Mind and body: Kate Dale, a pioneer of integrated health

J Pinching 31 July 2017



The link between mental and physical health is inseparable, but for decades the two have been divided by the labyrinthine complications of service delivery. This is a situation that Kate Dale, Physical Health Project Lead at Bradford District Care NHS Foundation Trust, was unwilling to let continue.


What is your background, Kate?

I’ve been a mental health nurse for 40 years and, during the last 14, I have been concentrating on getting mental health patients a better deal in terms
of their physical health. Over the years, we have focussed too much on segregating physical health from mental health, rather than treating the whole person. I’ve been campaigning for better overall care because these patients are dying up to 25 years younger than the general population. Suicide only accounts for 1% of that figure; people are mainly dying prematurely from natural causes, including cardiovascular disease, diabetes and respiratory failure.


Tell me what you’re doing about it?

The project I led developed an electronic template for SystmOne and EMIS for Primary Care and RIO for secondary care. These systems are designed to guide clinicians through a systematic physical health review appropriate for people with serious mental illness. We have a shared care agreement between local primary and secondary care, and the emphasis is for baseline and early monitoring, following the prescribing of anti-psychotic medication.


What has emerged from the project?

It is time to wake up, share responsibilities across healthcare and start looking after the physical health of people with serious mental illness. I set out to do this in Bradford, but never imagined it would be rolled out regionally and nationally. Now I’m ready and willing to help anyone to push it out even further.


What are the biggest challenges of an integrated system?

Patients with serious mental illness are currently entitled to an annual physical health check at their GP surgery, but when we’re prescribing anti-psychotic treatment in secondary care, we need a handle on the physical health as well. Medications often lead to an increased appetite, weight gain and a risk of diabetes. We need to get people more active and self-aware; enabling them to go for a walk and feel better about themselves. Weight management is one of the hardest things in the world to combat, but when you have a mental health problem it becomes much harder.


What have been the significant changes to mental health care since you started?

I walked up the driveway of an asylum for my first job in 1979 and, believe it or not, there were 450 beds, 600 nurses and industrial therapy was still happening. The physical health of patients was actually very good and they were checked regularly. On the downside, however, we used to reward patients with cigarettes for good behaviour. After the old models of care disappeared, I witnessed community care evolving, and in the 1990s worked towards becoming a community psychiatric nurse. During that time ‘mental health risks’ became a priority; the pressure to keep people well, safe and out of hospital grew, and so did the divide between mental and physical health.


When did you start focussing on the link between mental and physical health?

I took part in a Leeds Partnership Foundation Trust national pilot in 2003 and it involved physically health-checking an entire caseload of people I worked with. The outcomes were astonishing – people had been walking around with undiagnosed diabetes or borderline conditions. We were able to change their lifestyles and reverse the situation, and that’s where my passion began.


What’s your relationship with pharma?

The industry has improved massively. A pharma company sponsored the original pilot in 2003. There were people who thought it was inappropriate but, I thought, if the funding was used positively, it didn’t matter where it came from. Pharma companies have been very supportive in recent times and it’s getting vital messages out there. It’s through pharma that much of my good work has come to fruition.


How is society shifting its attitude?

Years ago, my mother developed Alzheimer’s disease, when she was only 58. She had been very popular and always had a house full of friends, but when she became ill they nearly all disappeared. People didn’t know how to deal with it. The young Royals, William and Harry, have talked about their own issues and that’s had a massive impact, particularly around men’s mental health. By talking about the difficulties they had dealing with their mother’s death, they are reducing stigma and giving people confidence to open up.


Your passion for changing the system is really admirable.

I’ve been like a dog with a bone, I wouldn’t let go and I probably drove people around the bend, but at least I can go to sleep knowing that somewhere down the line people will start to live longer, healthier and happier lives. I’ve worked one-to-one with patients over the years and there’s nothing more rewarding than to see people recover, move on and gather some self-worth.


What record would you choose for the sound-track of your life?

‘Angels’, by Robbie Williams.


It’s your last supper, what are you having?

Piri piri chicken. I’m going to Portugal in a couple of weeks.

How delightful. Goodbye Kate. Bye John.   





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