Serious Mental Illness (SMI)

Please note – this webpage is currently being built and information updated (Feb 2024)

The term severe mental illness (SMI) refers to all individuals who have received a diagnosis of psychosis, schizophrenia or bipolar affective disorder. This definition should not be seen to imply that other diagnoses are not ‘serious’ or ‘severe’, or that they do not carry any associated physical health risk, but is used to align this guidance with NICE guidance for physical health checks and the scope of the Quality and Outcome Framework (QOF) SMI register.

People living with SMI face one of the greatest health equality gaps in England. Their life expectancy is 15–20 years shorter than that for the general population, and this disparity is largely due to preventable physical illnesses. Work to address this inequality is part of Core20PLUS5, NHS England’s flagship approach for tackling health inequalities.

People living with SMI have:

  • 6.6 times increased risk of respiratory disease
  • 6.5 times increased risk of liver disease
  • 4.1 times increased risk of cardiovascular disease
  • 2.3 times increased risk of cancer
  • are 3 times more likely to lose their natural teeth

It is important that the SMI physical health checks (PHCs) start at the point of initial diagnosis.

The 6 elements of the ‘core’ annual SMI PHC are:

  • Alcohol consumption status
  • Blood glucose or HbA1c test (as clinically appropriate)
  • Blood pressure
  • Body mass index
  • Lipid profile
  • Smoking status

Here are some experiences of people in Norfolk and Waveney following their SMI physical health check:

“…physical health is very important and just as important as mental health”