10th November 2017, Volume 130 Number 1465

Aimee Staveley, Ian Soosay, Anthony J O’Brien

Characterised by central obesity, dyslipidaemia, hypertension and insulin resistance,1 metabolic syndrome is a major public health issue that affects a diverse range of population groups.2 Compared to the general population,…

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People with mental illness have a 20-year reduction in life expectancy compared to people in the general population. One of the factors contributing to this difference is antipsychotic medication, commonly prescribed for people with severe mental illness. We surveyed the district health boards’ mental health services to investigate their policies for monitoring the physical health of people with severe mental illness. We found that most DHBs had policies for monitoring physical health, but also that there was scope for improvement in those policies. Our recommendation is that the Ministry of Health adopt a best practice standard in this area, and require DHBs to report against this standard.



To audit New Zealand district health boards’ (DHBs) metabolic monitoring policies in relation to consumers prescribed second-generation antipsychotic medications using a best practice guideline.


Metabolic monitoring policies from DHBs and one private clinic were analysed in relation to a best practice standard developed from the current literature and published guidelines relevant to metabolic syndrome.


Fourteen of New Zealand’s 20 DHBs currently have metabolic monitoring policies for consumers prescribed antipsychotic medication. Two of those policies are consistent with the literature-based guideline. Eight policies include actions to be taken when consumers meet criteria for metabolic syndrome. Four DHBs have systems for measuring their rates of metabolic monitoring. There is no consensus on who is clinically responsible for metabolic monitoring.


Metabolic monitoring by mental health services in New Zealand reflects international experience that current levels of monitoring are low and policies are not always in place. Collaboration across the mental health and primary care sectors together with the adoption of a consensus guideline is needed to improve rates of monitoring and reduce current rates of physical health morbidities.

Author Information

Aimee Staveley, Research Student, School of Nursing, University of Auckland, Auckland; 
Ian Soosay, Honorary Academic, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Anthony J O’Brien, Senior Lecturer, School of Nursing, University of Auckland, Auckland.


This research was partly funded by a grant from the University of Auckland Faculty of Medical and Health Sciences. We are indebted to the service users and clinicians who advised on various aspects of the research, and to the DHB staff who provided metabolic monitoring policies.


Anthony J O’Brien, Senior Lecturer, School of Nursing, University of Auckland, Private Bag 92019, Auckland.

Correspondence Email


Competing Interests

Aimee Staveley reports grants from The University of Auckland Faculty of Medical and Health Sciences during the conduct of the study. Dr O'Brien reports summer scholarship from University of Auckland during the conduct of the study.


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