Improving metabolic risk in patients with mental illness through ‘mental health care plans’ in primary health care

Aim: To determine the association between types of mental illness, levels of social disadvantage and metabolic risk factors (obesity, tobacco smoking, high blood pressure and high cholesterol) and to investigate whether mental health care plans modify metabolic risk. Methods: Two cohorts (2016–2023) of all primary care patients in Western Sydney with active mental illness or never having a mental illness (reference cohort) were compared on metabolic risk and change in metabolic risk during the period of the care plan (12 months) using random effects regression. Also, the social gradient of metabolic risk in patients with active mental illness was determined. Analyses were adjusted for age, sex and social disadvantage. Results: There were 29,592 patients with active mental illness and 962,416 never having mental illness. Care plan utilisation ranged from 35% to 51%, with the lowest utilisation for Schizophrenia (33%). Daily tobacco smoking rates were elevated for all mental illness types. Care plans were associated with a reduction in daily tobacco smoking rates (0.7 odds ratio; 95% confidence interval: 0.6–0.99). Patients with schizophrenia had excess body mass index (+5.6 body mass index; 95% confidence interval: 2.1–9.1). Care plans reduced the excess body mass index (−6.6 body mass index; 95% confidence interval: −17.7 to +4.5)). Obesity and daily tobacco smoking followed a social gradient in patients with mental illness, but cholesterol and blood pressure did not. High blood pressure and high cholesterol was not elevated compared to the reference group in all types of mental illness. Conclusion: Metabolic risk was particularly elevated in tobacco smoking rates for patients with any active mental illness and for obesity in patients with schizophrenia. Care plans were associated with a reduction in much of this risk.