Making Every Contact Count: Improving the Physical Health of People with Mental Health Problems

Abstract

The physical health of people with mental health problems is a significant source of health inequality, with this group three times more likely to have a physical illness and dying 15-20 years earlier than counterparts without recognised mental health problems. Making Every Contact Count (MECC) is an opportunistic health promotion strategy supporting people to make healthier choices and achieve positive long-term lifestyle changes. The purpose of this study was to explore the barriers and facilitators of the MECC approach to improving the physical health of people with mental health problems in primary care. Ten people with mental health problems and ten GPs including stakeholders within the Clinical Commissioning Group were interviewed. Thematic analysis identified themes relating to patient factors, clinician communication, and systemic factors. These were further analysed based on principles of realist evaluation, articulating ‘context-mechanism-outcome’ (CMO) statements; whereby, in a specified context a particular mechanism generates different outcomes. Patients were more likely to take on brief interventions if they trusted and had good rapport with their clinician. Clinicians valued transmitting knowledge of the effects of the unhealthy lifestyles and how to address these. Systemic factors included continuity of care and the annual review, although a number of patients viewed this as lacking fruitful discussion. Medication reviews were highlighted as an area for improvement. Taken together, these patient, clinician and systemic factors can be used to ‘make every contact count’ in improving the physical health of people with mental health problems. There are also gaps in terms of clinician skills as well as processes that can be improved to ‘making every contact count.’