancer and stroke • Save you a fortune (At today’s rates, a 20-a-day smoker can save over £3,000 a year). Why do we advise the use of nicotine replacement products? Scientific studies have shown that the use of Nicotine Replacement Therapy (NRT) products such as patches or inhalator: • Are safe to use because they don’t contain the toxic chemicals found in cigarettes such as tar, carbon monoxide and other poisons • Increase the chance of quitting smoking by 50-70% • Reduce nicotine cravings • Reduce withdrawal symptoms such as irritability and anxiety, hunger and difficulty concentrating. www.swlstg-tr.nhs.uk19 Thinking about quitting or managing your smoking? Get support today Ask a member of staff to refer you to your local specialist adviser for support to stop smoking and they can arrange an appointment for you. Please do not hesitate to contact us if you require further information about our Smokefree policies and/or smoking cessation services. Specialist mental health stop smoking service 079 3616 7350 (Wandsworth Smoking Cessation Team) 075 9044 5168 (Merton and Sutton Smoking Cessation Team) “Kick it” Stop Smoking Service 020 3434 2500 (Kingston & Richmond Kick it service) 20 Physical health handbook 10 ways to stay smoke free 2 Get rid of any cigarettes, tobacco, lighters and ashtrays 3 Stay away from second hand smoke 4 Keep reminding yourself why you want to stop smoking 5 Say to yourself “A cigarette won’t solve anything” 6 Relax, breathe, stretch 7 Stay positive 8 Drink a glass of water, fruit juice or herbal tea 9 Take some stop smoking medication 10 Speak to your local Stop Smoking Specialist 1 Say no to cigarettes www.swlstg-tr.nhs.uk21 Exercise Therapy The benefits of physical activity Physical activity can: • Help you lose weight, especially fat • Lower heart rate and blood pressure so your heart doesn’t have to work so hard • Reduce risk of heart disease • Help circulation • Reduced risk of falls and injuries from falls in older people. Physical activity can: • Improve feeling of well being • Help you release stress and feel more relaxed • Help improve mood due to release of endorphins • Increase energy levels • Help sleep patterns • Decrease anxiety and depression. Exercise can help in the treatment and prevention of many illnesses including: • Type II diabetes • Osteoporosis. It also helps reduce the likelihood of contracting some cancers and can improve the immune system. 22 Physical health handbook Exercise can help boost self confidence Exercise doesn’t have to mean leggings, lycra, gyms or aerobics. There are many other ways to increase your activity levels. • Walking is free. Take the dog to make it more interesting or take part in an organised walking group • Park at the far end of the car park • Get off the bus one stop earlier and walk • Use stairs instead of escalators or lifts • Exercise with others to make it more fun and sociable • Take part in more structured exercise with the Exercise Therapy Team. Why exercise? • For enjoyment • For social reasons • For the psychological benefits • Physical health benefits People take up exercise for many reasons, but tend to only continue exercising if they enjoy it. Exercising with others can help you to meet new people and make it more fun. www.swlstg-tr.nhs.uk23 Healthy eating Tips to make sure you eat a balanced diet • Avoid foods that have a lot of calories like burgers, fried foods and takeaways • Choose low-fat dairy options (e.g. skimmed milk, reduced- fat cheese, low-fat yoghurts) • Try not to skip breakfast. This should stop you needing to snack before lunch • Watch the amount of food you eat. Weighing out portion sizes so you know how many calories you have eaten may help • Remember that sugary drinks and alcohol contain calories it’s not just food 24 Physical health handbook www.swlstg-tr.nhs.uk25 Useful Resources There are lots of local and national resources where you can find additional information to support your wellbeing. Local mental health teams can provide information about in your specific areas. NHS Choices - www.nhs.uk British Heart Foundation - www.bhf.org.uk Greater London House, 180 Hampstead Road, London NW1 7AW 0300 333 1333 Diabetes UK - www.diabetes.org.uk 10 Parkway, London NW1 0345 123 2399 British Lung Foundation - www.blf.org.uk 73-75 Goswell Road, London, EC1V 7ER 0300 003 0555 Cancer Research UK - www.cancerresearchuk.org 0207 242 0200 Smokefree England - www.smokefree.nhs.uk NHS Stop smoking helpline 0800 022 4332 Drink Aware UK - www.drinkaware.co.uk 0300 123 1110 Rethink Mental - www.rethink.org Head Office,15th Floor 89 Albert Embankment, London, SE1 7TP 0300 500 0927 Mental Health Foundation - www.mentalhealth.org.uk Colechurch House, 1 London Bridge Walk, London SE1 2SX 020 7803 1100 MIND - www.mind.org.uk 15-19 Broadway, Stratford, London E15 4BQ 0208 519 2122 Samaritans - www.samaritans.org 0845 790 9090 26 Physical health handbook About this Handbook Physical Health Handbook – was written by specialists, and reviewed by healthcare professionals and patients. Contacting the Trust Trust Headquarters, Springfield University Hospital Building 15, 2nd Floor, South West London and St George’s Mental Health NHS Trust, Springfield University Hospital, 61 Glenburnie Road, London SW17 7DJ 020 3513 5000 In an emergency (for existing patients of the Trust) • Mental Health Support Line: 0800 028 8000 (5pm to 9am Monday to Friday, 24 hours Saturday and Sunday). Patient Advice and Liaison Service (PALS) You can call our dedicated Patient Experience team and talk to someone about the service you, or the person you care for, has received. 020 3513 6150 (Monday to Friday 9am to 5pm) Disclaimer We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, South West London and St George’s Mental Health NHS Trust does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Sources For a full list of the sources we used: 020 3513 6006 [email protected] www.swlstg-tr.nhs.uk27 We are the leading provider of mental health services across south west London and a beacon of excellence for national mental health specialist services. Help us make our services even better The views of patients, their carers, friends and families are at the heart of improving the way we deliver our services. We are committed to delivering high quality care. Your feedback will help us understand what we do well and what we can do better. If you would like to give us feedback please contact: • Patient Advice and Liaison Service (PALS): 020 3513 6150 • Feedback online at: https://feedback.swlstg-tr.nhs.uk • Patient Opinion: www.patientopinion.org.uk Become a member: To find out about becoming a member E-mail: [email protected] Physical health handbook Our values If you require this document in an alternative format please call: 020 3513 6006 South West London and St George’s Mental Health NHS Trust Springfield University Hospital, 61 Glenburnie Road, London SW17 7DJ Telephone: 020 3513 5000 Website: www.swlstg-tr.nhs.uk Copyright © 2016 South West London and St George’s Mental Health NHS Trust Published and distributed by: Communications Department Published: March 2016 Review date: March 2018 Ref: PHH0815 All information correct at time of printing