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The Whole Person Approach

Physical wellbeing

Click here to download our care planning information sheet on Personal Care and Physical Wellbeing.

Physical Health

You may choose to:
- Make sure you are registered with a local GP
- Take care of your health paying attention to your diet, smoking, exercise and drinking
- Avoid taking illegal or street drugs
- Go to the dentist for regular check-ups
- Go to the optician
- Attend well man or well woman clinics
- Avoid taking illegal or street drugs and alcohol







1. Healthcare
GP
Dentist
Optician
Health Check
More Information
2. Lifestyle
Smoking
Alcohol
Illegal Drugs
Food
Be More Active
Weight
Sun
Sleep
3. Major Physical Diseases

People who have had contact with mental health services have an average 8.8 years' shorter life expectancy than those who have not. It is therefore important to continue looking after your physical health even when severe mental health problems occur.

How can I improve my physical health?
- Ensure you are accessing the healthcare you are entitled to
- Make changes to your lifestyle

1. Healthcare
You have a right to physical health care as well as your mental health care when you have a severe mental illness. Regular checks by the dentist, the optician and the practice nurse may spot early signs of more serious physical illnesses such as diabetes, which can be a particular risk if you are taking anti-psychotic medication.

ACTION - Register with a GP

We all have the right to be registered with a GP and you will need to do this to access all the services available. Your GP is often the person who helps with managing ongoing illness (physical and mental). As most prescriptions are obtained through the GP, it is important to be registered so that there is no break in your medication. Also you can make sure that you are getting the most up-to-date treatment available in a way that suits you by asking your GP to review the medication or other health care you are receiving. For more on medications click here.

How do I register with a GP?

- Pick up a form from reception at the surgery you wish to join in your area
- complete the form - you are usually asked for your name and contact details, your previous doctor's name and some information about current health problems. This will make sure that you get all the help and support available for your current health problems
- hand in the competed form and arrange to have a health check with the nurse or the doctor.

How do I find my nearest GP?

If you are experiencing difficulty in becoming registered with a GP, contact the Local Health Board for your area, who will arrange for you to be registered.

If you are not currently registered with a GP and need medical advice now, contact NHS Direct on 0845 46 47, or in an emergency attend your local hospital accident and emergency department

ACTION - Make an appointment

A visit to the GP can be stressful for everyone but preparing for your appointment will help.

- Usually, it will be necessary to book an appointment - find out the system for your surgery
- some GPs sometimes run open surgeries but it is wise to ring to check
- attend on time - otherwise there may be a delay before you are able to see the GP, and broken appointments cause many problems both for the GPs and other patients

ACTION - Prepare for your appointment:

- Write down what you want to say to the doctor before you go
- If you would like to you can take along a friend or family member for support
- take notes while there
- ask the doctor to explain any words or terms you don't understand
- before you leave find out what will happen next, if anything.

ACTION see a dentist

As well as looking after your teeth, the dentist is able to detect problems with the mouth and tongue such as cancers, and by promoting good dental care can prevent certain heart infections. Get your teeth checked at least every 1 or 2 years unless your dentist says otherwise or a problem occurs. When looking for a dentist you will need to ask if they accept NHS patients if you want NHS treatment. You will still have to pay towards your treatment but it will be lower than private charges and you may be entitled to some free treatment if you are receiving certain benefits. If your registration lapses you may no longer be entitled to NHS treatment. This is likely to happen if you don't attend for more than 15 months so it may be worth having a check up every 12 months.

The same applies to registering and making appointments as with your GP in the section above.

How do I find my nearest Dentist?

ACTION see an optician or optometrist

An optician can sell glasses and contact lenses without qualifications but an optometrist is qualified to test sight and examine eyes - then prescribe and fit glasses and contact lenses if necessary. An eye test tells a great deal more than what glasses are needed. By looking at the eyes, the optometrist can detect early signs of conditions such as high blood pressure, high cholesterol or diabetes. You should get your eyes checked every 2 years unless you have a specific medical or eye condition.

How do I find my nearest Optometrist/Optician?

ACTION get a health check

You are entitled to a health check when you first register with a new GP. If you're feeling fit and well and want a health check after this, ask your surgery.

Many NHS GP surgeries now hold 'well-person clinics'. These are often run by a practice nurse and may include a height and weight check, blood pressure test, cholesterol test and a urine sample test to look for kidney disease or diabetes. If you're over 75, you're eligible for free annual health and medication checks at your GP surgery. If you require a health check for insurance or other purposes you will usually have to pay. You can also get health checks at private clinics for which you will also have to pay.

ACTION find out more

Pharmacists can provide a wide range of information and advice on general health issues. They can answer questions you may have about your medication and may be able to give you some helpful information leaflets.

How do I find my nearest pharmacy?

Sexual health - For advice on sexual health including contraception call the National Sexual Health Helpline on 0800 567 123 (available 24 hours a day, 7 days a week) or visit NHS direct for a range of web-site addresses with more information

Visit these web-sites for free resources:

www.patients-association.org.uk - The Patients Association is a charitable organisation providing patients with an opportunity to raise concerns and share experiences of healthcare.


http://www.bbc.co.uk/health/physical_health/conditions/index.shtml?women - information and advice on common health problems
www.nhsdirect.wales.nhs.uk - list of web-sites where you can access more information


2. Lifestyle

The symptoms of mental illness and the side-effects of medication mean it can be easy to neglect your physical health when you have a severe mental illness. However, physical problems may affect your mental health and being in good physical health is beneficial for everybody. Making positive changes to your lifestyle, such as reducing your alcohol intake or doing more exercise, can give you more energy, boost your self-esteem and improve your mood. This is an opportunity to make changes which can form part of your recovery.

ACTION reduce or give up smoking

Recent research shows that more people with a mental illness smoke, and smoke a greater number of cigarettes than those without a mental illness. 46% and 61% of those with bipolar and schizophrenia respectively compared to 33% of people without either illness. Studies have found that nicotine is an especially addictive substance for people with severe mental illness.

- Find a way of giving up that suits you - whether it's nicotine replacement, smoking cessation classes, willpower or any others (see web-sites below for more information)
- Set a 'stop' date - it's best to give yourself a few weeks to help prepare. Research has shown that the more prepared you are, the more likely you are to succeed.
- To give yourself the best chance, try and choose a stress-free day to give up.

Resources to help give up smoking:

All Wales Smoking Cessation Service - specially trained staff offer guidance, advice and information as well as free access to counselling and support groups across Wales. Phone 0800 085 2219 to find out where your local service is based and how to join a support group

NHS Stop Smoking Service - you can arrange to meet with a specialist advisor face-to-face or join a group of fellow smokers who also are trying to give up for good. The NHS Smoking Help line is also available for advice and support on 0800 1690169. The web-site http://smokefree.nhs.uk/ includes details of their free support programme - 'Together' - and tips from other people who have given up

Smokers Helpline Wales is also available on 0345 697500

www.nosmokingday.org.uk includes an interactive calculator to find out how much you save, events in your area, links to other web-sites and a resources page. The next No Smoking Day is Wednesday 14th March 2007

ACTION give up or reduce Alcohol

People with severe and enduring mental illnesses such as schizophrenia are at least three times as likely to be alcohol dependant as the general population. Research has found that women with bipolar disorder are seven times more likely to suffer from alcoholism than other women. Men with bipolar disorder are three times more likely to suffer from alcoholism than other men. Even moderate alcohol use may worsen bipolar disorder symptoms: a recent study found that modest levels of alcohol consumption were associated with important measures of bipolar illness severity, including emergency department visits, number of mood episodes, and current symptoms.

It's also possible that alcohol will interact with medication you're taking and make you feel sleepier: see also.

The Department of Health advises that maximum drinking levels should be:

- No more than 3 to 4 units of alcohol per day for men
- No more than 2 to 3 units of alcohol per day for women.

This applies whether you drink most days, once or twice a week, or just occasionally. There is no longer a weekly limit as it is thought that 'binge' drinking, ie drinking all your weekly units on one day, is particularly damaging to your health.

If you do become drunk, have a break of at least 48 hours before drinking any more alcohol to give your body time to recover.

A unit of alcohol is:

- Half a pint of ordinary strength beer or lager
- One pub measure of spirits
- A small glass of wine

Cutting down

If you think you might need to cut down on the amount you drink, keeping a "drink diary" is a good idea. This will not only tell you how much you drink, but also the situations where you have a drink.

You can cut down by:

- Going out a bit later in the evening
- Buying lower-strength beers
- Trying alcohol-free alternatives
- Cutting out the "quick drink" at lunchtime
- Staying out of rounds
- Set yourself a (sensible) limit on each occasion
- Try doing something else to relax - exercise is a good alternative.

Visit these web-sites for more information and advice:

www.alcoholconcern.org.uk - information about alcohol and links to websites with advice on cutting down, also details of 'Down your drink' - a 6 week online programme for people who are worried about their drinking.

Drinkline is a free and confidential telephone helpline for people who need help and support with their own or someone else's drinking. The Drinkline number is 0800 917 8282 and lines are open 24 hours a day, seven days a week.

www.alcoholics-anonymous.org: a non-profit organisation for people who have had a drinking problem. Membership is open to anyone who wants to do something about his or her drinking problem and it follows the 12 step recovery programme.

ACTION give up or reduce illegal drugs

Recent research has found that cannabis might worsen mental health problems (including schizophrenia) and may even trigger them in some cases.

It's also possible that illegal drugs will interact with medication you're taking for the illness: see also.

For more information go to:

www.talktofrank.com free, confidential drugs information and advice, 24 hour helpline number

www.drugscope.org.uk provides comprehensive information on drugs and has a campaigning role

www.ukna.org narcotics anonymous is a non-profit organisation aimed at people for whom drugs had become a major problem. Recovering addicts meet regularly to help each other stay clean and the only requirement for membership is the desire to stop using.

ACTION eat more healthily

Food can influence your mood and have a significant effect on your health, changes you make here can have a big impact.

- It can be difficult to make a lot of changes all at once, so do it at a pace that suits you.
- Keep a food diary so you can see how the changes make you feel and work out a plan best for you
- Get advice from your GP before cutting out any major food groups such as wheat or dairy

Healthy changes you can make to your diet include:

- Having at least 5 servings of fresh fruit or vegetables every day
- Eating 2 portions a week of oily fish, such as salmon, mackerel or sardines
- Reducing the amount of 'trans' fat in your diet. This is found in pies and factory made pastry, cakes & biscuits
- Eating more beans and pulses, such as lentils and chickpeas
- Switching to wholegrain rice, pasta and bread
- Drinking about two litres (3.5 pints or 6-8 glasses) of fluids a day. Everything counts - water, milk, and hot drinks - but alcohol doesn't
- Cutting down on caffeine
- Cutting down on sugar
- Eating a variety of different foods
- Eating foods rich in starch and fibre.

See also

Things other people with mental illness have found helpful when changing their diet include:

- Eating breakfast
- Eating regular meals
- Planning meals
- Carrying healthy snacks

Further information and advice can be found at:

www.eatwell.gov.uk information about a healthy diet from the food standards agency

www.mentalhealth.org.uk information about the links between food and mental health

ACTION be more active

As soon as you begin regular physical activity you'll feel the benefits immediately - these include less anxiety and depression, less stress, lower rates of smoking and substance misuse, improved sleep, better maintenance of a healthy weight & increased social opportunities - you meet more people and might develop friendships. See also.

- Aim for 30 minutes of activity 5 days a week that makes you slightly out of breath. You don't need to do all this in one go, you could split it into smaller sessions through the day
- walk whenever you can
- use stairs rather than lifts
- join a dance class or activity club
- get together with other people to exercise, you could play badminton, go for a walk, go to the gym, or go swimming
- gardening and housework mean you can get active around the house

For more information go to:

http://www.takelifeon.co.uk  tips on becoming more physically active by incorporating it into your day

http://www.bbc.co.uk/health/treatments/healthy_living/index.shtml includes a fitness planner and has general information about exercise

www.forestry.gov.uk to find places to walk or cycle.

www.sustrans.org.uk to find cycle routes throughout the country

ACTION control your weight

About a third of people with bipolar disorder and a third of people with schizophrenia are obese, compared to only a fifth of the general public. Controlling body weight can be an issue for people with severe mental illness, particularly as some antipsychotic medications can cause weight gain.

If you are particularly overweight, your GP can advise you on weight reducing diets, or refer you to a dietician.

For more information go to:

www.direct.gov.uk how to measure you body mass index (BMI) and advice on healthy eating

www.bigmatters.co.uk for a positive approach and support for losing weight, includes a bigmatters online 'community forum'

ACTION be careful in the sun

Photosensitivity is a side-effect of certain psychotropic drugs so it is important to check the side-effects of any drugs you are taking before exposure to the sun. Sunscreens are available to protect you if you are photosensitive and they should have an SPF of at least 30.

The following advice applies to every-one:

- Avoid the sun between the hours of 11.00 am to 3.00 pm when it is at its most dangerous
- Cover-up by wearing a hat, long-sleeves and sunglasses
- Use a minimum of SPF 15 sunscreen, apply generously and reapply every two hours

Although we all need sunlight to produce vitamin D (vital for building and maintaining bones), 15 minutes exposure 2 or 3 times a week will provide plenty for a fair-skinned adult. It is not necessary to get a tan to make sure you get enough vitamin D.

Further advice about sun exposure and the danger of skin cancer is available on the following web-sites:

http://www.sunsmart.org.uk/index.htm

ACTION get better sleep

For most of people, a good night's sleep is crucial for mental and physical well-being.

Sleeping problems occur in almost all people with mental disorders, including those with severe mental illness. Extreme sleep deprivation can lead to a seemingly psychotic state of paranoia and hallucinations in otherwise healthy people, and disrupted sleep can trigger episodes of mania (agitation and hyperactivity) in people with bipolar disorder.

If you are having trouble sleeping, there are changes you can make to help you get a good night's sleep:

- Make sure your bedroom is at the right temperature, usually people keep it too warm
- have the right bed and mattress for your needs
- keep the bedroom free of clutter and distractions
- don't use the bed for watching tv or reading
- if you can't get to sleep within half an hour, get up and do something boring until you feel sleepy again
- establish a regular sleep-wake routine by getting up and going to bed at the same time every day
- don't nap
- drink less caffeine in the afternoon and evening
- don't drink alcohol in the few hours before bed
- take regular exercise, but not right before going to bed
- have a relaxing routine leading up to bedtime.

If you try all of these but still have trouble falling asleep night after night, or if you always feel tired the next day, then you may have a sleep disorder and should see your GP. Most sleep disorders can be treated effectively so you can get the sleep you need.

Major Physical Diseases:

Poor diet and excessive weight are major risk factors in conditions such as:

- Diabetes
- Heart disease
- Lung disease
- Stomach and bowel disorders
- Cancer

People with schizophrenia/bipolar disorder are:

- 2.4 times more likely to have diabetes
- 1.6 times more likely to have heart disease
- 1.8 times more likely to have a stroke.

For more information on any of these click on the following:

http://www.diabetes.org.uk/home.htm

British Heart foundation

British Lung Foundation

http://www.corecharity.org.uk/

http://www.cancerresearchuk.org/

www.stroke.org.uk

 

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