Improving access to physical healthcare for older people in mental health settings: the ImPreSs-care qualitative study

In the general population, the worldwide pandemic of physical inactivity is responsible for an estimated 13.4 million disability-adjusted life-years, costs the worldwide economy an estimated INT$53.8 billion (1), and is the cause of approximately 9% of premature mortality worldwide (2). People experiencing mental illness represent a particularly vulnerable population at high risk for poor lifestyle factors such as physical inactivity and experience an unacceptable level of early mortality of between 15 and 25 yr (3). People experiencing mental illness engage in significantly lower levels of moderate–vigorous physical activity and spend significantly more time engaging in sedentary behavior (4). A growing number of clinical trials (5,6) demonstrate efficacy of lifestyle interventions including exercise, for both physical and mental health in people with mental illness. However, large-scale translation into routine clinical care has not occurred. This international consensus statement aims to delineate the key factors that must be addressed by key decision makers to increase access to appropriate exercise programs for people with mental illness and subsequently contribute to closing the life expectancy gap. CULTURE CHANGE Psychiatric services at all levels of care (acute and long-term inpatient, transition/outpatient, and community care) need to provide holistic care for people with mental illness, addressing the body and the mind simultaneously (7). Typically, psychiatric services have prioritized symptoms of mental illness, whereas physical health care is often disregarded or deemed to be a low priority. Increasingly, people with mental illness are seeking integrated physical and mental health care (8). Exercise practitioners, as members of the multidisciplinary team, have a core role as advocates for positive lifestyle change, addressing all major modifiable risk factors contributing to premature mortality. Embedded within the multidisciplinary team, these exercise practitioners can affect change among staff through staff wellness programs that leads to positive role modeling for patients, increasing the likelihood of long-term behavior change (9). In addition, exercise is a highly acceptable intervention strategy, and dedicated interventions may act as a facilitator to help-seeking or stigma reduction among vulnerable populations such as young people experiencing mental illness. INFRASTRUCTURE Advocating for access to trained exercise practitioners and appropriate exercise facilities across all treatment settings, and for all mental health conditions, regardless of patient age, socioeconomic, or physical health status is a key requirement for ensuring integration within mental health and primary care settings. This must include acute and long-term inpatient settings, community mental health centers, and primary care facilities. Taking into account local health system contexts, it may be necessary to draw on resources from both the general medical and mental health budgets to provide access to necessary infrastructure and human resources. Partnering with nongovernment and not-for-profit community agencies to deliver exercise interventions may aid in providing human and physical resources, while managing health service governance and financial barriers. TRAINING To effectively integrate exercise practitioners within the multidisciplinary mental health team, exercise practitioners (e.g., exercise physiologists, physiotherapists, and kinesiologists) must receive training in basic mental health literacy and in illness-specific exercise prescription considerations. Likewise, to facilitate referral and maximize long-term behavior change, mental health and general medical practitioners working with people with mental illness need to understand the role, scope of practice, and competencies of exercise practitioners working in mental health settings. Ideally, training should take place at the undergraduate level and be reinforced through pragmatic student placements established within functional multidisciplinary mental health teams. Postgraduate courses for exercise practitioners focusing on mental illness (such as those available in Belgium and Scandinavia [10]) should be designed and delivered in consultation with psychiatric services to promote an integrated approach to mental health service delivery. Professional organizations representing exercise practitioners have an obligation to provide opportunity for upskilling and continuing professional development to provide the highest levels of evidence-based exercise prescription to people with mental illness. The organizations that endorse this consensus statement commit to promoting the role of exercise interventions as a key component of a global strategy toward achieving a 50% reduction in the life expectancy gap of people experiencing mental illness by 2032. We believe that enhanced training of our members, facilitating culture change within mental health services, and advocating for the provision of required infrastructure are the cornerstones of achieving this goal.

BackgroundIndividuals experiencing serious mental illness (SMI) have higher rates of comorbid physical health conditions, poorer associated health outcomes, and die on average 10–20 years earlier than the general population. They encounter multiple barriers to accessing appropriate physical health care in many countries, including Canada, where policies and practices to promote integrated care delivery to this population remain scant. This qualitative study aimed to explore health provider perspectives and experiences with integrated physical and mental health care within mental health settings in Canada, in efforts to address the health needs of this population.MethodsThis qualitative descriptive study involved conducting individual semi-structured interviews with 13 health administrators and four focus groups with 15 clinicians between July 2023 and April 2024. The data analysis team, inclusive of individuals with SMI, used thematic analysis to identify overarching themes that capture participants’ perspectives on and experiences with delivering integrated physical and mental health care within mental health settings in Canada, including their clinical practices and organizational contexts.ResultsWe identified four themes in participant narratives: (1) the need for integrated care delivery within mental health settings; (2) organizational readiness for integrated care; (3) moving integration forward: addressing challenges; and (4) leveraging opportunities to advance integrated care. Both participant groups highlighted challenges with fragmented healthcare services, emphasized the urgent need for policies, practices and guidelines that support person-centered, comprehensive care within mental health settings, and called for engaging people with living/lived experience and family members in service redesign.ConclusionFindings underscore the importance of accelerating efforts to promote integrated health care delivery for adults with SMI within mental health settings, and of implementing policies that address health disparities for this population in the Canadian context.Clinical trial numberNot Applicable.

The future of mental health in the UK: an election manifesto

Background The overlap between physical and mental health is a common challenge for older adults, and many live with co-occurring physical and mental health disorders. Different service models have been adopted; however, the majority provide specialist mental health input to older adults with physical health needs in acute hospital trusts. Few service models are available providing comprehensive physical health input to older adults in secondary mental healthcare settings. Furthermore, little information is available regarding specific physical healthcare needs facing older people receiving specialist mental healthcare. The aim of this qualitative study was to determine the facilitators and barriers to delivering physical healthcare for older adult patients, their carers, and staff within specialist mental health settings (inpatients and community). Methods 54 semi-structured interviews (REC:22/IEC08/0022) were conducted with different stakeholders (staff (n = 28), patients (n = 7), carers (n = 19)) across two mental health trusts (Leicester, Nottingham). Interviews explored the facilitators and barriers to delivering physical healthcare to older people (aged >65 years) receiving secondary mental healthcare (dementia and functional disorders) with combined physical health needs. Interviews were audio recorded and transcribed verbatim. Data were analysed thematically, drawing on an underpinning framework of integrated care for individuals with multimorbidity (SELFIE). Results Three main themes were identified: 1) service delivery; focussing on care coordination and communication between services, 2) workforce; focussing on training and skills alongside support and availability of physical health expertise, 3) the individual with multimorbidity; focussing on mental-physical health interplay and patient experience. Conclusions The findings from this study can be used to inform service development to improve the provision of physical healthcare for older people receiving secondary mental healthcare in the UK, focussing on improving care coordination and communication between physical and mental health services, and upskilling and training mental health teams in physical health provision with appropriate support from physical health experts.

Physical health and severe mental illness: If we don't do something about it, who will?

Assessment of Physical Illness by Mental Health Clinicians During Intake Visits

The COVID-19 pandemic has had a major impact on physical health and psychological or mental health. The number of deaths that are increasing day by day due to the corona virus not only causes physical symptoms and illnesses, but also has a major impact on mental health. This study aims to determine what factors affect people's mental health and determine the effect of COVID-19 on people's mental health. This study is a systematic review using online databases namely Scholar, ScienceDirect, and ProQuest. The keywords used were Impact of the Covid-19, people's mental health. The selection process used the PRISMA protocol, resulting in 15 articles that met the inclusion criteria. The results of the review analysis revealed the impact of the pandemic on mental health, causing several disorders such as excessive fear and anxiety about anxiety for themselves and those closest to them; changes in sleeping and eating patterns, feeling depressed and having trouble concentrating; bored and stressed from being constantly at home, especially children; drug and alcohol abuse; and the emergence of psychotic disorders. COVID-19 has had a major impact on people's physical and mental health and alcohol abuse; and the emergence of psychotic disorders. COVID-19 has had a major impact on people's physical and mental health.

Achieving advance care planning in diverse, underserved populations

Risks, roles and responsibilities: Evaluating falls in inpatient mental healthcare settings for older people

Background It is recognised within the national framework that palliative and end of life (EoL) care must be a priority. Empowering individuals to think about their wishes and what is important to them is an extremely important and developing part of healthcare. The Advance Care Planning (ACP) Facilitator role was developed to support ACP within local care homes. After a three year project the role became permanent receiving full funding from the local Clinical Commissioning Group. Aims The aim of the role is to support local care homes with ACP. Supporting them to achieve the national ambition that states everyone approaching EoL must be given the opportunity to plan. The role provides care home staff with support and education regarding EoL care. This allows them to work towards improving outcomes wherever the setting, which is a priority within the national framework. Methods ACP support has been provided to care home staff and residents. Free educational sessions have been delivered on subjects relating to palliative and EoL care. Work has been undertaken within the local community to enhance their knowledge and understanding on ACP. A good working relationship has been developed with the multidisciplinary team to encourage a pro-active response to ACP. Results Increased use of ACP documents has been noted within care homes. Good attendance and evaluations from the educational sessions have been recorded through registers and feedback forms. Verbal feedback has been received from numerous individuals with gratitude of the support provided. Conclusion The role has shown to benefit residents, their loved ones and the staff. Residents are given the opportunity to discuss and record future plans which are in accordance with their wishes. Residents’ loved ones are able to access various services the hospice offers. Care home staff have expressed feeling more confident with ACP and EoL care.

Early mortality experienced by people living with mental health issues (hereon termed consumers) is largely preventable. Healthcare professionals perceive healthcare system inadequacies such as diagnostic overshadowing, stigma and fragmentation of physical and mental healthcare services can be resolved through effective integration approaches. Service- and individual-level integration approaches involve multidisciplinary teams collaborating and coordinating care to holistically meet consumers' physical and mental health needs. Evidence suggests appropriately trained healthcare professionals can deliver effective integrated treatment without financial or organisational restructuring. Specialist nursing positions such as Physical Health Nurse Consultants can support and integrate physical and mental health care. Consumers report the Physical Health Nurse Consultant as providing dedicated, integrated, coordinated and holistic mental and physical health care. This study aimed to explore the Physical Health Nurse Consultant role from the perspectives of healthcare professionals. A qualitative exploratory study design was used. Fourteen healthcare professionals participated in individual interviews or focus groups. Interview recordings were transcribed, and thematically analysed. Three themes were identified: (i) role functions, including integration of physical and mental health care, (ii) impact on consumer physical health outcomes and (iii) impact on service delivery. Healthcare professionals perceive the Physical Health Nurse Consultant effectively integrates physical and mental health care and subsequently support the continuation and embedding of the role in routine practice. Future research is required to explore healthcare professionals' experiences and perceptions of how these roles be translated to routine clinical practice. Examining the professional development requirements, service provider constraints and economic implication to achieve these outcomes also warrants attention.

Introduction: This initiative aims to address the critical training gap in paediatric mental health services by implementing simulation-based education (SBE), with a focus on equipping healthcare professionals to respond effectively to mental and physical health emergencies. Simulation-based education is well-established in acute and physical healthcare settings but remains underutilised in mental health services, particularly in paediatrics [1]. This gap persists despite evidence that simulation can enhance clinical confidence, interprofessional collaboration, and patient safety [2]. Within the new Simulation Strategy launched at BWCFT, the recognition of the need for both physical and mental health simulation support was paramount. The goal was also to begin growing expert faculty trained to deliver simulation-based education within our mental health setting. Methods: A series of immersive simulations were conducted within our inpatient unit, combining physical and mental health scenarios such as respiratory/cardiac arrest following ligature incidents and severe hypoglycemic patients with eating disorders, alongside post-incident risk assessment. Sessions were delivered in-situ, with a flexible approach to environment and staff availability. Multidisciplinary team members, including those less confident in managing physical health emergencies, were actively encouraged to participate. Results: The simulations facilitated engagement from a broad range of staff, enhancing competencies in airway management, A–E assessment, advanced life support (ALS), escalation protocols, and secondary assessment. Participant feedback indicated improved confidence in recognising and managing physical deterioration, strengthened interprofessional communication, and a greater sense of preparedness for real-life emergencies. Staff specifically reported “a better understanding of checking for vital signs when completing physical observations and interacting with an unwell young person.” Another participant commented, “I really appreciated the training; it mimicked real scenarios that we encounter, particularly with decision-making under pressure,” highlighting the realism and relevance of the scenarios. The initiative also fostered a culture of continuous learning and collaboration within each ward, as this was completed through a multi-agency approach. The need for regular simulations has now been identified, and the growth of our core expert faculty has greatly supported this delivery. Discussion: Integrating simulation into paediatric mental health settings addresses a critical training gap, promoting holistic care that encompasses both mental and physical health emergencies. This approach not only enhances clinical skills but also strengthens team dynamics and patient safety. The success highlights the potential for simulation to drive cultural change and improve outcomes in mental health services. Future directions include expanding the range of scenarios and conducting longitudinal evaluations to assess the impact on clinical practice and patient care. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable

With the rapid development of modern society, the problem of people's mental health has become more and more prominent, and it has become a key course that cannot be ignored in our lives. Paying attention to people's mental health, solving people's physical and mental health problems, and building an education curriculum system for people's physical and mental health is an important research topic related to the harmonious development of society, and it is also an ideal and belief to promote quality education. At present, our country's evaluation of people's mental health reflects the inadequacy of our country's mental health education. Predicting, categorizing and reflecting on people's mental health will help us further strengthen our mental health education and construct our mental health education. This paper studies the construction of a mental health prediction model based on data mining technology, and summarizes related factors affecting mental health on the basis of relevant literature data, as the independent variables predicted by the model below, and then analyzes the data mining technology for the model prediction experiment in the following text has laid the groundwork. According to the construction of the mental health prediction model based on data mining technology in this paper, the test results show that in terms of emotional management, they have better adaptability in the face of stress, healthier. In addition, because society has different expectations of male and female roles, women’s pressure coefficient has reached 2.01. This shows that women must work harder to succeed in society, and they will face greater pressure, that is, they are more prone to psychological problems.

WHAT IS KNOWN ON THE SUBJECT?: A clear association exists between serious mental illness (SMI) and poor physical health. Individuals with SMI have markedly higher risks for mortality and morbidity. Mental health nurses play an important role in enhancing service users' mental and physical well-being. The attitudes of mental health nurses towards physical health care have been explored in the western part of the world. However, cross-country differences should be determined to reveal the importance of this global issue. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study adds new data to the literature on the Physical Health Attitude Scale's (PHASe) validity and nurses' attitudes when working in acute mental health services in different cultures. Nurses in acute mental health wards mostly focus on the basic physiological indicators of patients' existing physical health problems, so health promotion practices such as sexual health and eye/dental examinations are neglected for individuals with SMI. Nurses' higher level of confidence about their delivery of physical health care is due to their familiarity with basic nursing practices (e.g. monitoring blood pressure and checking blood glucose levels). Differences that exist between countries in relation to smoking habits are probably due to different regulations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To improve patients' physical healthcare outcomes, nurses should be provided with additional training and supervision to strengthen their skills and confidence. Nurses' perceived need for additional training reflects the importance of physical health care in mental health settings, in which training could substantially improve patient outcomes. Authors believe that standard protocols must be established in acute psychiatric care to eliminate obstacles to holistic patient care. Training needs of mental health nurses on health promotion practices should be considered by administrators of mental health settings. Abstract Introduction Nurses play an important role in improving the physical health of individuals with serious mental illnesses. The literature on the attitudes of mental health nurses towards physical health care provides a small amount of data. Assessing trends in nurses' attitudes through suitable surveys is important to ensure holistic care. Aim/Question This study sought to examine the Turkish version of the Physical Health Attitude Scale's (PHASe) validity and reliability and to survey Turkish mental health nurses' attitudes towards physical health care. Method The sample consisted of 174 nurses working in acute psychiatric wards. Firstly, the psychometric properties of the scale were analysed using factor analysis and measures of internal consistency and reliability. Then, the survey results of the attitudes of mental health nurses towards the physical health of patients with serious mental illnesses were determined using the Physical Health Attitude Scale (PHASe). Results The translated PHASe functioned best as a 24-item version and 4-factor solution that explains 51.3% of the variance. The internal consistency value was 0.83. The respondents' attitudes were generally positive about their role. There was less agreement for the involvement of nurses in practices of health promotion, such as sexual health, eye and/or dental examinations. The nurses surveyed also tended to use smoking for therapeutic purposes. Implications for practice Mental health nurses' knowledge and attitudes should be enhanced by additional training in the ways of meeting patients' biopsychosocial needs. Obstacles to physical health care can be removed by implementing standard protocols nationwide.

Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in Dutch mental health facilities completed a survey. Nine participated in in-depth interviews. Results Thirty-six percent of nurses had experience with providing palliative care to psychiatric patients with physical co-morbidity in the past 2years. Of all patients, 63% received physical care before death, 46% psychosocial care and 33% spiritual care. In 91% of all cases, care was provided by multidisciplinary teams. Patient characteristics and little attention to palliative care were barriers for timely and adequate palliative care. Discussion In palliative care for psychiatric patients, there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Yet there are barriers to adequate palliative care provision. Implications for practice Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of psychiatric patients. Since mental health care is increasingly provided ambulatory, palliative care for psychiatric patients outside mental health facilities should be closely monitored.