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The Royal College of Psychiatrists Improving the lives of people with mental illness

National Audit of Schizophrenia

The Lester Positive Cardiometabolic Health Resource (CMH-resource) - Further information



This clinical resource provides a simple framework for identifying and treating cardiovascular and type 2 diabetes risks in patients with psychosis receiving antipsychotic medication, which supports collaborative practice across professional disciplines and service settings. 

The updated 2014 version was co-produced by NHS England, NHS Improving Quality, Public Health England and the National Audit of Schizophrenia team to support the 2014 physical health CQUIN. This resource has now been endorsed by the National Institute for Health and Care Excellence (NICE, November 2015).

The development was facilitated by the National Audit of Schizophrenia (NAS) an initiative led by the Royal College of Psychiatrists’ Centre for Quality Improvement, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patients Outcomes Programme (NCAPOP) and involving a close collaboration with the Royal College of General Practitioners (RCGP) and the Royal College of Nursing (RCN). 

The RCGP Clinical Innovation and Research Centre worked the NAS project team to produce the 2012 version of the clinical resource for the United Kingdom (UK), adapted from work by Australian colleagues (Curtis et al, 2012). This resource provides a simple collaborative framework for identifying and treating cardiovascular and type 2 diabetes risks in any service setting. The resource was adapted for UK use initially through a consensus group led on behalf of the RCGP by Professor Helen Lester and has now been fully endorsed by the RCGP, Royal College of Psychiatrists, Royal College of Nursing, Royal College of Physicians, HQIP (NCAPOP), Rethink Mental Illness and Diabetes UK. 


Lead Authors on the UK adaptation (2014 update)


Dr David Shiers: Retired GP North Staffordshire and Clinical advisor to NAS

Dr Imran Rafi: GP in Surrey; Chair of RCGP Clinical Innovation & Research Centre; Senior Lecturer in Primary Care Education, St George’s University of London

Professor Stephen Cooper: Consultant Psychiatrist and Clinical advisor NAS

Richard Holt: Honorary Consultant Physician and Professor of Diabetes and Endocrinology, Southampton University


Lead Authors on the UK adaptation (2012 version)

Helen Lester, David Shiers, Imran Rafi, Steven Cooper, Richard Holt.


To cite:  Lester H, Shiers DE, Rafi I, Cooper SJ, Holt RIG. (2012) Positive Cardiometabolic Health Resource: an intervention framework for patients with psychosis on antipsychotic medication. Royal College of Psychiatrists. London.


Expert contributions and review comments:


Particular thanks to: Salima Adatia, Thomas Barnes, Mike Crawford, Ahmet Fuat, Roger Gadsby, Fiona Gaughran, Ellie Gordon, Kathryn Griffiths, Ian Hulatt, Kamlesh Khunti, Ian Maidment, Carol Paton, Maxine Patel, David Taylor, Jogin Thakore, Andre Tylee, David Yeomans.


Special acknowledgement:

This resource was inspired by the HETI initiative Positive Cardiometabolic Health Algorithm in Sydney, New South Wales led by Dr Jackie Curtis, Consultant Psychiatrist,  Professor Katherine Samaras, Professor of Endocrinology, and Dr Hannah Newall, Psychiatrist, to whom we offer very warm thanks for their ongoing involvement and support in developing this UK adaptation of their original work.


References and useful resources


Alberti K, Zimmet P, Shaw J. The metabolic syndrome - a new worldwide definition. Lancet. 2005; 366: 1059-62.

Curtis, J., Newall H. & Samaras, K. (2012) The heart of the matter: cardiometabolic care in youth with psychosis. Early Intervention in Psychiatry,6; 347-53

De Hert M, Dekker JM, Wood D, et al. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). European Psychiatry. 2009; 24: 412-24.

Holt RIG. (2012) Cardiovascular disease and diabetes in people with severe mental illness: causes, consequences and pragmatic management PCCJ Practice Review.

Maudsley Prescribing Guidelines in Psychiatry, 11th Edition (2012), Eds Taylor D, Paton C, Kapur S, ISBN: 978-0-470-97948-8 Wiley-Blackwell


Mitchell AJ, Vancampfort D, De Herdt A, Yu W, De Hert M. Is the Prevalence of Metabolic Syndrome and Metabolic Abnormalities Increased in Early Schizophrenia? A Comparative Meta-Analysis of First Episode, Untreated and Treated Patients. Schizophrenia Bulletin Advance Access published August 27, 2012 doi:10.1093/schbul/sbs082


NICE Schizophrenia Guidance CG 82 (Updated) 2009NICE guideline PH 38 ‘Preventing type 2 diabetes: risk identification and interventions for individuals at high risk’ (recommendation 19).


Newcomer JW, Hennekens CH. Severe Mental Illness and Risk of Cardiovascular Disease. JAMA. 2007; 298: 1794-6. MJA. 2009; 190: 185-9.


Shiers D & Kendall T. (2012)Tackling a scandal of premature mortality; time for a ‘hearts & minds’ approach. London School of Economics Health and Social Care Blog.

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