Title: Cluster randomised controlled trial of the Serious Mental Illness Health Improvement Profile (HIP)
Funder: Department of Health (England)

Abstract: Background People with serious mental illness (SMI) die up to 25 years younger than the general population. As a population they receive inadequate physical health and this is unacceptable. Modifiable cardiovascular risk factors, rates of respiratory disease, some cancers, and HIV are highly prevalent. Nurses are ideally placed to assess and intervene but current preparation for this work is inadequate. Current 'wellbeing' programmes are complex and costly and focus almost exclusively on modifying cardiovascular risk factors at the expense of other aspects of physical health. The SMI Health Improvement Profile (HIP) is a brief pragmatic tool (competency training takes 6 hours) to enable practitioners to profile patients physical health and promote evidence/guideline based intervention. Aims The overall aim of this study is to demonstrate the efficacy of the HIP in improving SMI patients physical health. To achieve this we will establish if, compared to treatment as usual (TAU) (at the 52 week study end point) patients who receive the HIP: 1. Show improved physical and mental health; 2. Modify cardio-vascular risk and lifestyle factors. Additionally we will: 3. Establish the cost effectiveness of the HIP; 4. Explore the process experience of using the HIP from the point of view of patients, mental health nurses, psychiatrists and GPs; 5. Examine the impact of the HIP on communication between secondary and primary care services; 6. Establish the effect of HIP training on nurse attitudes to and knowledge about physical health in SMI patients. Plan of Investigation A single blind parallel group cluster RCT comparing the HIP with TAU in a sample of 50 nurses and 200 SMI patients in receipt of services provided by the Norfolk Trust (NWMHFT). Nurses will be the unit of randomisation with eligible SMI patients selected at random from their caseload by their locality manager. Nurses in the HIP group will receive 6 hours training to be competent in the HIP. If nurses drop out of the study patients will be transferred to the care of a HIP/non-HIP nurse to ensure continuity of intervention. Measures will be completed at baseline and 52 weeks by an RA blind to treatment allocation.The primary end point will be change in the physical health component sub-scale of the SF-36v2. The trial will strictly adhere to CONSORT standards of reporting cluster RCTs. Potential Impact If the results of our trial are positive nurses across the NHS working with SMI patients can use the HIP to identify and plan care and treatment to enhance physical health. Our aim would be that every SMI patient in England completes a HIP every year; leading to evidence based phyiscal health care and treatment, enhanced quality of life and, ultimately increased life expectancy. Achiving this aim is made more likely by the relative brevity of HIP training for nurses and a focus on enhancing communication between primary and secondary care services.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH