Physical Health Care For People Research Articles

Physical health nurse consultant role to improve physical health in mental health services: A carer's perspective.

The physical health of people diagnosed with a mental illness is significantly poorer in comparison with the general population. Awareness of this health disparity is increasing; however, strategies to address the problem are limited. Carers play an important role in the physical health care of people with mental illness, particularly in facilitating navigation of and advocating in the health care system. A specialist physical health nurse consultant position has been suggested as a way to address the physical health care disparity and limited research available suggests that positive outcomes are possible. In the present study, a qualitative exploratory research project was undertaken, involving in-depth interviews with people identifying as mental health carers. Two focus groups and one individual interview were conducted involving a total of 13 carers. The resulting data were analyzed thematically. Views and opinions about the proposed physical health nurse consultant (PHNC) position were sought during these interviews and are reported in this paper. Two main sub-themes were evident relating to characteristics of this role: reliability and consistency; and communication and support. Essentially carers expressed a need for support for themselves and consumers in addressing physical health concerns. Successful implementation of this position would require a consistent and reliable approach. Carers are significant stakeholders in the physical health of consumers of mental health services and their active involvement in identifying and tailoring services, including development of the physical health nurse consultant must be seen as a priority.

Addressing the physical health of people with serious mental illness: A potential solution for an enduring problem

People with serious mental illness face significant inequalities in physical health care. As a result, the risk of cardiometabolic disorders and premature mortality is far greater than that observed in the general population. Contributiung to this disparity, is the lack of routine physical health screening by mental health clinicians. One possible solution is the implimentation of a physical health nurse consultant, whose role is to monitor and coordinate the physical health care of people with serious mental illness. Current evidence supports the implimentation of such a role, and a failure to address the widening gaps in physical health care will only serve to increase the disparities faced by people with serious mental illness.

Rise in emergency admissions linked with mental health

People with mental health problems are five times more likely to be admitted to hospital in an emergency than the rest of the population, a survey has revealed.

The Physical Care of People with Mental Health Problems – A Guide for Best Practice Collins Eve Drake Mandy and Deacon Maureen (Eds) The Physical Care of People with Mental Health Problems – A Guide for Best Practice 248pp £24.99 Sage 978 0 8570 2921 8 0857029215

The barriers to better physical health care for people with poor mental health often relate to weak communication, compliance and health promotion, inflexible healthcare services and poor co-ordination of services.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Access to Physical Health Care for People with Serious Mental Illness: A Nursing Perspective and a Human Rights Perspective-Common Ground?

Relative to the general population, people with serious mental illness (SMI) experience elevated risks of physical disease and illness and live shorter lives. A human rights perspective argues that people with serious mental illness have a right to equal access to physical health care. Nurses in mental health services can contribute to improving the availability and accessibility of physical health care. This study, involving focus group interviews with nurses in a large regional and rural mental health care district of Queensland, Australia, revealed significant problems in access to physical health care for service users. The current article reports on our exploratory analysis of nurses’ views and perceptions to identify (1) orientation of nurses to human rights, and (2) access of consumers with SMI to general practitioner services. It was rare for nurses to raise the topic of human rights, and when raised, it was not as a strategy for improving access to physical health care services that they felt consumers with SMI greatly needed. Two main themes were identified as causes of poor access: clinical barriers to physical care and attitudinal barriers to physical care. In light of these results, the authors explore a human rights perspective on access and how this provides an inclusive lobbying umbrella under which nurses and other groups can pursue access to physical health services that are adequate, accessible, and non-discriminatory. The article then discusses the implications for these findings for the value of human rights as a perspective and means of increasing physical health of people with SMI.

Are Nurses in Mental Health Services Providing Physical Health Care for People with Serious Mental Illness? An Australian Perspective

People with serious mental illness are at high-risk for physical illnesses and premature death, and nurses can contribute to ensuring mental health services address these risks. There is very little research examining the role of nurses in mental health who provide physical health care. To identify the levels of participation in physical health care of people with serious mental illness (SMI), a national Internet-based survey of nurses working in mental health in Australia was conducted (n = 643). The survey included an adapted version of the Robson and Haddad Physical Health Attitude Scale. Data were analysed through comparison of frequencies, correlations, principal components analysis, and Mann-Whitney tests. Nurses reported regular physical health care in 12 of the 17 tasks presented to them. The three most common self-reported physical health care activities were inquiring about consumers’ contact with GPs, doing physical assessments, and providing information on drug use and lifestyle. Although some practices were less common (e.g., contraceptive advice) nurses who provided one type of care tended to do other types as well. In addition, credentialing in mental health nursing was associated with slightly more regular engagement in all practice domains except screening and assessments. Nurses in mental health in Australia may be engaged in improving physical health of consumers with SMI more than is assumed.

Physical health care for people with mental illness: Training needs for nurses

People diagnosed with serious mental illness have higher rates of physical morbidity and decreased longevity, yet these people are not adequately served by health care systems. Nurses may provide improved physical health support to consumers with serious mental illness but this is partly dependent on nurses having necessary skills and interest in training opportunities for this component of their work. This survey investigated Australian nurses' interest in training across areas of physical health care including lifestyle factors, cardiovascular disease, and identifying health risks. A nation-wide online survey of nurse members of the Australian College of Mental Health Nurses. The survey included an adapted version of a sub-section of the Physical Health Attitudes Scale. Participants were asked to indicate their interest in various aspects of physical health care training. Most (91.6%) participants viewed educating nurses in physical health care as of moderate or significant value in improving the physical health of people with serious mental illness. Interest in training in all areas of physical health care was over 60% across the health care settings investigated (e.g. public, private, primary care). Forty-two percent sought training in all nine areas of physical health care, from supporting people with diabetes, to assisting consumers with sexually-related and lifestyle issues. The findings suggest that nurses in mental health services in Australia acknowledge the importance of training to improve physical health care of consumers with serious mental illness. Training programs and learning opportunities for nurses are necessary to reduce inequalities in health of people with serious mental illness.

Mental Health Nurse Incentive Program: Facilitating physical health care for people with mental illness?

People with serious mental illness have increased rates of physical ill-health and reduced contact with primary care services. In Australia, the Mental Health Nurse Incentive Program (MHNIP) was developed to facilitate access to mental health services. However, as a primary care service, the contribution to physical health care is worthy of consideration. Thirty-eight nurses who were part of the MHNIP participated in a national survey of nurses working in mental health about physical health care. The survey invited nurses to report their views on the physical health of consumers and the regularity of physical health care they provide. Physical health-care provision in collaboration with general practitioners (GPs) and other health-care professionals was reported as common. The findings suggest that the MHNIP provides integrated care, where nurses and GPs work in collaboration, allowing enough time to discuss physical health or share physical health activities. Consumers of this service appeared to have good access to physical and mental health services, and nurses had access to primary care professionals to discuss consumers' physical health and develop their clinical skills in the physical domain. The MHNIP has an important role in addressing physical health concerns, in addition to the mental health issues of people accessing this service.

Perceptions of Barriers to Physical Health Care for People with Serious Mental Illness: A Review of the International Literature

Premature death and poorer access to quality care for physical health concerns is common for people diagnosed with serious mental illness (SMI). However, there is lack of clarity regarding the nature of barriers encountered at different points in the physical health care process, and the level of consistency of these barriers both among countries, and between consumers with SMI and health care staff. The current narrative review integrates views of consumers and health care staff on barriers to physical health care. It involved a search of CINAHL, Proquest, and Web of Science, for peer-reviewed papers published between 2005 and June 2012, for studies of perceptions of barriers to physical health care, published in English. Despite variations in health care systems among countries, there is agreement between consumers and health care staff that division between physical and mental health care and stigma of mental illness act as barriers to all phases of the physical health care process. This uniformity is grounds for international policy development (in general public health and within mental health nursing) for reforms that improve the physical health care, quality of life, and longevity of people with serious mental illness.

Emergency department staff views and experiences on diagnostic overshadowing related to people with mental illness

Aims. To investigate recognition of diagnostic overshadowing, i.e., misattribution of physical symptoms to mental illness, among emergency medicine professionals; further, to identify contributory and mitigating factors to diagnostic overshadowing. Methods. In-depth individual interviews of 25 emergency department clinicians and qualitative analysis using thematic analysis. Results. Diagnostic overshadowing was described as a significant issue. Contributing factors included: (1) problems of knowledge and information gathering; (2) clinicians' attitudes toward people with mental illness, substance misuse and frequent attenders; and (3) difficulties in working with mental health services in the context of a 4-h target for discharge from the emergency department. Avoidance of patients with a psychiatric diagnosis was also described, due to fear of violence. Conclusion. The physical health care of people with mental illness in emergency departments may be adversely affected by diagnostic overshadowing and avoidance by clinical staff, along with difficulties created by the illness, medication and the emergency department environment. Greater joint working between psychiatric and emergency department staff is suggested as one way to reduce diagnostic overshadowing.

Mental health nursing and physical health care: A cross‐sectional study of nurses' attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness

Mental health nurses have a key role in improving the physical health of people with a serious mental illness, however, there have been few studies of their attitudes or the extent of their involvement in this work. The aim of this study was to examine mental health nurses' attitudes to physical health care and explore associations with their practice and training. A postal questionnaire survey including the Physical Health Attitude Scale for mental health nurses (PHASe) was used within a UK mental health trust. The 52% (n = 585) of staff who responded reported varying levels of physical health practice; this most frequently involved providing dietary and exercise advice and less frequently included advice regarding cancer screening and smoking cessation. Having received post-registration physical health-care training and working in inpatient settings was associated with greater reported involvement. More positive attitudes were also evident for nurses who had attended post-registration physical health training or had an additional adult/general nursing qualification. Overall, the attitudes of mental health nurses towards physical health care appear positive and the willingness of nurses to take on these roles needs to be recognized. However, there are areas where nurses in our sample were more ambivalent such as cancer screening and smoking cessation.

A Tail with a Thorn in it: Second-Generation Antipsychotics Hand in Hand with Statins

Schizophrenia is a chronic, severe, and disabling mental disorder characterized by deficits in thought processes, perceptions, and emotional responsiveness. Its prevalence in the USA is estimated at 1.1 % by the American Institute of Mental Health [1]. Left untreated, patients with schizophrenia will suffer from severe and prolonged psychotic episodes, causing them to become more and more removed from reality and from the ability to cope with their social and occupational environment. The introduction of chlorpromazine, the first effective anti-psychotic agent, heralded a new era in psychiatry. For the first time a drug that modified the course of the disease became available [2]. Traditionally, antipsychotic agents have been classified into 2 major groups: first-generation (conventional) agents and second generation (atypical) agents. The atypical agents differ pharmacologically from previous antipsychotic agents in their lower affinity for dopamine D2 receptors and higher affinities for other neuroreceptors, including those for serotonin (5-hydroxytryptamine 1A, 2A, 2C, 3, 6, and 7) and norepinephrine (α1 and α2) [3]. First generation antipsychotic agents cause extrapyramidal symptoms. These are manifested by Parkinsonism (hand tremor, rigidity, and reduced facial expression) and repetitive movements (tardive dyskinesia, dystonias, and akathisia), which add to patients’ morbidity and awkwardness. Second generation antipsychotics, owing to their lower affinity for dopaminergic receptors, cause significantly fewer extrapyramidal symptoms. Because of their more favorable side-effect profile second generation antipsychotics became very popular, even though they were not proven to be more effective than typical antipsychotics in controlling psychotic symptoms [2, 4]. Schizophrenic patients have reduced life expectancies compared with the general population [5–7]. From the earliest reports it became increasingly clear that the higher death rate could not be attributed exclusively to unnatural death causes such as trauma and suicide [8]. Other major causes include cancer and cardiovascular diseases. The greatly increased risk of cardiovascular disease in schizophrenic patients is mainly attributable to a high prevalence of conventional risk factors. Smoking rates among these patients are 3 to 5 times higher than in the general population. Furthermore, schizophrenic smokers take in more nicotine per cigarette than smokers without this disorder [9, 10]. Access to physical health care for people with schizophrenia is hindered by both the structure and the underfunding of publicly supported systems of physical health and behavioral health care. Schizophrenic patients often lack the resources for private medical providers, and coordination between health care and behavioral health care systems is usually poor. Research also suggests that schizophrenic patients frequently face discrimination in accessing R. Durst : E. Leitersdorf (*) Center for Research Prevention and Treatment of Atherosclerosis, Hadassah Hebrew University Medical Center, Jerusalem, Israel e-mail: eranl@hadassah.org.il

Evolving role of mental health nurses in the physical health care of people with serious mental health illness

Life expectancy in members of the general population has steadily improved in most countries since 1960. However, during the same period, the life expectancy of people with serious mental illness (SMI) has actually reduced. The majority of premature deaths result from natural causes, such as coronary heart disease. Obesity, a key risk factor for heart disease in this client group, might be caused both by unhealthy lifestyle behaviours and the side-effects of antipsychotic medication. Mental health nurses (MHN) nurses have an important role to play in improving the physical health of people with SMI. Evidence, however, suggests that they are often ambivalent about this role, and might perceive themselves as being inadequately trained and lacking in confidence. In this paper, we will argue that MHN need to re-evaluate their practice and recognize that the provision of physical health care is as important as other roles they occupy in relation to the care of people with SMI. We will also consider examples of best practice in physical health care, and discuss how these might be adopted by MHN and other professionals, in order to begin to improve services and to reduce health inequalities in this client group.

Nurses' views on physical activity for people with serious mental illness

ObjectivesPeople with serious mental illness experience heightened physical ill-health. Physical activity is an effective strategy for improving physical health in this group. This paper explores nurse views on the place of physical activity in the physical health care of people with serious mental illness who are receiving mental health care services. MethodsA qualitative exploratory study involving 38 nurses working in a regional and remote area of Queensland, Australia. Focus group interviews were audio recorded and transcribed and a thematic analysis was conducted. ResultsHolism was identified as the main theme and physical activity was thought about as an aspect of holism at the level of the person and environment. For nurses, holism equated with supporting consumers in being more physical active and having healthier lifestyles. This was qualified by the sub-themes of fragmentation (that rendered physical activity difficult for consumers, and the nurses supporting them), and integration (where nurses and colleagues sought to address fragmentation in conjunction with consumers, but with transient success). ConclusionAs part of their holistic outlook, nurses recognise the importance of physical activity for consumers' overall health, and were involved in promoting physical activity through health education. When nurses tried to develop holism in mental health care (e.g. re-integrating services) sources of fragmentation were too significant and wide-ranging to overcome.

Mental health nurses’ attitudes towards the physical health care of people with severe and enduring mental illness: The development of a measurement tool

Background It is well established that people with schizophrenia and related serious mental illnesses die prematurely and have significantly higher medical co-morbidity compared with the general population. Mental health nurses have a key role in improving the physical health of patients but their attitudes to this aspect of their role have not been systematically examined. Objectives To develop and validate a measure of mental nurses’ attitudes towards physical health care. Design The measurement tool was developed from a literature review, focus groups and responses to a postal questionnaire. Participants and setting All registered nursing staff working within a NHS mental health trust in the UK were sent the questionnaire and 585 (52%) staff responded. Methods Completed questionnaires were analysed by standard descriptive statistical methods. Exploratory factor analysis (principal component analysis) was used to examine and reduce attitude items to a coherent and parsimonious scale. Results A 28-item measure comprised of four factors accounted for 42% of the variance. The factor solution appeared to provide meaningful dimensions, and the internal consistency of the measure and of its derived subscales was adequate (Cronbach's alpha between 0.76 and 0.61). The factors were labelled nurses’ attitudes to involvement in physical health care; nurses’ confidence in delivering physical health care; perceived barriers to physical health care delivery and nurses’ attitudes to smoking. Validity was established by associations between the total scale and subscales with pre-determined respondent variables. Conclusion The Physical Health Attitude Scale for mental health nurses (PHASe) is a first attempt to develop a valid and reliable measure of this important area. The initial development methods and its testing in a large sample provide indications of content and construct validity. Further testing in different samples and consequent refinement are necessary, however the PHASe appears to be a useful tool for measuring attitudes among this professional group and evaluating the effects of professional development.

Physical healthcare for people with serious mental illness

PurposeThis paper aims to design and implement an audit of physical health monitoring for patients with schizophrenia or bipolar disorder in primary care.Design/methodology/approachEvidence‐based criteria for physical health monitoring were developed from current clinical guidelines. Physical health monitoring of 128 patients with a diagnosis of either schizophrenia or bipolar disorder was audited against these criteria in two urban GP practices.FindingsThe number of patients whose smoking history, alcohol consumption history, blood pressure and body mass index had been recorded in the preceding 15 months varied significantly by practice, whilst recording of blood cholesterol and diabetes status did not. Patients with a diagnosis of schizophrenia were significantly more likely to have had a diabetes status recorded in the preceding 15 months compared to patients with bipolar disorder.Research limitations/implicationsStandards for compliance with audit criteria need to be debated and agreed with stakeholders. Further research is needed into how physical healthcare services can effectively engage patients with serious mental illness.Practical implicationsAudit of physical health monitoring in primary care is feasible and could be used to identify shortcomings in physical healthcare for people with serious mental illness. Inviting patients on practices' mental health registers for cardiovascular risk screening should be considered.Social implicationsRegular audit of physical health monitoring in people with schizophrenia or bipolar disorder may help ensure equitable healthcare delivery for patients with serious mental illness.Originality/valueThis paper presents an audit methodology that primary care trusts and general practitioners can use to assess how effectively the physical health of people with serious mental illness is being monitored.

Can making physical healthcare policies more readable improve healthcare standards?

Gonzalez et al1 have pointed out an interesting omission in the form of poor physical healthcare monitoring in routine psychiatric practice and there is evidence from various local and national audits2,3 that it is not restricted to just the out-patient settings. The authors have also rightly picked up on key barriers to the implementation of physical healthcare monitoring in psychiatric settings, namely unclear responsibilities, competing demands on limited resources and liability issues. We believe that, for a start, this can be addressed by having readable, succinct and unambiguous physical healthcare policies. Tosh et al4 examined the physical healthcare policy documents of the three mental healthcare trusts in the north sector of the East Midlands Strategic Healthcare Authority in detail. We found significant disparities between the policies in terms of size, readability, external references and reading cost. All the policies incorporated vague language in their directives and none could be read swiftly. It is only fair to make a reasonable observation here that if a policy cannot be accessed or is unfocused or vague, then it will be ignored. Multiple layers of guidance and variation between deaneries, trusts and teams also complicate the situation. This leads to confusion and lack of confidence between team members as to which policy to follow. The result is a huge wastage of money from duplication and undermining of the ability of the policy to deliver its objectives. A collaborative effort at the national level could produce a simple, clear and succinct policy for physical healthcare of people with serious mental illness. We believe that the Royal College of Psychiatrists is in a unique position to take a lead on this very important aspect of patient health and well-being. There are already themes emerging from research that it is an area which is very important to the patients, carers and their families alike.5 A clear national policy statement from the College should dispel current confusion, policy fatigue and waste.

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

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

Health Care Homes to Meet the Unique Needs of Persons with Serious Mental Illness

Several articles in this issue of the Journal of Behavioral Health Services & Research examine access to care and a “home” for people with mental illness, including the articles Accessing Specialty Behavioral Health Treatment in Private Health Plans and The BMC ACCESS Project: The Development of a Medically Enhanced Safe Haven Shelter. The patient-centered medical home model, developed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association in 2007, focuses on team-based care led by a personal physician who maintains a relationship with the patient, provides continuous care management by coordinating with other qualified professionals as needed, and supports the patient in learning about and managing illness, particularly chronic conditions. All of these concepts are consistent with the care of persons with mental illness. National policy discussions offer the “medical home” model as a fundamental tenet of health care reform proposals. However, these discussions generally ignore the needs of people with serious mental illnesses. In April 2009, the National Council released a report entitled Behavioral Health/Primary Care Integration and the Person-Centered Healthcare Home that brings together current developments around the patient-centered medical home with evidence-based approaches to the integration of primary and behavioral health care. The report also proposes renaming of the patient-centered medical home as the person-centered health care home. The name change is more than cosmetic. Person-centered health care home emphasizes that behavioral health is a central part of health care, and such a shift in perspective can begin to address the behavioral health needs in primary care and the significant health disparities for people with serious mental illness. These disparities cause people with serious mental illness to die an average of 25 years sooner than other Americans. Three out of every five people with serious mental illnesses die from preventable, co-occurring chronic diseases such as asthma, diabetes, cancer, heart disease, and cardiopulmonary conditions. Access to physical health care for people with serious mental illness is hindered by both the structural impediments and the under-funding of the publicly supported physical health and behavioral health systems of care. While community mental health organizations, which treat a majority of persons with serious mental illnesses, consider general health care for patients a priority, only one of two organizations has any general health care capacity, as revealed by a provider survey. In light of these tragic statistics, the Behavioral Health/Primary Care Integration and the Person-Centered Healthcare Home: The Person-Centered Healthcare Home report features an