Examining the effects of national initiatives to improve the physical health of people with psychosis in England: secondary analysis of data from the National Clinical Audit of Psychosis

Background: There are longstanding concerns regarding physical health inequalities for people with psychotic disorders. In recent years concerted efforts have been made to address these.
Aims: To examine whether recent national initiatives in England have led to improvements in the physical health of people with schizophrenia and related psychoses.
Methods: Secondary analysis of data from multiple rounds of a national audit of services for people with psychosis, conducted over a 9-year period. Proportions of patients in ‘good health’ according to seven discrete measures, and one composite measure derived from national standards, were compared between each round of the audit.
Results: The proportion of patients in overall ‘good health’ under the care of ‘Early Intervention in Psychosis’ (EIP) teams increased between 2014 and 2019 (OR=4.65, 95% CI 3.32 to 6.52, P<0.001). There were isolated improvements for these patients in measures of ‘good health’ relating to smoking (OR=1.22, 95% CI 1.11 to 1.35, P<0.001), alcohol use (OR=1.43, 95% CI 1.23 to 1.68, P<0.001) and illicit substance use (OR=1.86, 95% CI 1.68 to 2.07, P<0.001). There was no significant change in the proportion of patients in overall ‘good health’ under the care of ‘Community Mental Health Teams’ (CMHTs) between 2011 and 2017. However, there were improvements for these patients in specific measures relating to alcohol use (OR=1.48, 95% CI 1.31 to 1.67, P=<0.001), blood glucose levels (OR=2.12, 95% CI 1.89 to 2.36, P<0.001) and blood lipids (OR=1.78, 95% CI 1.60 to 1.98, P<0.001).
Conclusions: There have been modest improvements in the physical health of people with psychotic disorders over the last nine years, particularly those who are under the care of EIP teams. Continuing efforts are required if these improvements are to translate into reductions in premature mortality among people with psychosis.