Acknowledgements
        We would like to thank:
        •    Dr Sheila Hardy, Education Fellow at UCLPartners, and author of these materials.
        •    The expert reference group, steering group and project team:
    Michael Benson           Lead Nurse Education and Practice Development, Barnet, Enfield and Haringey Mental Health NHS Trust
    Stephanie Bridger        Director of Nursing, North East London NHS Foundation Trust
    Eileen Bryant            Primary Care Nurse Advisor, NHS England 
    Stephen Cook             Interim Deputy Director of Nursing and Clinical Governance, Barnet, Enfield and Haringey Mental Health NHS 
                             Trust
    Dr Rhiannon England      CCG Mental Health GP Lead
    Professor Peter Fonagy   Director, Integrated Mental Health Programme, UCLPartners
    Kate Hall                Director of Education, UCLPartners 
    Cate Hogan               Project Coordinator
    Gemma Houghton           Project Coordinator
    Dr Henrietta Hughes      Medical Director, North and East London, NHS England
    Claire Johnston          Director of Nursing, Camden and Islington Foundation Trust 
    Becky Kingsnorth         Programme Manager, Adult Mental Health, UCLPartners
    Dr Anna Moore            Director, Integrated Mental Health Programme, UCL Partners
    Dr Fiona Nolan           Deputy Director of Nursing, Camden and Islington Foundation Trust
    Gill Rogers              Londonwide LMCs
    Antony Senner            Head of Development, Health Education North Central and East London
    Dr Geraldine Strathdee  National Clinical Director, NHS England 
    Jonathan Warren          Director of Nursing, East London NHS Foundation Trust 
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    Introductions
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      Learning objectives
      1.  Be aware that patients attending for physical problems may have underlying distress or mental 
          health problems.
      2.  Be confident in: 
        •    Screening patients for depression and anxiety
        •    Talking to a patient who has just divulged that they are distressed or concerned about a 
             mental health problem.
        •    Carrying out a biopsychosocial assessment
        •    Assessing the severity of depression and anxiety
        •    Assessing suicide risk.
      3.  Know how to refer patients to the appropriate mental health services.
      4.  Know where to signpost patients to get help with social issues such as debt and housing.
      5.  Understand how practice nurses can help reduce the risk of cardiovascular disease and  
          premature death in patients with mental illness. 
      6.  Feel confident in assisting a patient with severe mental illness to plan their care.
      7.  Be aware of the medications used in mental illness.
      8.  Feel competent in carrying out an assessment of side effects in patients taking antipsychotic 
          medication.
      9.  Know how to refer patients with drug or alcohol problems to the appropriate services.
      10. Consider how to make it easier for patients with mental illness to attend primary care.
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        Underlying distress or mental health problems
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     Underlying distress or mental health 
     problems
    Adults with a mental health problem in England:
    •  Anxiety or depression 17.6%
    •  Alcohol dependence 6%
    •  Drug dependence 3%
    •  Hazardous drinking 24%
    •  Nicotine dependence 21% (42% of smokers have a mental 
       health problem)
    •  Severe mental illness 0.4%
    •  Sub-threshold mental health problems 17%
    McManus S, Meltzer H, Brugha T, Bebbington P and Jenkins R. (2009) Adult 
    psychiatric morbidity in England, 2007: results of a household survey. Leeds: 
    NHS Information Centre for Health and Social Care.
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