Table 3 Secondary care screening model: Advantages and disadvantages

Perceived advantages of delivering screening in secondary care

• CMHT staff have a better rapport and understanding of people with SMI

• CMHT has better access to and knowledge of people with SMI

• The CMHT setting and workers are less threatening for patients than the GP environment and easier to trust – this might reduce the non-attendance rates

• CMHT staff can access patients in a greater variety of settings, thus enhancing the uptake of screening

• It promotes a more holistic model of care – 'not just a prescription'

• It is better to unite clients' physical and mental health care in one place

• CMHT staff are more experienced than GPs in working assertively with people with SMI

• If the CHD risk factors are linked to having SMI, then the CMHT should take responsibility for screening

• Psychiatrists prescribe the antipsychotics which require risk factor screening

• CMHT workers have more time and can offer longer appointments

• It would allow CMHT staff to develop new skills

• There are shorter waiting times at CMHT compared to the GP

Perceived disadvantages

• The CMHT workload is already high – they lack the time for extra responsibilities

• Lack of skills and knowledge required for screening amongst care coordinators, especially those without nursing or medical training

• Lack of appropriate facilities – e.g. equipment, clinical rooms, access to blood results in community settings

• Unwillingness of CMHT staff to take on extra roles

• Lack of medical expertise in the CMHT regarding appropriate interventions if screening results are positive – care will either be inferior or simply result in re-referral to primary care.

• It blurs the role of the CMHT

• Some service users mistrust psychiatric services and don't want their involvement

• CMHTs only see the most severely mentally ill people, so some patients will be overlooked

• It would be stigmatising (not normalising) to have separate services for people with SMI

• Patients like to keep their mental health and physical health separate

• Mental health meetings such as Care Programme Approach meetings are inappropriate settings for screening

• It would cause stress for CMHT staff who might feel to blame if CHD morbidity was undetected

• Lack of continuity with CMHT staff – they tend to come and go more often than GP staff

• CMHT bases are less accessible than GPs geographically