Mental health-friendly health check resources for health and social care professionals

About us

This webpage is dedicated to providing information to health and social care professionals involved in providing health checks to people who might find taking part in them difficult. There are some articles which we have produced around different types of physical health checks, but so far, our work has been mostly around cancer screening and in particular cervical cancer screening. Below you will find this work plus related work by others who have kindly allowed us to share it.

Research type

  • Systematic reviews
  • Mixed methods.

Chief Investigator

Professor Elizabeth Barley

Co-investigators

Funding source(s) of related work

  • Grant funded by Public Health England (GFWLAGR) - 2014-2016
  • University of West London Vice Chancellor’s PhD Scholarship (Allied health) – 2017-2020
  • University of Surrey Clinical Innovation Fund – 2019
  • Imperial College Health Partners
  • West London NHS Trust
  • Jo’s Cervical Cancer Trust.

Project start date

August 2014.

Status

Ongoing.

Mental health-friendly health checks

Mental health-friendly cancer screening

In a series of studies (see publications below), we have identified barriers to cancer screening access and uptake among people diagnosed with a severe mental illness, such as psychosis or bipolar disorder. Within this group, there is a high prevalence of people who have experienced victimisation or trauma such as sexual and/or domestic violence (Khalifeh et al., 2016). Having survived a traumatic experience has been identified in the literature as one of the key barriers to attending cervical cancer screening (Clifton et al., 2016; Lamontagne-Godwin et al., publication in preparation). Research has shown a reduced likelihood in this group of attending cancer screening in comparison with the general population, in the region of 20-60 per cent (Aggarwal et al., 2013; Fujiwara et al., 2017; Inagaki et al., 2018; Woodhead et al., 2016). Cancer mortality is 30 per cent higher in people with severe mental illness than in the general population (Kisely, Crowe, and Lawrence, 2013).

In order to address some of these barriers in relation to cervical cancer screening, we have developed an ‘informed choice leaflet’, which supports women’s decision-making of whether to attend screening. This is designed to help anyone with a cervix who finds cervical cancer screening difficult for any reason. An animated video, depicting some of the key features of the leaflet, was also developed.

In the course of our work, we have identified several other resources which can help address this health inequality. These include physical resources for health professionals and specialist services (such as cervical screening clinics for those who have experienced sexual violence or female genital mutilation/cutting (FGM)). Currently, these resources are only available to, or even known about by, a small number of people local to the where the work was conducted.

We have produced this online resource, hosted by the University of Surrey, which draws together all these existing resources (including the cervical screening leaflet and animated video) and to which new work can be added.

Aims

To help people who typically find it hard to attend cancer screening to make an informed decision as to whether to attend, and, if they want to take up screening, to make it easier for them to attend. This resource is designed to help clinicians and researchers working with people who find it hard to take up screening to:

  • Access resources to use with patients/people to be screened
  • Share knowledge about best practice in order to develop effective interventions and services
  • Share knowledge to identify unmet needs in order to raise awareness and to influence policy changes and local service development
  • Share data around their use of this resource so that we can understand and increase its impact.

Cervical screening informed choice leaflet for women with mental illness and/or who have experienced trauma

Leaflet 

The leaflet is held under a Creative Commons Licence. We are happy to provide this leaflet free of charge, but would ask you to have regard to the following conditions on its use:

  1. Do not distribute this to anyone else – if anyone asks for a copy please ask them to obtain it from this webpage.
  2. If you use the leaflet, or any part of it, we would be grateful if you would please:
    • Acknowledge the authorship team
    • Send copies of any reports/papers that are produced to Professor Elizabeth Barley (e.barley@surrey.ac.uk)
    • Please email any translation of the leaflet which you have commissioned
    • Anyone using a translated version of the leaflet we would recommend having it checked through back translation
    • Let us have any comments/suggestions that you feel might improve the leaflet so that your experience can be incorporated into subsequent updates.

Download a copy of the leaflet: Support available for your cervical screening (smear test)©.

Feedback 

These are typical quotes from people who have commented on the leaflet:

"Having your leaflet during the appointment would give me a voice!", Service user, London community mental health team.

“This leaflet would be helpful to women who don't go”, Service user, London community mental health team.

"It captures quite difficult things but in an easy to understand way", Psychiatrist, West London NHS Trust.

Animated Video

View a 90-second animated video illustrating key parts of the cervical screening leaflet.

The aim is for services, charities, health professionals and members of the general public to share it with women who find it hard to attend cervical screening. 

We would be grateful if you could let us know if you intend to use the video by emailing e.barley@surrey.ac.uk.

Other projects and resources to support people who find it hard to attend cancer screening:

The Screening Access Project is a project aimed at supporting people who use the services of Nottinghamshire Healthcare NHS Foundation Trust to access NHS Screening. This document has been written for frontline staff working with adult clients (or children over the age of 12 who have a diagnosis of diabetes), who have a mental health illness and/or an intellectual developmental disability. The toolkit contains a brief introduction to each of the screenings:

  • Breast screening  
  • Bowel screening
  • Cervical screening
  • Diabetic eye screening and
  • Abdominal aortic aneurysm screening (AAA).

It provides staff with a sample conversation pathway that will enable them to talk confidentially to their patient/s about particular screening, signposts to other resources and where possible gives direct contact numbers to enable staff to support their patient to arrange a specific screening. 

Materials:

Specialist training in trauma-informed care (Healing our Way CIC)

The aim of this project is to help clinicians and other professionals improve their work and understanding of sexual violence and trauma through high quality specialist training. It aims to train health professionals on how to deliver trauma-informed care, especially for intimate procedures such as cancer screening. All of their training is delivered by experts by experience and qualified trainers.

Find out more:

This resource pack is intended for dental professionals but was included here as it relates to the provision of trauma-informed care.

The resource pack aims to implement trauma-informed practice and better support for victims and survivors of abuse and trauma when they visit the dentist. It includes:

Find out more: 

Within an acute mental health hospital, Wotton Lawn, in Gloucester, nurses offer education, support, and cervical screening to all women within the inpatient environment. These clinics also include; breast care, bowel health and cardiovascular checks. Following this successful initiative, ‘Men’s Health Mondays’ were introduced in June 2019. 

Find out more:

The clinic, run by Barts Health NHS Trust, in Waltham Forest gives local women the opportunity to use a convenient walk-in service with an FGM specialist gynaecologist, psycho-social practitioner, an FGM specialist midwife, a female FGM trained sample taker and access to an interpreter. The clinic also offers psychological support, information and advice and deinfibulation.

My Body Back Project works with women, who have experienced sexual violence, regarding their physicality. The project supports women who have experienced rape or sexual assault to love and care for their bodies again.

They do this by running specialist services, including a cervical screening clinic and maternity clinic. Both clinics work very sensitively with women, so they feel safe, relaxed, and their individual needs are met.

Find out more:

SHRINE: Sexual and Reproductive Health Rights, Inclusion and Empowerment is a four-year Mind and Body project launched on 16 May 2016 and funded by Guy’s and St Thomas’ Charity

SHRINE delivers and evaluates sexual and reproductive healthcare for three specific communities in Lambeth and Southwark:

  • People who use drugs problematically
  • People with Serious Mental Illness
  • People with Intellectual Disabilities.  

Find out more:

One of the services provided by RSVP, a specialist abuse and rape crisis charity, is to support children and adults of all sexes and genders, who have been subjected to rape and/or sexual abuse, violence or exploitation, to attend certain health checks. It can be very distressing and re-traumatising to attend some types of health appointments if you have been subjected to any type of sexual abuse. Intimate examinations, sexual health testing, natal care, dental and optician’s appointments can trigger distressing memories.

RSVP’s Independent Sexual Violence Advocates (ISVAs), including ISVA’s for children, adults, female sex workers and LGBT survivors, offer a range of practical and emotional support around health appointments; whatever the person’s age, gender identity, or sexual orientation. Support includes writing support letters to health care professionals, emotional support in the build up to your health appointment, booking appointments with you or on your behalf, arranging for you to be seen at specialist abuse survivors clinics (for some health care needs), and even going with you to the appointment.

Find out more:

Publications

Barley, EA, Borschmann, RDWalters, P, and Tylee, A. (2016). Interventions to encourage uptake of cancer screening for people with severe mental illness. Cochrane Database Syst Rev, 9: p. CD009641. doi: 10.1002/14651858.CD009641.pub3, 

Clifton A, Burgess C, Clement S, Ohlsen R, Ramluggun P, Sturt J, Walters P, Barley E. 2016 Influences on uptake of cancer screening in mental health service users: a qualitative study. BMC Health Services Research 16:257.

Howard LM, Barley EA, Rigg A, Davies, E, Lempp, H, Rose D, Thornicroft G. A diagnosis of cancer in people with severe mental illness: practical and ethical issues raised. Lancet Oncology 2010, 11:8; 797- 804.

Lamontagne-Godwin F, Burgess C, Clement S, Gasston-Hales M, Greene C, Manyande A, Taylor D, Walters P, Barley EA. 2018 Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review. BMJ Open BMJ Open 2018;8:e019412. 

Lamontagne-Godwin F, Henderson C, Lafarge C, Stock R, Barley E. The effectiveness and design of informed choice tools for people with severe mental illness: a systematic review (in submission). Protocol of the review.

Woodhead, C., Cunningham, R., Ashworth, M., Barley, E., Stewart, R. J. & Henderson, M. J. 2016 Cervical and breast cancer screening uptake among women with serious mental illness: A data linkage study. BMC Cancer. 16, 1, 819.

Barley, E.A., Clifton, A., Burgess, C., Clement, S., Ohlsen, R., Ramluggun, P. et al. (2015) Identifying barriers and facilitators to cancer screening uptake by people living with a diagnosis of mental illness to inform policy and practice. London: Dorset Healthcare University NHS Foundation Trust, Kings College London.

Contact us

If you have accessed this page and are happy for us to contact you in future, please email e.barley@surrey.ac.uk. And if you have a relevant project/resource that you would like us to include on our webpage, please also get in touch.