Key messages

  • People with mental illness are at a higher risk for physical illness and it is important that they receive regular health checks.
  • Mental health services should ensure they obtain a complete and accurate medical history and provide comprehensive healthcare.
  • It is important for examinations to be comprehensive or both physical and mental wellness whether a patient is presenting to an emergency department or coming into the system by a different route.
  • Older people have increased chances of experiencing comorbidity and steps should be taken to ensure their safety.

These guidelines relate to the legal and clinical steps for meeting the physical health needs of people with a mental illness, including the steps to identify physical illnesses in different service settings.

People with a mental illness are at higher risk of physical illnesses

Risk factors for people with a mental illness include:

  • smoking
  • alcohol and substance use
  • obesity
  • poor diet
  • other lifestyle factors.

Medications prescribed for mental illness can have interactions and side-effects.

In addition, some people with a mental illness may be less likely to access good health advice than the general population, due to their lifestyle or condition, including being itinerant, increased risk of self-neglect, misattribution or difficulty describing physical symptoms.

Providing integrated care for people with a mental illness

Providing integrated care for people with a mental illness can be challenging.

Despite the delivery of services through a coordinated response, it can be possible to overlook a person’s physical health needs.

An individual who is linked to a general practitioner may not necessarily receive regular physical health checks.

Identifying medical conditions in people with a mental illness

People receiving treatment from public mental health services should also receive treatment for their physical healthcare needs.

Mental health services should ensure the delivery of comprehensive medical assessment to address physical healthcare needs, particularly where they impact on mental health.

Diagnosing and providing care for physical illnesses is essential to prevent deterioration of a person’s health and to manage their mental illness.

Medical history of people with a mental illness

The medical history should:

  • summarise the person’s current state of health
  • identify past medical or surgical treatment
  • identify current and recent medications and any use of non-prescribed substances.

Confirm the person’s clinical record with them.

Physical examination of people with a mental illness

In discussing the need for a physical examination, the following issues should be explored:

  • Explain the reason for physical examination and what it will involve.
  • Gain the person’s consent before the examination.
  • Take into account the person’s gender and cultural needs. Consider having another health professional of the same gender present.
  • For children and young people, a parent, guardian or a health professional of the same gender as the young person should be present.

When an individual is admitted as an inpatient, perform and document a physical examination as soon as possible. If the initial examination is limited by the person’s state of mind, undertake a more complete examination at the earliest opportunity.

Order the appropriate investigations and note and act on results.

In community settings, physical examinations will depend on the clinical needs of the person and their circumstances. If the person has a general practitioner, it may be sufficient to encourage the person to have regular health checks with their primary carer.

Emergency departments

People presenting to emergency departments usually receive a general medical evaluation to assist with diagnostic and treatment decisions.

Do not delay psychiatric assessments while waiting for medical evaluation.

Medical assessment of older people

Older people have increased incidence of medical comorbidity, including medication interactions and toxicity.

In respect to older people with a mental health condition, there is a need to:

  • consider delirium in new presentations and in relapse of established illness, and communicate closely with community practitioners
  • consider the possibility of elder abuse in situations of trauma
  • ensure that people living in aged persons mental health residential services receive appropriate psychiatric and physical care; this is the responsibility of the authorised psychiatrist
  • make sure that people living in aged persons mental health residential services receive care from a general practitioner of their choice
  • ensure that the authorised psychiatrist liaises with general practitioners to enable physical needs to be met and any possible drug interactions to be assessed and managed.