The limited value of the annual physical health examination in long-term secure care

Sir: We were concerned that psychiatric patients have increased physical morbidity and mortality (Santhouse & Holloway, 1999), yet their general health care may be neglected. Prisoners also end up with reduced access to health care (Smith, 1999). Thus, we wondered how effective the annual physical examination is for our long-stay psychiatric patients at Rampton high security hospital. We felt this was particularly needed as general practice services have extended in recent years.

An SPSS computer program (weighted to ensure case balance for gender, age and ward) randomly selected 120 cases for a sample of 447 patients at Rampton 1995-1998, 72 (16%) of which were women. We examined the notes consecutively over 3 years, which resulted in 360 records. These were examined for documentation of the annual physical health check.

Results showed that 302 (84%) had recorded evidence of the annual physical, and 11 patients (3%) had declined examination. Few clinically significant abnormalities were detected (6 of 360, 1.7%), though these included cases of previously undiagnosed asthma, diabetes and anaemia. Wider review indicated that physical disease management was variable and non-systematic.

We concluded that the traditional annual physical health check is of limited value. We felt that psychiatrists should review their current care and consider systematic primary care based services for long-term psychiatric in-patients and those on long-term follow-up.