Physical Health Checks for Severe Mental Illness in Ireland: A Care Staff Guide

This guide covers Ireland. For the UK equivalent, see our guide: Annual Physical Health Checks for Severe Mental Illness: A Care Staff Guide.

People with severe mental illness (SMI) can have poorer physical health than the rest of the population, and care staff are often the people who notice the early signs. According to the Mental Health Commission (MHC) report Physical Health of People with Severe Mental Illness by Dr Susan Finnerty, Inspector of Mental Health Services (published 17 May 2019), a person with SMI typically dies 15 to 20 years earlier than a person without mental illness, and the physical illnesses involved are largely preventable. This guide pulls together what the Irish sources say about physical health monitoring, and what care staff in Dublin and nationally can sensibly observe and report. For the wider regulatory picture, see our guide to the Mental Health Act 2026 and MHC compliance.

What the Irish sources say about the physical health gap

The MHC report states that, for people with SMI, mortality is 4 times higher for respiratory disease and 2.5 times higher for cardiovascular disease. It lists five causes of the gap: higher rates of suicide, accidental and violent death; modifiable risk factors such as smoking, inactivity and obesity; medication side effects; reduced access to healthcare; and stigma among healthcare professionals. It also reports that people with SMI have three times more Emergency Department attendances and almost five times more emergency admissions, and that fewer than one in five of those emergency admissions are for mental health needs.

The HSE National Clinical Programme for Early Intervention in Psychosis, in its Model of Care (approved April 2019, published June 2019), describes the same problem in its own words. It says people with conditions such as schizophrenia and bipolar disorder die up to 25 years earlier than the general population, that about two-thirds of these premature deaths are due to physical health problems, and that three-quarters of service users with first-episode psychosis smoke. It names antipsychotic medication, particularly the atypical antipsychotics, as a second major factor, linked to weight gain and changes in glucose and lipid metabolism, and it says the evidence suggests people receive less health promotion, screening and effective physical healthcare. The two documents give different figures for the gap (15 to 20 years and up to 25 years), so if you quote a figure in a policy or training session, name the source.

Metabolic and cardiovascular risk

The MHC report explains metabolic syndrome as a cluster of risk factors: abdominal obesity, raised blood pressure, abnormal blood lipids and raised blood glucose, diagnosed when three or more are present. It reports that metabolic syndrome affects 25% to 50% of people with SMI. For people with schizophrenia it reports at least double the risk of type 2 diabetes, and states that up to 15% have diabetes, 58% have elevated blood pressure and about half are significantly overweight. These are the figures the report gives; they are not a prediction for any one person.

What monitoring do the Irish sources describe?

The MHC report sets out annual physical health monitoring that includes family and personal medical history, diet, activity, tobacco, alcohol and substance use, cardiovascular risk, blood pressure, dental health, weight, BMI, waist circumference, fasting glucose or HbA1c and fasting lipids. For people on antipsychotics it says regular monitoring is needed of weight, blood pressure, blood sugar, lipids, ECG, full blood count, urea and electrolytes, liver function and prolactin. It says that monitoring and treating these risk factors should be part of the routine clinical care of the psychiatrist and the GP.

For inpatient mental health services, Regulation 19 (General Health) of the Mental Health Act 2001 (Approved Centres) Regulations 2006 (S.I. No. 551 of 2006) requires the registered proprietor of an approved centre to ensure that residents have access to general health services and referral to other health services, that each resident's general health needs are assessed regularly as indicated by the individual care plan and in any event not less than every six months, and that residents have access to national screening programmes where available and applicable. The regulations apply to approved centres, which the explanatory note describes as in-patient facilities registered with the Mental Health Commission; they do not by themselves set rules for other settings.

The MHC has reported on how this works in practice. In its 2019 review of 100 residents in 10 continuing care centres, 71% were on antipsychotics and 42% had one or more symptoms of metabolic disease. The report found that most doctors carried out a physical examination every six months for each resident, but recorded monitoring rates of 45% for weight, 25% for BMI, 9% for waist circumference, 72% for glucose, 66% for lipids and 65% for ECG, and noted that care plans did not include annual monitoring. A 2 June 2021 MHC news release on four inpatient centres in Dublin and Wicklow, each scoring above 90% compliance overall, noted that at one centre not all six-monthly general health assessments recorded BMI, waist circumference, weight, blood pressure or family and personal history, and that another centre did not record annual blood tests for some patients prescribed antipsychotics.

The HSE Model of Care for People with Severe and Enduring Mental Illness and Complex Needs (the date is not shown on the pages reviewed) says guidance, support and monitoring of physical health are vital elements of high-quality rehabilitation services, and that all multidisciplinary team members have a responsibility to promote healthy living. It says medical staff carry out regular physical health assessments, that liaison with GPs is crucial as people move toward community living, and that there must be agreement on who undertakes routine physical health monitoring and how results are shared.

What care staff can observe and report

None of the sources above asks care staff to diagnose or to carry out clinical monitoring on their own initiative. Whether support staff take readings is a matter for the service's own procedures. A practical approach, and our suggestion rather than a requirement, is to treat staff as the eyes and ears of the clinical team:

• Notice change: weight changes, reduced activity, smoking, or a person who has stopped going out, which are the kinds of risk factors the sources name, and tell the clinical team rather than judging what they mean.
• Record and pass on: note what you saw, when, and who you told, in the way your service requires.
• Support appointments: help the person to attend GP reviews and blood tests, because the MHC has found missing annual blood results in clinical files.
• Support lifestyle goals: smoking, activity and diet are named risk factors in the sources, and the HSE rehabilitation model describes team members using coaching or motivational interviewing to promote healthy living.
• Challenge assumptions: the MHC report lists "diagnostic overshadowing", where physical symptoms are put down to mental illness, among the barriers to recognising physical illness.

If a person's physical health needs appear to be going unmet, that may also need to be raised under your safeguarding procedures; our guide to safeguarding vulnerable adults training in Ireland explains the wider context.

Blood pressure and emergencies

If your service does record blood pressure, the HSE page on high blood pressure (last reviewed 3 January 2022, with the next review shown as due 3 January 2025) says a raised reading in one test does not mean you have high blood pressure, and that high blood pressure is 140/90mmHg or higher (or an average of 135/85mmHg at home). Treat that page as general information, and follow the clinician's targets for the individual. The HSE stroke page (last reviewed 28 June 2023) says that if someone has facial drooping, arm weakness or slurred speech, you should phone 999 or 112 immediately and ask for an ambulance.

Medicines

Several of the monitoring tests above relate to medicine side effects, but changes to medicines are prescriber decisions. Staff should follow the prescriber's instructions and the service's own medicines procedures, and report side effects rather than stopping or adjusting anything. Our guide to medication management training for healthcare staff in Ireland covers the practical side.

Learnsignal's offices are off Baggot Street in Dublin, and we offer in-person training from there. For current details, see our CPD pages.

Frequently asked questions

Is there a single national physical health check programme for severe mental illness in Ireland?

The sources reviewed do not describe one. The MHC report sets out recommended monitoring and the HSE models of care address physical health within their own services, but this post does not claim a universal national checklist.

Who is responsible for physical health monitoring?

The MHC report says it should be part of routine care by the psychiatrist and GP, and the HSE rehabilitation model says agreement is needed on who undertakes routine monitoring and how results are shared. Check your own service's arrangement.

Does Regulation 19 apply to my care home or community house?

Regulation 19 applies to approved centres registered with the Mental Health Commission. If you work elsewhere, follow your provider's procedures and the standards that apply to your setting.

What should I do if I am worried about someone's physical health?

Report your observations to the appropriate clinician or manager as your service requires. If someone has signs of a stroke, phone 999 or 112.

Physical health is part of mental health care, and small observations by support staff can change what happens next for the person you support.