"Bridging the Gap”: Assessing the Efficacy of Co-Locating a Physical Health Clinic in a Community Mental Health Setting

Background: This rapid evaluation study aimed to assess the efficacy of a physical health clinic (PHC) within Laurel House and Kings Road Practice, a community-based mental health service for adults with moderate to severe mental health needs in Kent and Medway, UK. The clinic, led by Dr Will Davis, provides support and treatment for adults aged 18-65 with moderate to severe mental health needs.

The study used a mixed-methods approach, combining audit data and qualitative semi-structured interviews with seven health practitioners involved in the PHC between January and March 2023. This methodological choice was aimed at gaining a comprehensive and holistic understanding of the PHC practice.

Quantitative Data Results: The quantitative data shows that the PHC had 170 referrals since its inception and provides high value to the community Mental Health Team. Of the group reviewed (n=87) 37% Did Not Attend (DNA), although this is not uncommon in the mental health sector, it highlights the need for strategies to improve patient attendance and reduce the associated impact on healthcare resources. The core physical health needs discussed in appointments were related to weight management, highlighting a specific demand in this area for service users.

The clinic is focused on providing a service user-centered approach, with the main value being on general reviews of the service user's health and addressing any concerns they may have. In addition, it pays attention to any other concerns the service user may discuss during appointments and can help with any issues related to accessing GP services. The clinic also collects and records Core Physical Health Data during appointments.

Qualitative Data Results: Qualitative analysis of the data identified three main themes: Service user Outcomes, Collaborative Working Practices, and Resource Management. The subthemes under Service user Outcomes include addressing health inequality, physical health objectives, service user-centered care, and time. The subthemes under Collaborative Working Practices include the benefits of having a GP in the mental health team, supportive staff culture, clinician skills, knowledge and understanding, risk management, training, experience, development, and support value. The subthemes under Resource Management include communication systems and administration, referral pathways and information exchange, and cost-benefit opportunities.

Conclusions: Overall, the evaluation found the PHC to be effective in providing support and treatment for service users with severe mental illnesses. The clinic's service user-centered approach and collaborative working practices contributed to positive outcomes for service users, additionally there were opportunities identified that have cost-benefit saving to primary health, particularly within the area of weight management advice, and the gathering of Physical Health Core Data.

Findings also suggest that the combination of the in-house clinic together with the expertise of the PHC GP has high value from the perspective of the Community Mental Health Team. However, resource management could be improved, particularly in the areas of communication systems and referral pathways, potentially addressing the DNA rates. The report recommends that the physical health clinic continues to be offered within Laurel House, and further research is needed to assess the long-term impact on service user outcomes.