Table 1 Views on the importance of CHD risk factor screening and obstacles to its success

• There is a high prevalence of smoking and weight problems among their own caseload with SMI

• Physical health is often neglected by services due to their focus on clients' mental health problems

• Side effects of antipsychotics, e.g. weight gain and metabolic

• Physical health can be neglected due to clients' poor motivation and social isolation – they need extra help and encouragement with this

• Research evidence indicates people with SMI are a high risk group for CHD

• Knowing about one's personal risk for CHD would enable clients to take timely preventative action (e.g. to make lifestyle changes)

• Regular screening would allay client's fears about their physical health

• Clients are aware of their own risk factors for CHD, especially smoking, family history, diet and weight

• Screening should be offered to everyone, regardless of SMI diagnosis

• Recent experience of clients with SMI dying due to undetected CHD

• The stress of having SMI may adversely affect the heart

• People with SMI are harder to engage and so need more assertive screening

• It is important for staff to recognise risk and be able to interpret any new physical symptoms as organic rather than psychological in nature

Perceived obstacles to/negative views of CHD screening

• Lack of appropriate resources in existing services – e.g. time, trained staff

• Anticipation of low uptake rates by patients with SMI

• Perceived difficulty in making lifestyle changes amongst people with SMI, even if risk CHD factors are identified

• Patients dislike having blood tests

• Lack of funding for CHD screening services or it not being seen as a priority by Trust management

• A screening offer might be viewed as interference in patients' lives – they may feel defensive, anxious or paranoid

• Stigma: a perception that services such as smoking cessation can't deal with people with SMI

• CMHT services already "squeezed"

• Staff resistance to more changes in their role – CHD screening would be moving too far away from their mental health role

• Poor communication of results between primary and secondary care

• Lack of appropriate services to refer patients to if risk factors are identified – e.g. long waiting lists, narrow referral criteria, group sessions

• It would not be cost effective to screen all SMI patients, only those in high risk groups e.g. overweight

• Prior experience of low attendance when routine screening appointments were offered to people with SMI in line with the new GP contract