Join up physical and mental health, says Parliamentary Cross Party Group

12th January 2021

The Cross Party Group on Mental Health is calling on the Scottish Government to join up physical and mental health support in its latest report, and stresses that action is needed to prevent earlier deaths of people with mental health problems. 

Access to physical health care and opportunities to be active must be increased for people with mental health problems, in order to tackle inequalities. That’s the key finding from a new report by the Scottish Parliament’s Cross Party Group on Mental Health, as part of its inquiry into progress with the Scottish Government’s Mental Health Strategy.

The World Health Organisation says that people with severe and enduring mental health conditions live 10 to 20 years less than the general population, mainly due to preventable and manageable health problems such as cardiovascular disease, respiratory disease, hypertension, obesity, diabetes, suicide, smoking and a lack of exercise.

But today’s report says it can be difficult for people with mental health problems to get access to vital physical health check-ups and treatment; that there should be more choice of opportunities to be physically active; and that too often medical professionals assume physical symptoms are caused by the person’s mental health problem.

Beatrice Wishart MSP, Deputy Convenor of the Cross-Party Group said:

“It is often said that mental health should be treated with the same attention as physical health. That is, of course, true – but it should not lull people into thinking that they are separate and distinct issues. The pandemic has made the relationship between physical health and mental health clear. A daily walk served as a lifeline in lockdown, and the cancellation of non-urgent treatments was a heavy weight for many. But it has also made it clear that worrying gaps remain and there is plenty of work to do to establish a coherent system.”

Craig, who lives with depression, said:

“My journey began when I broke my hand playing football and despite months of physio I developed Complex Regional Pain Syndrome, leaving me with chronic pain. I couldn’t cope with having a disability and eventually I was diagnosed with reactive depression. My doctor suggested a programme which involved sessions with a Personal Trainer. He was fantastic and could see that I was struggling.

“As part of ALBA (Active Living Becomes Achievable), I had one to one sessions with a Behaviour Change Practitioner and I was also given a step counter. We would set a daily step target and it gave me the determination and focus to beat it - this was something I had not felt since before my accident. Even now, if I feel my mood dropping I’ll stick some music on and go for a walk-  it just gives me that rest and reset.

“It has been harder during the pandemic with gyms being closed and for myself I’ve tried my best to continue walking, but I do find it more difficult with restrictions and anxieties around covid.”

People with experience of mental health problems told the group that they were not routinely called for physical health check-ups and sometimes found it hard to access services like opticians and podiatrists – which can be crucial in diagnosing diabetes.

The group cites evidence from the Royal Pharmaceutical Society (RPS) that medications like lithium and clozapine are linked to acute and chronic health risks, making routine health monitoring essential. And the group also heard calls for more information about the side-effects of medications when these are first prescribed.

The group concluded that there is a lack of clarity about physical health monitoring for people with mental health problems, especially for people also experiencing eating disorders. It cites a recent Mental Welfare Commission report which found that only a few NHS boards had a formalised joint working protocol in place.

The group heard of some positive steps, such as ASH Scotland’s IMPACT project, which helps people with mental health problems who want to stop smoking.  The Scottish Government’s Care About…Physical Activity improvement programme was also highlighted as an effective way of improving the physical activity of older people in care homes.

However, the group also heard that effective initiatives to tackle physical health inequalities, such as the Equally Fit Charter of Rights and the Active Living Becomes Achievable project, did not receive continuation funding, despite successful pilots.

The report makes six recommendations, including a call for local authorities and NHS Boards to develop protocols and guidance about physical health monitoring of people with mental health problems who are being treated in the community, with an initial focus on eating disorders.

This report is the third in the group’s inquiry into progress with the Mental Health Strategy. The first two reports were published in 2020 and focused on prevention and early intervention and treatment and support, respectively. The group has written to the Minister for Mental Health with its recommendations. 

SAMH is issuing the report as part of its role as secretariat for the Cross Party Group on Mental Health. Find out more about the group and read the full report here.