Severe Mental Illness (SMI)

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:

Dr Ardyn Ross, Norfolk and Waveney’s Mental Health Clinical Lead and Kristy Austin, Registered Nursing Associate (RNA) share their experiences of undertaking SMI PHCs below:

People in Norfolk and Waveney share their experience of having their SMI PHC: