Consumers at the centre: interprofessional solutions for meeting mental health consumers’ physical health needs

People Living With Mental Illness Perceptions of Physical Health, Mental Health and Well-Being

Understanding the perspectives of regional people living with mental illness is crucial to adapting services, improving holistic care and meeting individual needs. This study explored people living with mental illness perceptions of physical health, mental health and well-being. A descriptive qualitative study design underpinned by empowerment theory was conducted. Qualitative data were collected verbally via semi-structured interviews, with demographic details provided verbally at the end of the interview. Thematic analysis was utilised to identify themes. The COREQ checklist was used for reporting. Fourteen participants admitted to regional mental health inpatient units aged between 25 and 84 years old were interviewed. Participants felt their overall well-being was good despite feeling their physical health or mental health was suboptimal, suggesting that their perceived well-being is influenced by factors beyond their physical and mental health. Most participants reported looking after their physical health, mental health and well-being and identified various behavioural lifestyle strategies they found helpful. Thematic analysis identified three themes: functioning well, feeling in control and meeting basic needs. Mental health services and clinicians play an important role in empowering people with mental illness to improve their physical health, mental health and well-being while admitted to inpatient services; however, it is acknowledged resources can be limited. Mental health services may consider referring people with mental illness to social prescribing programmes to meet their individualised needs on discharge.

Severe mental illness and cardioprotective medication prescribing: a qualitative study in general practice

BACKGROUND

Patients with severe mental illness (SMI) die 10-20 years earlier than the general population. They have a higher risk of cardiovascular disease (CVD) yet may experience lower cardioprotective medication prescribing.

AIM

To understand the challenges experienced by GPs in prescribing cardioprotective medication to patients with SMI.

DESIGN & SETTING

A qualitative study with 15 GPs from 11 practices in two Scottish health boards, including practices servicing highly deprived areas (Deep End).

METHOD

Semi-structured one-to-one interviews with fully qualified GPs with clinical experience of patients with SMI. Interviews were transcribed verbatim and analysed thematically.

RESULTS

Participants aimed to routinely prescribe cardioprotective medication to relevant patients with SMI but were hampered by various challenges. These structural and contextual barriers included the following: lack of funding for chronic disease management; insufficient consultation time; workforce shortages; IT infrastructure; and navigating boundaries with mental health services. Patient-related barriers included patients' complex health and social needs, their understandable prioritisation of mental health needs or existing physical conditions, and presentation during crises. Professional barriers comprised GPs' desire to practise holistic medicine rather than treating via cardioprotective prescribing in isolation, and concerns about patients' medication concordance if patients were not prioritising this aspect of their health care at that particular time. In terms of enablers for cardioprotective prescribing, participants emphasised continuity of care as fundamental in engaging this patient group in effective cardiovascular health management. A cross-cutting theme was the current GP workforce crisis leading to 'firefighting' and diminishing capacity for primary prevention. This was particularly acute in Deep End practices, which have a high proportion of patients with complex needs and greater resource challenges.

CONCLUSION

Although participants aspire to prescribe cardioprotective medication to patients with SMI, professional-, system- and patient-level barriers often make this challenging, particularly in deprived areas owing to patient complexity and the inverse care law.

A critical review of research into mental health consumers' perspectives on their physical health: Is there an absence of consumers in the design, conduct, analysis and reporting of this research?

We conducted a critical review, using systematic methods, of the literature examining mental health consumer perspectives on their physical and mental health in academic research published between 2005 and 2021. This review examined the inclusion, extent, type and centrality of consumer perspectives regarding their mental and physical health. The search produced 1,865 papers from which 116 met the inclusion criteria. Studies predominantly focused on consumers' individual experiences of their physical and mental health, including but not limited to their understandings and experiences of medication and associated risk factors. They also captured some social aspects of mental health consumers' physical health, including factors that impacted individual agency, stigma, and social and interpersonal factors. Structural factors affecting physical and mental health, such as accessibility of services and financial constraints, were also identified. The review revealed that in comparison to clinician perspectives, the direct representation of consumer perspectives was lacking. Similarly, while clinician and carer perspectives on structural factors were investigated, the consumer perspective in this area was missing. The review also found few genuine codesigned or coproduced research studies. To better identify and respond to the health needs as prioritized by consumers, this paper argues it is imperative that future studies prioritize codesigned and coproduced research. It is argued that a focus on "services as provided" rather than "services as received" has contributed to a lack of progress in addressing the life expectancy gap for consumers. It is recommended that journals, ethics committees and research policy organizations develop guidelines and standards to inform best practice in research on consumer perspectives and experience and to support the implementation of codesigned and/or coproduced approaches in future research. Respecting and including consumers as equal partners in the research process will lead to more meaningful insights to inform policy and practice and reduce the life expectancy gap for people living with mental health concerns.

Mental health consumers' perspectives of physical health interventions: An integrative review

Consumers of mental health services experience poor physical health compared to the general population, leading to long-term physical illness and premature death. Current research and policy activity prioritizes the physical health of consumers yet few of these recommendations have translated to practice. This implementation gap may be influenced by the paucity of literature exploring consumer perceptions and experiences with physical healthcare and treatment. As a result, little is understood about the views and attitudes of consumers towards interventions designed to improve their physical health. This integrative review aims to explore the literature regarding consumer perspectives of physical healthcare and, interventions to improve their physical health. A systematic search was undertaken using (i) CINAHL, (ii) MEDLINE, (iii) PsycINFO, (iv) Scopus, and (v) Google Scholar between September and December 2021. Sixty-one papers comprising 3828 consumer participants met the inclusion criteria. This review found that consumers provide invaluable insights into the barriers and enablers of physical healthcare and interventions. When consumers are authentically involved in physical healthcare evaluation, constructive and relevant recommendations to improve physical healthcare services, policy, and future research directions are produced. Consumer evaluation is the cornerstone required to successfully implement tailored physical health services.

A practical toolkit to support Australian mental health clinicians to manage Metabolic Syndrome: A pilot study

Metabolic syndrome (MetS) results in poor physical health outcomes and reduced life expectancy of up to 20 years less for people living with severe mental illness. The aim of this pilot study was to evaluate a locally developed practical toolkit (Let's Get Physical-Improved Physical Health in Mental Health Services-A Practical Toolkit) to support mental health clinicians to manage MetS. The study explored clinician's knowledge and attitudes towards managing MetS, confidence to screen for and intervene in MetS, and improvement in documentation. A longitudinal prospective study, utilizing audit and pre-post-questionnaire design, was conducted. Of the 60 clinicians who were employed in the regional inpatient unit, 65% (n = 39) participated in at least one of the intervention education sessions. The final sample comprised 17 clinicians with matched pre- and post-intervention data (28% of eligible participants). A total of 80 (20 per month) eMR metabolic monitoring form and patient file audits were conducted. Whilst the results were not statistically significant, this study found an overall improvement in clinicians' knowledge of, and confidence to screen for and intervene in, MetS. Attitude scores were overall positive. There was also overall improvement in MetS documentation. The implementation of the practical evidence-informed physical health in mental health services toolkit may have a positive impact on clinician knowledge, attitudes, and confidence in screening and intervening in MetS. Replicating this study with a larger sample is recommended.

An academic-community interprofessional telehealth online training partnership: Impact on students and providers

Telehealth can be used to improve rural communities' access to specialized healthcare services and ameliorate rural care barriers. Use of telehealth quickly increased with the COVID-19 pandemic, and universities shifted to online instruction for the safety of students and faculty. This rapid uptake of telehealth and online instruction has created an urgent need for examples of online training for health professional students in telehealth. Participants for this study included 44 students enrolled in an interprofessional online mental health telehealth course and four health care professionals from rural clinics. Qualitative data were collected and analyzed from students and providers. Four primary themes were identified: student benefits from the IPE telehealth course, patient benefits, clinic benefits, and technological challenges. Student subthemes included learning skills needed for telehealth, improving team skills, learning about professional roles and responsibilities, and understanding rural health needs. Clinic benefits included improving telehealth readiness. This study presents an early example of online interprofessional mental health telehealth training using an academic-community partnership. Our pilot findings suggest that this course experience resulted in positive benefits for students and rural clinic providers.

"People just don't understand their role in it." Collaboration and coordination of care for service users with complex and severe mental health problems

PURPOSE

To explore professionals' and service users' experiences and perceptions of interprofessional collaboration and coordination for service users with complex and severe mental health issues.

DESIGN AND METHODS

A qualitative study involving semi-structured interviews of professionals and individual interviews of service users. Data were analyzed by thematic analysis.

FINDINGS

Participants described challenges and suggested improvements concerning Distribution of roles, responsibilities, and tasks; Communication; and Knowledge and attitudes.

PRACTICE IMPLICATIONS

Mental health nurses and other professional helpers should have a particular focus on common aims, clear division of roles, planning and timing of interventions, and communication with other professionals and service users.

Experiences of individuals with severe mental illnesses about physical health services: A qualitative study

AIM

This study aims to understand the ideas and experiences of individuals' with severe mental illnesses regarding their access to physical health care services.

METHODS

In this study, a qualitative descriptive approach and content analysis were used. The sample comprised 14 individuals with severe mental illnesses in a psychiatric clinic.

RESULTS

Three themes emerged: i) a barrier theme related to the patient and the illness, health care professionals, and the health system; ii) a theme that comprised facilitators, for example, health care system facilitators and family support; and iii) an expectations theme, comprising patients' and health care services.

CONCLUSION

Individuals with severe mental illnesses must overcome many barriers while receiving physical health care, and nursing interventions are critical for increasing these patients' access to physical health services.

Interprofessional education in nursing: The impact of collaboration between physical and mental health care professionals

Objectives

Interprofessional collaboration in the training of nursing and psychology students helps provide students of both disciplines with the ability and competences they need to best attend to their patients. This study implemented and analyzed a method for developing the competences of each discipline in a scenario of joint clinical simulation that incorporates mental and physical health simultaneously, and measured the caring ability of the participating students.

Methods

Participants took a self-applied survey measuring their own caring ability. After, a clinical simulation was performed where nursing students performed clinical interviews on psychology students, who acted as standardized patients. Caring abilities were measured in the nursing students, and the psychology students implemented an intervention service measuring caring ability and brief - debrief simulation by coaching to nursing students.

Results

The results indicated that the self-applied questionnaire of caring ability resulted in scores significantly higher than what was measured by observers.

Conclusions

The results contribute to the development of protocols, training and collaborative work practices in interprofessional education, which allow the scaling of these competences.

Developing an Evidence-Based Specialist Nursing Role to Improve the Physical Health Care of People with Mental Illness

The substantial physical health disadvantage experienced by people diagnosed with mental illness is now identified in a growing body of research evidence. The recent promulgation of improved physical health care as a goal of contemporary Australian Mental Health Policy should provide impetus for initiatives and strategies to address this inequity. To date increased knowledge of the problem has not resulted in obvious and sustained changes. The aim of this article is to introduce the role of the Physical Health Nurse Consultant as a potential strategy. The potential contribution and value of this role is considered by reviewing the evidence from the perspective of multiple stakeholders and considering the suitability of nursing to meet the complex needs involved in improving physical health. The requirement for a multi-faceted and comprehensive evaluation is also articulated. A robust, prospective and long-term evaluation plan includes physical health measures, changes in health behaviours, cost-benefit analysis and consumer acceptability to ensure the intervention is effective in the long term. This thorough approach is essential to provide the level of evidence required to facilitate changes at the practice and policy levels. The specialist nursing role presented in this article, subject to the comprehensive evaluation proposed, could become an integral component of a comprehensive approach to addressing physical health inequities in people with mental illness.

Prevalence of Chronic Health Conditions in Australian Adults with Depression and/or Anxiety

The association between psychotic illness and poor physical health is now clearly articulated in the literature. By contrast the impact of depression and/or anxiety on physical health is considerably less understood, despite depression being the leading cause of disability worldwide and is associated with significantly higher prevalence of physical comorbidities than found in the general population. An Australia national cross-sectional population-based survey was conducted to ascertain the prevalence of chronic physical health conditions in persons with, and without depression and/or anxiety, allowing for demographic characteristics and lifestyle factors. The telephone-based survey was conducted using trained interviewers. Survey questions included those eliciting information about demographics, health status, and health behaviours. Independent t-tests and chi square tests showed demographic, health behaviours, and physical illness differed between those with and without depression and/or anxiety. Heart disease, high blood pressure, stroke, cancer, arthritis, chronic neck and/or back pain, and asthma were significantly higher in participants diagnosed with depression and/or anxiety. Binary logistic regression showed the strongest predictor of chronic illness was having a diagnosis of depression and/or anxiety. Depression and anxiety present major health problems impacting a considerable proportion of the population. A greater understanding of the associated physical health issues should provide impetus to broaden the physical health and mental illness research agenda to include these diagnoses.