Room for improvement
Evidence shows people with severe and enduring mental health challenges can live up to 25 years less than the rest of the population . Cardiovascular disease accounts for 40-50 percent of this premature mortality, and this can largely be prevented .
In 2020 only 42 percent of people on long-acting, intramuscular, antipsychotic medication received lipids screening to identify risks for common conditions like heart disease, and only 46 percent were screened for impaired glucose intolerance and diabetes.
For people on clozapine (a medication for people with schizophrenia resistant to other treatments), the rates were 61 percent and 66 percent, respectively . Everyone on these medicines should be checked at least annually for these risk factors  – and in many cases more often.
The specific group this project will work with those on long-acting, intramuscular, antipsychotic medication, and with people on clozapine (a medication for people with schizophrenia resistant to other treatments).
Equity will be at the centre of this work, given that Māori and Pasifika tāngata whaiora experience higher rates of cardiovascular disease, have higher rates of being diagnosed with schizophrenia and being prescribed antipsychotic medication, and are more likely to be receiving treatment under the Mental Health (Compulsory Assessment and Treatment) Act 1992.
Work to date
The MHA quality improvement programme project team has been undertaking work to establish the foundations of the project including:
- gathering evidence about the problem
- exploration to determine data availability and baselines
- developing an aim statement and a suite of potential measures
- sharing the focus area with the MHA quality improvement programme’s Tāngata Whaiora and Whānau Advisory Rōpū, Māori Advisory Group and Expert Advisory Group
- defining the quality improvement methodology and approach to be used ensuring local co-design is central.
Making a difference requires a whole-of-health-service approach. We will work with tangata whaiora, whānau and care providers to ensure tangata whaiora on particular antipsychotic medications (clozapine and long-acting intramuscular injections) receive best-practice care to reduce their risk of poor cardiovascular health.
In early July 2022, ahead of a co-design phase organised by the Commission, letters highlighting the need for cardiovascular disease screening to be implemented and measured for consumers on clozapine and long-term IMI, were sent by Commission CE Janice Wilson to DHB CEs, clinical directors, MHA directors of nursing and general managers, the MHA QI network and others.
A reminder email was sent to groups yet to respond, with the request their project lead contact details be sent by Wednesday 10 August 2022 to MentalHealthAddiction@hqsc.govt.nz.
The following slides were presented at the project’s ‘setting the scene’ meeting held online on 14 September.
Presentation slides and templates from the first supra-regional co-design workshops held for district teams during October November 2022 are available here.
Presentation slides from the second supra-regional co-design workshops held for district teams during February and March 2023 are available below:
- Consumer, family, whānau experience, Arana Pearson (889KB, pdf)
- Measurement in quality improvement, Karen O'Keeffe (767KB, pdf)
- Planning for testing, Karen O'Keeffe (1006KB, pdf)
- Theming and prioritising change ideas, Jacqueline Ryan (923KB, pdf)
- Next steps, Jacqueline Ryan (424KB, pdf)
This project contributes to the Equally Well which the Commission is a supporter of. Equally Well is a group of people and organisations with the common goal of achieving physical health equity for people who experience mental health and addiction issues.
 Thronicroft G. 2013. Premature death among people with mental illness. BMJ 346: f2969. DOI: https://doi.org/10.1136/bmj.f2969.
 Data sourced from the Pharmaceutical Collection and the Laboratory Claims Collection.
 bpacnz. 2007. Monitoring for metabolic disorders in patients taking antipsychotic drugs. Dunedin: bpacnz. URL: https://bpac.org.nz/magazine/2007/february/antipsychotics.asp.
 Lambert TJR, Reavley NJ, Jorm AF, et al. 2017. Royal Australian and New Zealand College of Psychiatrists expert consensus statement for the treatment and monitoring of the physical health of people with an enduring psychotic illness. Australian & New Zealand Journal of Psychiatry 51(4): 322–37. URL: https://journals.sagepub.com/doi/full/10.1177/0004867416686693.