Understanding SMI Annual Health Checks
People living with a Severe Mental Illness (SMI), such as schizophrenia, are at higher risk of developing long-term physical health conditions and experiencing health inequalities. SMI Annual Health Checks are designed to support people to stay well by identifying physical health concerns early, preventing the onset of long-term conditions, and reducing health inequalities. Attending these checks provides an important opportunity to look at both physical and mental wellbeing and to connect patients with the right support at the right time.
This case study highlights the impact of social prescribing within Pennine GP Alliance, delivered through Lower Valley PCN.
Patient A was referred to the Social Prescribing team by a practice nurse following their SMI Annual Health Check. The patient lives with schizophrenia and attends these yearly checks to help them remain well.
At the time of the appointment, Patient A was in the process of applying for Personal Independence Payment (PIP) but was struggling to complete the paperwork and provide the necessary evidence. They discussed this with the nurse, who signposted them to Mark Wilcock, Social Prescribing Link Worker.
Patient goals
- Support with benefits
- Feel less lonely
- Improve physical fitness and reduce pain
- Regain confidence to do their own shopping
- Improve their living environment
Due to the patient’s complex needs, their situation was discussed at the Lower Valley multi-disciplinary team meeting. This resulted in coordinated support involving a Welfare Rights Worker from Healthy Minds, alongside a Community Pharmacist, Community Matron, Mental Health Social Worker, and West Yorkshire Fire Service.
Outcome
When Mark first visited Patient A, they were extremely anxious. Living with schizophrenia and PTSD, they rarely left their home, and their living environment had become cluttered. What started as support with benefits quickly developed into a wider, multi-agency approach.
With the pharmacist supporting pain management, the Community Matron focusing on physical wellbeing, the fire service improving home safety, the mental health social worker offering ongoing support, and Mark building a trusting relationship, Patient A slowly regained confidence and independence.
Today, Patient A attends community physiotherapy appointments, has agreed to join a group to reduce isolation, completed housing repairs, and has even taken a holiday. Reflecting on their progress, they said:
“I am going to get better. I just needed a bit of support to get there.”
This case study demonstrates the importance of SMI Annual Health Checks and social prescribing. Without the nurse identifying the need and signposting to the Social Prescribing team, and without the time taken to build trust, this patient may have remained housebound and fearful of going out.