Nikita Le Sauvage, Equally Well UK Expert by Experience member
As an expert by experience, I have been fortunate to have had many examples of good care, and my physical health checks have been no exception. One example of this is that each of my appointments are tailored to times which suit me. I’m a single mum so they are generally between 10am and 2pm, and as I can get very anxious they take place when the Community Mental Health Team (CMHT) building is quiet. Another positive aspect is the relationship between me as the service user and the physical health nurse, who also passes on feedback to my consultant psychiatrist. This means that everyone involved in my care has a good understanding of my history and my needs, and that if I’m not doing so well, they can all recognise the signs and know what works best to help me deal with any difficulties. For example, if I’m not quite myself but don’t feel it necessary to call the CMHT, because of my relationship with the physical health nurse there is at least a record of how I have been feeling when I come to my quarterly consultant psychiatrist appointments.
In the past I have also been under a dedicated lithium and clozapine clinic. This worked well as the nurses knew about the medications and how they interact and gave me advice about daily things to consider, such as my fluid intake, all in minute detail. It was this clinic which familiarised me with annual physical health checks and meant that I was able to learn about electrocardiograms (a test used to check for heart problems), lithium and other blood tests, blood pressure checks as well as many other elements and their relevance to me. This information was provided to me in advance – before the appointments for these checks started.
Of course, as in all areas of life and health care, I have also experienced some less than favourable treatment. On registering with a GP at one trust, I was told to contact the receptionist if I had any questions or concerns about my physical health and there was no mention of an annual physical health check. Even following discharge from an acute ward there was no physical health follow-up by the GP or CMHT. This made it easy for me to forget the impact of my medication on my physical health as it felt unimportant and I didn’t have any regular appointments in my diary.
Though I don’t believe that there’s a perfect method of communication, as everybody is different, I have spoken to a lot of fellow service users who dread the unexpected letters from services. I know that if I’m unwell I go into a maintenance mode where I do the bare minimum, meaning post which is ambiguous is usually ignored. I prefer a text rather than a letter, so asking people their preferred method of communication is important.
After speaking to a carer in preparation for a webinar I recently spoke at on my experience, I also learnt about the difficulties some people have with trusting health services, particularly if they’ve never had a physical health check or a positive experience in the past. They don’t know why they should have it, and they don’t know what may happen at the physical health check, how their information will be used or what will happen if something is wrong.
I think that in cases of first-time attendees it would be helpful to open the doors, as it were, and allow people to see the spaces their appointments would be held in, familiarise themselves with the staff and maybe even have the electrocardiogram and blood pressure machines demonstrated to them. Being offered physical health checks is absolutely vital, and I think the key to spreading this understanding is to take away the fear, ease the anxiety and explain each step going forward.