Across 47 UK dietitians surveyed from inpatient mental health and learning disability settings, the dominant nutritional screening tool — the Malnutrition Universal Screening Tool (MUST) — was widely judged inadequate for capturing the distinctive nutritional risks facing people with severe mental illness (SMI) or learning disabilities (LD). Screening was established in most services, but practitioners reported low confidence that screening translated into meaningful care. Key barriers included time constraints, difficulty engaging distressed patients, poor physical-health prioritisation by nursing staff, and fragmented digital infrastructure. Dietitians largely held secondary or leadership roles, with nursing staff completing most screenings — yet those staff were frequently perceived as deprioritising the process. Some services adopted bespoke, unvalidated tools as workarounds.
This finding lands in a well-documented but underserved gap: people with SMI die on average 15–20 years earlier than the general population, with metabolic and diet-related conditions as leading contributors. That nutritional surveillance in these wards remains structurally weak is concerning but unsurprising given chronic underfunding of physical health in psychiatric settings. The authors cautiously flag SANSI and the NutriMental Screener as candidates for further evaluation — a useful signpost, though neither yet has robust validation data. The study's core limitation is its small, self-selected sample of 47 dietitians, limiting generalisability. As a preprint not yet peer-reviewed, findings should be treated as preliminary. Still, the message is clinically important: tool choice alone cannot fix a system where physical health remains a secondary concern.
