Health Care Providers Physicians Research Articles

Barriers and Needs of Mental Health Nursing Practitioners toward the Provision of Physical Health Care for Individuals with Severe Mental Illness: Findings from a Cross-Sectional Survey in India

Despite the potential and opportunity for nurses in mental health settings to deliver comprehensive care to individuals with severe mental illnesses, existing evidence indicates inadequacy in providing physical health care. To understand this gap, we examined the mental health nurse’s attitudes, practices, training needs, and barriers toward physical healthcare of individuals with severe mental illness and explored the associated socio-demographic differences. All mental health nurses working in an apex mental health care center in India were assessed using a self-administered questionnaire, which included a socio-demographic profile and the Physical Health Attitude Scale (PHASe). Overall, the nurses held positive attitudes, with items related to smoking and confidence toward physical health care delivery showing more positive ratings than those items related to attitude and perceived barriers. Lack of motivation from patients and nurse’s workload in provision of psychiatric care were perceived as major barriers. Nurses with lesser years of experience had a slightly more positive attitude. The findings have important implications for mental health nursing practice and training toward strengthening holistic nursing care for individuals with severe mental illness, specifically in countries with limited resources.

Comparison of outcomes for patients with and without a serious mental illness presenting to hospital for chronic obstruction pulmonary disease: retrospective observational study using administrative data.

There are few data on the profile of those with serious mental illness (SMI) admitted to hospital for physical health reasons. To compare outcomes for patients with and without an SMI admitted to hospital in England where the primary reason for admission was chronic obstructive pulmonary disease (COPD). This was a retrospective, observational analysis of the English Hospital Episodes Statistics data-set for the period from 1 April 2018 to 31 March 2019, for patients aged 18-74 years with COPD as the dominant reason for admission. Patient with an SMI (psychosis spectrum disorder, bipolar disorder) were identified. Data were available for 54 578 patients, of whom 2096 (3.8%) had an SMI. Patients with an SMI were younger, more likely to be female and more likely to live in deprived areas than those without an SMI. The burden of comorbidity was similar between the two groups. After adjusting for covariates, SMI was associated with significantly greater risk of length of stay than the median (odds ratio 1.24, 95% CI 1.12-1.37, P ≤ 0.001) and with 30-day emergency readmission (odds ratio 1.51, 95% confidence interval 1.34-1.69, P ≤ 0.001) but not with in-hospital mortality. Clinicians should be aware of the potential for poorer outcomes in patients with an SMI even when the SMI is not the primary reason for admission. Collaborative working across mental and physical healthcare provision may facilitate improved outcomes for people with SMI.

Effect of Educational Program on Nurses' Attitudes and Practices Regarding Provision of Physical Health Care for Patients with Severe Mental Illness

Effect of Educational Program on Nurses' Attitudes and Practices Regarding Provision of Physical Health Care for Patients with Severe Mental Illness

Effect of Educational Program on Nurses' Attitudes and Practices Regarding Provision of Physical Health Care for Patients with Severe Mental Illness

Effect of Educational Program on Nurses' Attitudes and Practices Regarding Provision of Physical Health Care for Patients with Severe Mental Illness

Nurses' views on the provision of physical healthcare for individuals with comorbid mental illness and chronic disease.

The prevalence of chronic diseases (such as diabetes, obesity, cancer, heart disease, and chronic obstructive pulmonary disease) continues to increase among patients with mental illness. This cross-sectional study investigated the factors affecting nurses' views on the provision of physical healthcare to patients with comorbid mental illness and chronic disease. In total, 369 nurses working in mental health were assessed for the physical healthcare attitudes and practices using the Physical Health Attitude Scale for Mental Health Nurses. The results of generalized linear modelling indicated that nurses' involvement in physical healthcare was associated with psychiatric mental health nurse credentials (B = 1.560, 95% CI = 0.292-2.828, P = 0.016) and their confidence in delivering physical healthcare was associated with prior physical healthcare training (B = 0.639, 95% CI = 0.104-1.174, P = 0.019). In addition, the frequency with which the nurses engaged in physical healthcare practices was associated with working in a community unit (B = -7.416, 95% CI = -9.652 to -5.180, P < 0.001), involvement in physical healthcare (B = 0.349, 95% CI = 0.162-0.535, P < 0.001), and confidence in delivering physical healthcare (B = 1.148, 95% CI = 0.776-1.519, P < 0.001). Our findings suggest that interventions aiming to help nurses assess and improve their own physical healthcare practices should consider nurses' background and patients' physical health needs in various settings and focus on cultivating an organizational culture that gives nurses confidence in providing physical healthcare.

Mental Health Nurses' Perceptions of Their Role in Physical Screening and Lifestyle Coaching for Patients With a Severe Mental Illness: A Qualitative Study.

The life expectancy of patients with severe mental illness (SMI) is estimated to be 20 to 30 years shorter than in the general population due to avoidable physical illnesses. This gap is widening. Health care professionals' performance with regard to physical health and lifestyle appears to be suboptimal. The purpose of this study is to formulate recommendations to enhance physical care for patients with an SMI. A generic descriptive qualitative study was conducted. Fifteen mental health nurses (MHNs) working in community mental health care in the Netherlands were interviewed. Thematic analysis of the data was performed. Most MHNs perceived physical screening and lifestyle interventions to be an important part of their professional role. However, they recognize discrepancy between their perception and actual practice. Most MHNs focus in particular on the psychiatric illness and its consequences for daily living, and they defined the provision of physical health care as a secondary concern. Participants described building a therapeutic relationship as a crucial, however, difficult part of the process of working on physical health promotion. Many MHNs tend to formulate goals and necessary behavioral changes on behalf of their patients, rather than helping them formulate their own goals and activities for themselves. Building a good therapeutic relationship with patients and supporting patients in defining their own lifestyle goals can enhance nursing physical care. Support by other team members (such as NPs) and managers is needed. In training and education for professionals, the lessons learned in this study should be included.

Partnership between patients and interprofessional healthcare providers along the multifaceted journey to medication adherence.

Partnership between patients and interprofessional healthcare providers along the multifaceted journey to medication adherence.

Oklahoma police would benefit from MH professionals on calls

A bipartisan study held Sept. 13 by Oklahoma's House Public Safety Committee affirmed that law enforcement would benefit from enhanced participation by mental health professionals on crisis calls, the Oklahoman reported Sept. 22. Rep. Randy Randleman, R‐Eufaula, and Rep. Collin Walke, D‐Oklahoma City, requested the study to establish the need for more mental health crisis units and help the police identify mental health crises more accurately, according to a news release from the Oklahoma State House of Representatives. Dr. David J. Thomas, a policing expert and a professor at Florida Gulf Coast University, said he's seen two successful models: One model, CAHOOTS, is used in Oregon and uses the police dispatch person to assess a situation and send an appropriate team of mental and physical health care providers, only dispatching police officers when absolutely necessary. The other version is a co‐responder program being used in Gainesville, Fla. this approach involves a designated car on each shift which pairs a specially trained officer and a mental health professional. When a mental health call comes in, that car is dispatched first as long as it is available.

The importance and availability of adjustments to improve access for autistic adults who need mental and physical healthcare: findings from UK surveys

ObjectivesTo investigate autistic people’s views on the importance and availability of adjustments to mental and physical healthcare provision. To explore whether specific categories of adjustments can be identified and to...

Attitudes to physical healthcare in severe mental illness; a patient and mental health clinician qualitative interview study

BackgroundPeople with severe mental illness experience physical health significantly worse than the general population. Physical health monitoring is shared between primary care and secondary mental healthcare services, though there is debate whether mental health teams should provide more physical healthcare. The views of mental health clinicians and patients with mental illness towards physical healthcare provision are unclear.AimsTo explore the attitudes of Community Mental Health Team (CMHT) clinicians and patients experiencing severe mental illness towards physical healthcare and its provision.Design and settingQualitative study in a CMHT setting.MethodsInterviews were carried out with CMHT clinicians and patients with severe mental illness. Data were collected using semi-structured interviews and analysed using thematic analysis.ResultsThere were 14 patients and 15 clinicians recruited. Patients varied in their awareness of the association between physical and mental health, but were engaged in physical health monitoring. Clinicians were aware of the importance of physical healthcare but reported barriers to provision, including lack of training, resource constraints and uncertainty in their role. There was no consensus in either group regarding how physical healthcare should be provided, with diverse attitudes expressed for why CMHTs should and shouldn’t provide more physical healthcare.ConclusionsIncreasing physical healthcare provision from mental health teams requires healthcare-related barriers be addressed, but it remains unclear whether CMHT clinicians or patients believe this to be a solution.

Barriers and Possible Solutions to Providing Physical Health Care in Mental Health Care: A Qualitative Study of Danish Key Informants’ Perspectives

Provision of physical health care to people diagnosed with severe mental illness is widely reported as inadequate. This interview study explored perspectives of a group of key informants on current practices of providing physical health care within two mental health care settings in Denmark. Thematic analysis of their accounts provided insights into 1) barriers to the provision of physical health care in mental health settings, and 2) possible solutions to overcome existing barriers. Negative attitudes and limited specialist health care knowledge among mental health care professionals constituted serious barriers. To effectively address these barriers, mental health services need to be reoriented towards the prioritisation of physical health alongside mental health. This will require equipping mental health professionals with relevant knowledge and skills and organisational resources, to effectively work with people experiencing or at risk of physical comorbidities.

Addiction psychiatry and COVID-19: impact on patients and service provision.

The Coronavirus Disease 2019 (COVID-19) pandemic has undoubtedly had a major impact on the provision of physical healthcare in Ireland and worldwide. The mental health impact of this pandemic cannot be underestimated, particularly relating to patients suffering from addiction. Heightened public stress and anxiety levels, increasing isolation and the physical consequences of addiction play a large role in the proliferation and ongoing relapse of substance misuse and behavioural addiction. Service provision is an ongoing challenge not only due to the increasing need for services given the increased mental health burden of COVID-19 but also the restrictions in place in clinical areas to achieve social distancing. The necessary adaptations to service provision provide opportunities for the analysis of current processes used in our addiction unit and the introduction of new processes to our service. The current crisis tests the sustainability of the service to provide the high standard of care required for these patients.

Preventive care for physical activity and fruit and vegetable consumption: a survey of family carer expectations of health service delivery for people with a mental health condition

BackgroundChronic disease is a leading cause of death globally, where inadequate fruit and vegetable consumption and inadequate physical activity are consistently implicated as key contributing risk factors for such diseases. People with a mental health condition are reported to experience a higher prevalence of such risks and experience an increased morbidity and mortality from resultant chronic disease. Despite guidelines identifying a need for services accessed by people with a mental health condition to provide care to address such health risk behaviours, sub-optimal care is frequently reported suggesting a need for innovative strategies to increase the provision of physical health care. An exploratory study was conducted to examine: 1) family carers’ expectations of care provision regarding fruit and vegetable consumption and physical activity by health and community services for people with a mental health condition; 2) carer’s own health risk behaviour status and perceptions of the influence of the health risk behaviours on mental health; and 3) possible associations of socio-demographic, clinical and attitudinal factors with carer expectations of care provision for fruit and vegetable consumption and physical activity.MethodsFamily carers (n = 144) of a person with a mental health condition completed a cross-sectional survey. Participants were members of a mental health carer support organisation operating in New South Wales, Australia.ResultsA high proportion of participants considered care for fruit and vegetable consumption and physical activity respectively should be provided by: mental health hospitals (78.5, 82.7%); community mental health services (76.7, 85.9%); general practice (81.1, 79.2%); and non-government organisations (56.2, 65.4%). Most participants perceived adequate fruit and vegetable consumption (55.9%), and physical activity (71.3%) would have a very positive impact on mental health. Carers who perceived adequate fruit and vegetable consumption and physical activity would have a positive impact on mental health were more likely to expect care for such behaviours from some services.ConclusionsThe majority of participants expected care for fruit and vegetable consumption and physical activity be provided by all services catering for people with a mental health condition, reinforcing the appropriateness for such services to provide physical health care for clients in a systematic manner.

\u201cIt\u2019s like I was out there by myself\u201d: The receipt of reentry support among HIV-infected formerly incarcerated individuals in New York City

BackgroundIn the U.S., approximately one in seven HIV-infected individuals experience incarceration at least once in their lifetime. While HIV-infected individuals experience positive health outcomes during periods of incarceration, they tend to experience treatment disruption as they return to their community after custody which results in poor health outcomes. The purpose of this study was to explore the transitional support received from the Department of Corrections during the reentry period.MethodsWe conducted in-depth interviews with 20 HIV-infected formerly incarcerated individuals in New York City. Interviews were audio recorded and transcribed. Three researchers performed line-by-line reading of the transcripts to identify dominant codes and themes that emerged. A mixture of deductive and inductive techniques was used to identify patterns that emerged in the data.ResultsMost of the participants were male and racial and ethnic minorities. There were five dominant themes that emerged during our analysis: 1) variations in the quantity of antiretroviral medication received during transition; 2) linkages to community-based physical health care providers was not well-coordinated; 3) insufficient housing and social resources; 4) structural and social challenges to post-release well-being; and 5) family as a source of resilience.ConclusionsDischarge support planning should include sufficient medication to prevent treatment disruption and a more comprehensive approach to linkage to community-based healthcare services. Such planning should also include thorough pre-release assessments to identify appropriate levels of support needed, including employment and housing assistance, which will be useful for resource allocation. Broadening public health partnerships may also increase availability and promote accessibility to the most appropriate healthcare services and programs, which may provide better opportunities to receive coordinated care and ensure continuity of care. Finally, ties to family members and other loved ones should be leveraged to help facilitate the achievement of optimal health outcomes among this population.

Improving physical health outcomes for people with severe mental illness: A proof-of-concept study of nurse practitioner candidate practice.

People with severe mental illness have significantly reduced life expectancy and higher risk of cardiovascular diseases than the general population. There is a critical need for quality physical health care to improve consumers' health outcomes. There is minimal knowledge, however, on the impact of mental health nurse practitioner candidate (NPC) practices on consumers' health outcomes. The aim of this proof-of-concept study was to describe the impacts of NPC practices on the quality of physical healthcare provision and physical health outcomes (cardiovascular and cardiometabolic) of consumers in community mental health service settings. Using a mixed methods design, quantitative data were collected for 12months prior to (Period 1), and 12months during (Period 2), the candidacy period. Qualitative interviews were conducted with a purposive sample of n=10 consumers to explore their perspectives on physical healthcare provision by the NPCs. During the 12-month candidacy period, the number of metabolic monitoring assessments rose from n=55 in Period 1 to n=146 in Period 2 (P<0.01, χ2 =41.20). Advanced practices provided by NPCs included taking an extensive holistic history and clinical examination, ordering diagnostic pathology, and clinical simulation of physical health medication prescription (under medical supervision). Analysis of consumer interviews resulted in two themes: (i) positive and helpful NPC health care and (ii) improvements in physical and mental health. The findings add new knowledge on specialist mental health nurse practitioner candidate roles and demonstrate the benefits these roles can have in reducing the significant morbidity and mortality of mental health consumers.

Embedding an exercise professional within an inpatient mental health service: A qualitative study

BackgroundIntegrating exercise professionals into mental health settings is a key strategy in addressing the physical health inequalities of people living with mental illness. Workforce culture surrounding physical health may impact the utilisation of exercise professionals across inpatient settings. AimsTo evaluate clinician perspectives regarding the implementation of an exercise professional at the mental health service in a large, urban hospital in Sydney, Australia. MethodsA qualitative study using semi-structured interviews with a purposive sample of mental health staff was conducted. Data were analysed using thematic analysis. ResultsFourteen mental health clinicians (approximately 35% of all eligible staff) participated in interviews. Three themes emerged regarding the role of the exercise professional; i) drivers and facilitators; ii) support from leadership; and iii) directions for future practice. ConclusionsAn exercise professional within a mental health service was identified as an effective strategy in improving consumer health outcomes while increasing the knowledge and confidence of mental health clinicians regarding the provision of physical health care. Exercise professionals should be recognised as important members of the standard multidisciplinary mental health team for in patients being treated for mental illness.

The provision of physical health care by nurses to young people with first episode psychosis: A cross-sectional study.

Background Registered nurses working in the area of mental health complete either a psychiatric/mental health or comprehensive/generalist nursing program, and their education preparation influences their physical health care nursing practices. The differences in educational preparation may be a contributory factor to nurses' delivery of physical health care to young people experiencing first episode psychosis. This paper addresses an identified gap in nursing practices related to physical health care of young mental health service users. Aim To examine the relationship between the educational preparation of nurses and attitudes, confidence level, perceived barriers and physical health care nursing practices. Method A cross-sectional survey was conducted in 2015 with 207 nurses using the modified Physical Health Attitude Scale for Mental Health Nurses (PHASe). Results Comprehensive/generalist prepared nurses were more likely to provide education on heart disease prevention and sexual health and support young people to stop cigarette smoking than psychiatric/mental health nurses. However, as the length of service progresses, the propensity for psychiatric/mental health nurses to be involve in smoking cessation increases. Implication for practice It is important to identify how nurses' educational preparation affects their nursing practices so as to address the gaps in their physical health literacy.

Providing physical health care for people accessing mental health services: Clinicians' perceptions of their role.

The prevalence of health risk behaviours and associated poor physical health is high in people with severe mental illness. Mental health service guidelines and policies stipulate that mental health services should address physical health of people who access services. This study reports results from a large, interdisciplinary, cross-sectional study exploring mental health clinicians' (n=385) views of role legitimacy in physical health service provision. All disciplines reported that mental health clinicians have a role to play in addressing the physical health of consumers. Among mental health clinicians, psychiatrists and mental health nurses received higher endorsement than allied health clinicians in relation to the provision of physical health care, with primary care providers including general practitioners also ranking highly. As community mental health services routinely appoint allied health staff to case management roles, a challenge for services and a challenge for clinicians are to ensure that physical health and the effects of medication are monitored appropriately and systematically. Online and telephone support services received relatively lower endorsement. As the availability of nonface to face services increases, there is a need to explore their utility in this population and where appropriate promote their uptake.

Using the capabilities approach to understand inequality in primary health-care services for people with severe mental illness

BackgroundEpidemiological studies show disparities in the provision of physical health-care for people with severe mental illness. This observation includes countries with universal health insurance. However, there is limited in-depth data regarding the barriers preventing equality of physical health-care provision for this population. This study applied the capabilities approach to examine the interface between general practitioners and patients with severe mental illness. The capabilities approach provides a framework for health status which conceptualizes the internal and external factors relating to the available options (capabilities) and subsequent health outcomes (functioning).MethodsSemi-structured in-depth interviews were conducted with 10 general practitioners and 15 patients with severe mental illness, and then thematically analyzed.Results: We identified factors manifesting across three levels: personal, relational-societal, and organizational. At the personal level, the utilization of physical health services was impaired by the exacerbation of psychiatric symptoms. At the relational level, both patients and physicians described the importance of a long-term and trusting relationship, and provided examples demonstrating the implications of relational ruptures. Finally, two structural-level impediments were described by the physicians: the absence of continuous monitoring of patients with severe mental illness, and the shortfall in psychosocial interventions.ConclusionThe capability approach facilitated the identification of barriers preventing equitable health-care provision for patients with severe mental illness. Based on our findings, we propose a number of practical suggestions to improve physical health-care for this population: 1. A proactive approach in monitoring patients’ health status and utilization of services. 2. Acknowledgment of people with severe mental illness as a vulnerable population at risk, that need increased time for physician-patient consultations. 3. Training and support for general practitioners. 4. Increase collaboration between general practitioners and mental-health professionals. 5. Educational programs for health professionals to reduce prejudice against people with severe mental illness.

Physical Health in Public Mental Health Care: A Qualitative Study Employing the COM‐B Model of Behaviour to Describe Views and Practices of Australian Psychologists

ObjectiveTo inform improvement in the process and outcomes of care by describing the views and practices of psychologists working in public mental health services (PMHS) regarding provision of physical healthcare for consumers.MethodCross‐sectional qualitative study employing a theoretical model of behaviour (capability, opportunity, motivation, and behaviour; COM‐B model). Data collected in semi‐structured interviews with maximum diversity sample of 29 psychologists were analysed using the framework approach.ResultsParticipants were cognisant of the need to improve physical health among people with severe mental illness (SMI); they endorsed, to varying extents, the obligation of PMHS and potential of psychologists, collectively to contribute to this goal through provision of interventions targeting health behaviours. Within a context in which psychology was generally underutilised, practice varied widely, ranging from avoidance to integration of physical health care in clinical practice. In combination, mixed‐messages about service priorities, role ambiguity, competing demands, and concern about adequacy of knowledge and skills inhibited attention to physical health for most participants, particularly those working in generic case management roles. Some highly motivated psychologists, most of whom worked in specialised teams within which attention to physical health was normative, made and capitalised on opportunities to develop and apply skills to enable consumers to change behaviour and improve physical health.ConclusionWhile further education and training will enhance capability and motivation of psychologists, realisation of the potential contribution to improvement in physical health of people with SMI will fundamentally, require assertion of the identity and value of the profession within mental health services. Ensuring optimal use of scarce resources necessitates careful consideration of deployment of discipline specific expertise, and clarity about responsibilities of psychologists within teams.