Improving cervical screening for women with mental health conditions

Since the introduction of the NHS Cervical Screening Programme, the number of women dying from cervical cancer has halved in England.

However, women who have mental health conditions are less likely to receive cervical screening (or ‘smear test’), putting them at higher risk. Research from Public Health England has suggested that there are three reasons why attending screening may be more difficult for these women:

  1. Administrative – factors such as not being registered with a GP or having an NHS number can mean that SMI patients don’t receive invitations to screenings.
  2. Patient – patients may need extra support or experience increased anxiety about what the screening entails.
  3. Staff – stigma can exist among staff delivering screenings, making them unwilling or scared to enter mental health sites.

Getting the message out

How the leaflet was developed

West London Trust (WLT) and the Universities of Surrey and West London have produced a leaflet designed to help tackle the anxiety around having a smear test, among women who’ve experienced trauma or who have mental health conditions. ICHP have been working in partnership with WLT and the University of Surrey to understand how to raise awareness of the leaflet and ensure it has the biggest possible impact.

Designed with service users, the leaflet provides information on every stage of the screening process, from booking an appointment to the procedure itself, with a specific focus for those who may have increased anxiety around attending screening. It includes tips to support women before, during and after their appointment, such as:

  • Asking for the first appointment of the day, so they are not waiting long
  • Bringing someone along for support; this could be a friend or relative, or a mental health support worker
  • Asking their GP practice for a chaperone – another member of staff working at the clinic who can provide support

The leaflet also includes a list of things that women have said make it hard for them to attend their appointment, such as having experienced sexual violence, being someone who hears voices, or being embarrassed about their body or scars. If women find some things hard to talk about out loud, they can bring the leaflet along and show this page to the person doing the smear test.

The leaflet has been endorsed by Jo’s Trust and made available free of charge.

Achieving sustainability

ICHP engaged end uses to decide the best approach

ICHP carried out interviews with stakeholders from north-west London CCGs, mental health trusts and the cervical screening team from Public Health England; performed desktop research on the spread of similar behavioural change innovations; and sought insight about the possible applications of local datasets to inform an evaluation approach.

From this work, we made recommendations for supporting the sustainability of the leaflet and provided a suggested approach for how it could be disseminated through North West London.

The leaflet is now being used across different CCGs and Trusts as well as various specialist clinics and other NHS organisations such as the Northern Cancer Alliance.


If you would like to find out more about this project please email us