Should we or shouldn't we? Mental health nurses' views on physical health care of mental health consumers

Experiences of receiving a medical consultation - an interview study among hospitalized psychiatric patients

PURPOSE

People with mental illness often experience more physical health problems, compared to the general population. Therefore, we conducted medical consultations to hospitalized psychiatric patients. The purpose of our study was to investigate experiences of medical consultations from a patient perspective.

MATERIALS AND METHODS

We conducted 17 qualitative, semi-structured interviews with hospitalized psychiatric patients who received a medical consultation in the period of February to May 2023. The interviews were analyzed using Braun and Clarke's thematic analysis.

RESULTS

Patients perceived the medical consultation as important in bridging the gap between psychiatric and somatic treatment. The consultation created a sense of security, with patients emphasizing the importance of acknowledgment by the medical doctor. However, some patients were affected by their state of mind and their psychiatric treatment, resulting in memory impairment, which prevented fully utilization of the medical consultation. The support from psychiatric staff proved crucial for patients in initiating somatic interventions.The results are presented in the two overarching themes: (1) Experiences of a medical consultation in a psychiatric setting and (2) communication and support as influential factors for benefits of the medical consultation.

CONCLUSION

Our interview study reveals that hospitalized psychiatric patients experience a medical consultation as an important initiative. The relationship between the patient and the medical doctor, the patient's state of mind, and the support of the psychiatric staff play significant roles. Incorporating these factors in the medical consultation enables a beneficial outcome that can improve the health of people with mental illness.

Implementing exercise recommendations into clinical practice-new findings from mental health professionals' and patients' perspectives in a university psychiatric setting

Introduction

To date, concrete recommendations for physical activity in psychiatric treatments are limited. Thus, we evaluated knowledge, barriers and beliefs associated with exercise prescription of mental health professionals (MHP) to people with mental illnesses. We aimed to identify patients' barriers to exercise participation and to work out options addressing these barriers.

Methods

In our cross-sectional and questionnaire-based investigation, we recruited medical, nursing and therapeutic staff and patients of a psychiatric clinic by email and personal contact. Questionnaires contained the German versions of The Exercise in Mental Illness Questionnaire (EMIQ-G) and the International Physical Activity Questionnaires (IPAQ).

Results

We included 100 MHP and 100 patients. MHP had significantly more knowledge regarding positive effects of exercise on general health than patients. Exercise was prescribed mostly (48.4%) or always (37.9%) by MHP. The data showed missing education in exercise prescriptions and different recommendation behavior. Male patients seemed to experience exercise more often as a positive distraction and had lower physical health barriers than females.

Discussion

Physical activity needs to be more integrated in psychiatric treatments. Some strategies as educating MHP and patients regarding potential benefits of exercise via psychoeducative brochures and adapting recommendations to individual symptoms could improve exercise behavior in psychiatric patients.

Which self-reported measures are useful to explore diabetes support needs among adults with diabetes and severe mental illness?

OBJECTIVES

To construct and test patient-reported outcome measures (PROMs) for identifying diabetes support needs of adults with co-existing diabetes and severe mental illness (SMI) provided by mental health professionals at psychiatric outpatient clinics.

METHODS

Design thinking was used to identify, select, and modify PROMs in collaboration with 18 adults with type 1 or type 2 diabetes and SMI and 10 healthcare experts. The PROMs were then tested with 86 adults with diabetes and SMI recruited from eight psychiatric outpatient clinics in Denmark. Data were analysed using systematic text condensation (questionnaire construction) and descriptive statistics (testing).

RESULTS

Four principles for PROMs were identified: (a) be modified to be relevant for the target group, (b) be concise and simple to complete, (c) have a clear and unambiguous wording, and (d) be designed to measure topics that are perceived as meaningful. Test of the questionnaire contained 49 items in four domains. Missing response rates in the test were 1.2-4.7% in three domains and 4.7-11.6% in a domain addressing potential sources of diabetes support.

DISCUSSION

PROMs can successfully be constructed in collaboration with this vulnerable population that yield low rates of missing responses.

The nurse-led GILL eHealth intervention for improving physical health and lifestyle behaviours in clients with severe mental illness: design of a cluster-randomised controlled trial

BACKGROUND

Clients with severe mental illness (SMI) have overall poor physical health. SMI reduces life expectancy by 5-17 years, primarily due to physical comorbidity linked to cardiometabolic risks that are mainly driven by unhealthy lifestyle behaviours. To improve physical health in clients with SMI, key elements are systematic somatic screening and lifestyle promotion. The nurse-led GILL eHealth was developed for somatic screening and the implementation of lifestyle activities in clients with SMI. Aims of this study are to evaluate the effectiveness of the GILL eHealth intervention in clients with SMI compared to usual care, and to evaluate the implementation process, and the experiences of clients and healthcare providers with GILL eHealth.

METHODS

The GILL study encompasses a cluster-randomised controlled trial in approximately 20 mental health care facilities in the Netherlands. The randomisation takes place at the team level, assigning clients to the eHealth intervention or the usual care group. The GILL eHealth intervention consists of two complementary modules for somatic screening and lifestyle promotion, resulting in personalised somatic treatment and lifestyle plans. Trained mental health nurses and nurse practitioners will implement the intervention within the multidisciplinary treatment context, and will guide and support the participants in promoting their physical health, including cardiometabolic risk management. Usual care includes treatment as currently delivered, with national guidelines as frame of reference. We aim to include 258 clients with SMI and a BMI of 27 or higher. Primary outcome is the metabolic syndrome severity score. Secondary outcomes are physical health measurements and participants' reports on physical activity, perceived lifestyle behaviours, quality of life, recovery, psychosocial functioning, and health-related self-efficacy. Measurements will be completed at baseline and at 6 and 12 months. A qualitative process evaluation will be conducted alongside, to evaluate the process of implementation and the experiences of clients and healthcare professionals with GILL eHealth.

DISCUSSION

The GILL eHealth intervention is expected to be more effective than usual care in improving physical health and lifestyle behaviours among clients with SMI. It will also provide important information on implementation of GILL eHealth in mental health care. If proven effective, GILL eHealth offers a clinically useful tool to improve physical health and lifestyle behaviours.

TRIAL REGISTRATION

Clinical trial registration NCT05533749, registration date: 8 September 2022.

Effects of a web-based education for community mental health case managers on physical healthcare for clients with severe mental illness

This study aimed to develop and verify the effects of a web-based physical healthcare education program for community mental health case managers during the time of COVID-19. Six modules of mental health case management physical health education program were developed and provided using the EdWith education platform, which enables real-time streaming, lecture participant management and whether participants have watched the video and watch time. A total of 51 community mental health case managers participated in the study. Collected data were analyzed using SPSS 26.0 software. Participants of the physical healthcare education program testified increased performance in, as well as enhanced attitudes toward physical healthcare. Their confidence in physical healthcare increased significantly from that of the individuals in the control group. The web-based educational program for mental health case managers in physical healthcare may be beneficial to improving the physical health of clients with chronic mental illness.

Exercise Promotion Practices among Mental Health Professionals: A Scoping Review

Mental health professionals (MHPs) have a unique opportunity to integrate PA and exercise promotion into clinical care. This scoping review employed the information-motivation-behavioral Skills (IMB) model to examine the exercise promotion practices of MHP. An electronic search of four major databases from 2007 to August 2020 was conducted and results were reported using PRISMA. Seventeen studies were included where the variables of interest were knowledge, attitudes, and beliefs regarding exercise promotion. MHP expressed a need for additional training and the integration of exercise specialists to care for the physical health of patients. Practitioners need additional education to understand the guidelines for exercise prescription for individuals with SMI and the role exercise could have in improving the quality of life for their patients. Findings were conceptualized utilizing the IMB model to inform future quantitative measures and health behavior interventions.

Nurse-Led Physical Health Interventions for People with Mental Illness: A Scoping Review of International Literature

People with mental illness have a higher prevalence of co-occurring physical health conditions and poor health behaviors, leading a mortality gap of up to 16 years, compared with the general population. Nurses working in mental health settings play an important role in addressing factors influencing sub-optimal physical health. Therefore, this scoping review aimed to identify nurse-led physical health interventions and align interventions to eight recognized physical healthcare priority areas (i.e. Equally Well in Victoria Framework). A systematic search strategy was used to identify relevant literature. Data extraction included alignment to the Equally Well priority areas, research design, and indication of co-design (meaningful and collaborative involvement of consumers and significant others) and recovery-oriented practice (focusing on needs and goals of a consumer's recovery journey). All included papers (n = 74) were aligned to at least one of eight Equally Well priority areas. Papers were predominately quantitative (n = 64, 86%), with the remainder mixed methods (n = 9, 9%) or qualitative (n = 4, 5%). Most papers were aligned to improving metabolic health and support to quit smoking. One study focused on nurse-led intervention designed to reduce falls. Recovery-oriented practice was evident in six papers. No paper described evidence of co-design. A research gap was identified for nurse-led intervention to reduce falls and improve dental/oral care. Relative to mental healthcare policy, there is a need for future nurse-led physical health research to be co-designed and include recovery-oriented practice. Evaluation and description of future nurse-led physical interventions should seek to report perspectives of key stakeholders as these remain relatively unknown.

Implementation of physical activity interventions in a community-based youth mental healthcare service: A case study of context, strategies, and outcomes

AIMS

Physical activity interventions are recommended for community-based youth mental health services to prevent physical health disparities. Implementation is challenging, and studies focusing on the methods to achieve change are needed. This study aims to identify the context, implementation strategies, and implementation outcomes that illustrate how physical activity interventions were implemented within an early intervention service in Australia.

METHODS

A theoretically informed case study was undertaken. Data from a community-based youth mental health service that delivers an early psychosis programme were collected between July and November 2020. Three data sources were accessed (1) interviews with service managers, mental health clinicians and exercise physiologists; (2) document review of organizational policies and procedures; and (3) survey using the Program Sustainability Assessment Tool. The implementation outcomes investigated were acceptability, fidelity, penetration, and sustainability. Framework analysis was used, and a logic model developed guided by an established template, to interpret findings.

RESULTS

Forty-three contextual factors and 43 implementation strategies were identified. The data suggests that creating a new clinical team and auditing and feedback are critical for implementation. High levels of acceptability and sustainability were described, while fidelity of implementation was difficult to establish, and penetration was low.

CONCLUSIONS

The relationship between constructs suggests several mechanisms underpinned implementation. These include changing professional beliefs, establishing new organizational norms, augmenting existing work processes, and aligning physical activity with priorities of the mental healthcare system and existing work tasks. This case study provides direction for future health service planning of physical activity interventions in community-based youth mental health service.

Primary care for individuals with serious mental illness (PriSMI): protocol for a convergent mixed methods study

INTRODUCTION

People with serious mental illness (SMI) have poor health outcomes, in part because of inequitable access to quality health services. Primary care is well suited to coordinate and manage care for this population; however, providers may feel ill-equipped to do so and patients may not have the support and resources required to coordinate their care. We lack a strong understanding of prevention and management of chronic disease in primary care among people with SMI as well as the context-specific barriers that exist at the patient, provider and system levels. This mixed methods study will answer three research questions: (1) How do primary care services received by people living with SMI differ from those received by the general population? (2) What are the experiences of people with SMI in accessing and receiving chronic disease prevention and management in primary care? (3) What are the experiences of primary care providers in caring for individuals with SMI?

METHODS AND ANALYSIS

We will conduct a concurrent mixed methods study in Ontario and British Columbia, Canada, including quantitative analyses of linked administrative data and in-depth qualitative interviews with people living with SMI and primary care providers. By comparing across two provinces, each with varying degrees of mental health service investment and different primary care models, results will shed light on individual and system-level factors that facilitate or impede quality preventive and chronic disease care for people with SMI in the primary care setting.

ETHICS AND DISSEMINATION

This study was approved by the University of Ottawa Research Ethics Board and partner institutions. An integrated knowledge translation approach brings together researchers, providers, policymakers, decision-makers, patient and caregiver partners and knowledge users. Working with this team, we will develop policy-relevant recommendations for improvements to primary care systems that will better support providers and reduce health inequities.

AN EXAMINATION OF EFFECTS OF INTIMATE PARTNER VIOLENCE ON CHİLDREN: A CROSS-SECTIONAL STUDY CONDUCTED IN PEDIATRIC EMERGENCY UNIT IN TURKEY

BACKGROUND

Intimate Partner Violence (IPV) against women causes inadequate and unbalanced nutrition in children aged 0-5 years and adversely affects their growth.

AIM

To examine the impact of intimate partner violence on a child's growth regarding the medical diagnosis in paediatric patients under 5-year-old, growth of the child, and mother's exposure to intimate partner violence.

METHODS

This descriptive cross-sectional study included 166 children, admitted to the paediatric emergency department, and their mothers.

RESULTS

Women exposed to emotional violence and controlling behaviour during pregnancy had children prone to being overweight and obese. Mothers' lifetime exposure to physical violence had an adverse effect on their children's wasting and moderate wasting. In contrast, mothers' exposure to emotional violence had a direct impact on childs' wasting and moderate wasting.

CONCLUSION

The lifetime effect of domestic violence may begin at birth. This vulnerability leads to negative outcomes in both children and women regarding biopsychosocial development. Implications for nursing management Nurses and midwives in primary healthcare services and one-on-one care should be trained to evaluate prospective mothers and children aged 0-5 regarding violence and its effects on the child's growth.

The Effectiveness and Cost of an Intervention to Increase the Provision of Preventive Care in Community Mental Health Services: Protocol for a Cluster-Randomized Controlled Trial

Preventive care to address chronic disease risk behaviours is infrequently provided by community mental health services. In this cluster-randomised controlled trial, 12 community mental health services in 3 Local Health Districts in New South Wales, Australia, will be randomised to either an intervention group (implementing a new model of providing preventive care) or a control group (usual care). The model of care comprises three components: (1) a dedicated ‘healthy choices’ consultation offered by a ‘healthy choices’ clinician; (2) embedding information regarding risk factors into clients’ care plans; and (3) the continuation of preventive care by mental health clinicians in ongoing consultations. Evidence-based implementation strategies will support the model implementation, which will be tailored by being co-developed with service managers and clinicians. The primary outcomes are client-reported receipt of: (1) an assessment of chronic disease risks (tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol use and physical inactivity); (2) brief advice regarding relevant risk behaviours; and (3) referral to at least one behaviour change support. Resources to develop and implement the intervention will be captured to enable an assessment of cost effectiveness and affordability. The findings will inform the development of future service delivery initiatives to achieve guideline- and policy-concordant preventive care delivery.

Evaluation of metabolic monitoring practices for mental health consumers in the Southern District Health Board Region of New Zealand

WHAT IS KNOWN ON THIS SUBJECT?: The physical health of people with serious mental illness (SMI) is an issue of growing concern in New Zealand and internationally. Metabolic syndrome is prevalent among people with severe mental illness and increases the likelihood of developing cardiovascular disease and diabetes. No previous international research has investigated rates of metabolic monitoring in specialist mental health services and in primary care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Rates of metabolic monitoring are low in this specialist mental health service and in primary care. Primary care nurses are positive in their views of their role in providing care for people with mental illness, and would value further education in this area. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Services need to consider ways in which nurses can be supported to improve rates of metabolic monitoring. Guidelines may have a role to play in improved monitoring but need service-level support in order to be effective. ABSTRACT: Introduction People with serious mental illness experience significant disparities in their physical health compared with the general population. One indicator of health impairment is metabolic syndrome, which increases the likelihood of developing cardiovascular disease and diabetes. No international studies have reported both primary care and mental health nurses' rates of metabolic monitoring among people with serious mental illness, and no New Zealand studies have investigated rates of metabolic monitoring. Aim To evaluate metabolic monitoring practices within one of New Zealand's 20 district health board regions. Method An audit of clinical records in primary care (n = 46) and secondary care (n = 47) settings and a survey of practice nurses were conducted. A survey was sent to 127 practice nurses with a response rate of 19% (n = 24). Data were analysed using descriptive statistics. Results Rates of metabolic monitoring were low in both services. Survey participants expressed positive views towards physical health monitoring and confidence in relating to mental health consumers. Rates of treatment of metabolic abnormalities were low, and communication between primary and secondary services was limited. Conclusion Despite existence of guidelines and protocols, metabolic monitoring rates in both primary and secondary health services are low. Incorporating metabolic monitoring systems into service delivery, supported by appropriate tools and resourcing, is essential to achieve better clinical outcomes for people experiencing mental illness.

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.

Physical health assessment and cardiometabolic monitoring practices across three adult mental health inpatient units - a retrospective cohort study

Australians with lived experience of mental illness die on average 10 or more years earlier than the general population. Cardiometabolic disorders, including cardiovascular disease and diabetes mellitus, are common causes of premature death in this cohort. Little is known about cardiometabolic monitoring practices in mental health inpatient units. The aim of this study was to examine the characteristics of cardiometabolic monitoring and physical health assessments of adult mental health consumers within the first 72 hours of admission to an inpatient unit. We implemented a retrospective descriptive exploratory design by medical record audit. Data were collected using a pre-validated audit tool, adapted with recent literature and policy, from a randomly selected sample of consumers admitted to three acute mental health adult inpatient units of a large Australian metropolitan health service in 2016. Of 228 consumers, the mean age was 37.5 (range 18-64) years and 51.3% were women. Cardiometabolic risks were common, yet most consumers received incomplete cardiometabolic monitoring. While few consumers (15%) were diagnosed with cardiometabolic comorbidities, 67.5% were prescribed psychotropic medications with high cardiometabolic risk. Compliance with recommended cardiometabolic monitoring varied considerably between risk factors: for example, blood pressure was measured in 56.1% of consumers, whereas waist circumference was never recorded. There were no statistically significant associations between cardiometabolic monitoring completion and sex or cardiometabolic risk. These findings demonstrate the need for increased education and awareness of cardiometabolic risk and identify a critical gap between physical health assessment practices and recommendations for this cohort.

Positioning Psychiatric and Mental Health Nursing as a Transformative Force in Health Care

From the perspective of psychiatric and mental health nurses in Sweden, this discussion paper aims to position psychiatric and mental health nursing as a transformative force contributing to enforcing person-centered values and practices in health care. We argue the potential impact of psychiatric and mental health nursing on service user health and recovery, nursing student education and values, and the organization and management of health care. Psychiatric and mental health nursing is discussed as a caring, reflective, and therapeutic practice that promotes recovery and health. Implications for nursing education, research, management, and practice are outlined.

Risk Factors of Metabolic Syndrome in Community-Dwelling People with Schizophrenia

This study investigated the prevalence and risk factors of metabolic syndrome in 100 community-dwelling people with schizophrenia registered in mental health facilities in Seoul, Korea. This study was conducted between 12 September and 15 November 2019. This study used a cross-sectional descriptive design. The data included were general and disease-related characteristics, diagnostic tests for metabolic syndrome, lifestyles, depression, and social support. The analysis of collected data was done by using the SPSS 24.0 program. The prevalence of metabolic syndrome was 42.0%. Higher body mass index (odds ratio [OR] = 1.60, 95% CI = 1.16–2.18, p = 0.004), and depression (OR = 1.22, 95% CI = 1.06–1.42, p = 0.008) were associated with higher risks of metabolic syndrome, while physical activity and weight control (OR = 0.71, 95% CI = 0.54–0.94, p = 0.018), dietary habits (OR = 0.72, 95% CI = 0.54–0.93, p = 0.011), and medication and health management (OR = 0.52, 95% CI = 0.31–0.86, p = 0.012) were associated with lower risks. Mental health care nurses need to recognize the high prevalence of metabolic syndrome in people with schizophrenia in the community and provide differentiated, customized lifestyle improvement programs based on the body mass index and depression status of each person with schizophrenia. Furthermore, comprehensive lifestyle improvement programs and health examination services that people with schizophrenia can easily adhere to should be developed.

Adolescents' Perceptions of Living With Co-Existing ADHD and Medical Disorder in Denmark

AIM

The study aim was to explore adolescents' with co-existing ADHD and medical disorder (MD) perceptions of everyday life and support from parents and healthcare professionals.

DESIGN AND METHODS

In this qualitative study, 10 adolescents aged 13-17 years diagnosed with ADHD and a MD were included from a general pediatric hospital clinic and a child and adolescent psychiatric hospital clinic. Data obtained through semi-structured interviews were analyzed using thematic analysis.

RESULTS

The adolescents' perceptions were categorized into four themes: 1) ADHD perceived as part of the adolescent's self-understanding - yet with daily frustrations, 2) MD perceived as an interruption in everyday life, 3) ADHD and MD - an overlooked dual task, and 4) the need for supportive relationships in navigating ADHD and MD.

CONCLUSION

Living with co-existing ADHD and MD is a complex dual task, as ADHD and MD interfere with each other in everyday life. However, the adolescents overlook the dual task as they believe their difficulties would be resolved if the MD was eliminated. Moreover, supportive relationships are essential in navigating the complexities in living with co-existing ADHD and MD. Nevertheless, the adolescents take a passive role in the encounters with the healthcare professionals, whereas they are more active in encounters with peers, parents and teachers.

PRACTICE IMPLICATIONS

Healthcare professionals treating and caring for adolescents with co-existing ADHD and MD need interventions facilitating patient involvement in a patient-centered approach to support both adolescents and healthcare professionals in recognizing the dual task of having co-existing ADHD and MD.

Do Mental Health Professionals Promote a Healthy Lifestyle among Individuals Experiencing Serious Mental Illness?

Purpose: While a healthy lifestyle would be an asset to people experiencing psychotic disorders, not all mental health professionals provide counselling regarding healthy behaviours, such as physical activity, healthy nutrition, and tobacco cessation. Therefore, the objective of the present study was to investigate the factors associated with health promotion practice (HPP) among mental health professionals.Methods: Cross-sectional survey including mental health professionals across the Province of Quebec (Canada). The promotion of health behaviour and the "Exercise in Mental Illness Questionnaire - Health Practitioner Version" and its adaptation for nutrition improvement and tobacco cessation were used to evaluate knowledge, beliefs, promotion behaviours, and barriers to HPP.Results: One hundred mental health professionals, most being nurses (29%) and medical doctors/psychiatrists (20%) were recruited throughout the province of Quebec (Canada). The rate of formal training among professionals was 11% for physical activity, 26% for nutrition, and 21% for tobacco cessation. Approximately 60% were promoting physical activity, 49% good nutrition, and 41% tobacco cessation. Professionals promoting healthy behaviours had a higher level of self-efficacy in HPP, were more likely to value physical health, and less likely to endorse barriers to HPP.Conclusion: Rates of formal training in lifestyle habits and health promotion (aiming at improving a healthy lifestyle in patients experiencing psychotic disorders) among mental health professionals are currently low in the Province of Quebec and need to be improved. In addition, the level of confidence and barriers that endorse healthy behaviours appear to be key factors in HPP among mental health professionals.

Mental health nurses' experience of physical health care and health promotion initiatives for people with severe mental illness

Health care for people with severe mental illness is often divided into physical health care and mental health care despite the importance of a holistic approach to caring for the whole person. Mental health nurses have an important role not only in preventing ill health, but also in promoting health, to improve the overall health among people with severe mental illness and to develop a more person-centred, integrated physical and mental health care. Thus, the aim of this study was to describe mental health nurses' experiences of facilitating aspects that promote physical health and support a healthy lifestyle for people with severe mental illness. Interviews were conducted with mental health nurses (n = 15), and a qualitative content analysis was used to capture the nurse's experiences. Analysis of the interviews generated three categories: (i) to have a health promotion focus in every encounter, (ii) to support with each person's unique prerequisites in mind and (iii) to take responsibility for health promotion in every level of the organization. The results show the importance of a health promotion focus that permeates the entire organization of mental health care. Shared responsibility for health and health promotion activities should exist at all levels: in the person-centred care in the relation with the patient, embedded in a joint vision within the working unit, and in decisions at management level.

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

Background

Chronic 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.

Methods

Family 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.

Results

A 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.

Conclusions

The 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.

Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services

People with mental illness experience increased chronic disease burden, contributed to by a greater prevalence of modifiable chronic disease risk behaviours. Policies recommend mental health services provide preventive care for such risk behaviours. Provision of such care has not previously been synthesised. This review assessed the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Four databases were searched from 2006 to 2017. Eligible studies were observational quantitative study designs conducted in mental health services, where preventive care was provided to clients for tobacco smoking, harmful alcohol consumption, inadequate nutrition, or inadequate physical activity. Two reviewers independently screened studies, conducted data extraction and critical appraisal. Results were pooled as proportions of clients receiving or clinicians providing preventive care using random effects meta-analyses, by risk behaviour and preventive care element (ask/assess, advise, assist, arrange). Subgroup analyses were conducted by mental health service type (inpatient, outpatient, other/multiple). Narrative synthesis was used where meta-analysis was not possible. Thirty-eight studies were included with 26 amenable to meta-analyses. Analyses revealed that rates of assessment were highest for smoking (78%, 95% confidence interval [CI]:59%-96%) and lowest for nutrition (17%, 95% CI:1%-35%); with variable rates of care provision for all behaviours, care elements, and across service types, with substantial heterogeneity across analyses. Findings indicated suboptimal and variable provision of preventive care for modifiable chronic disease risk behaviours in mental health services, but should be considered with caution due to the very low quality of cumulative evidence. PROSPERO registration: CRD42016049889.

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.

Physical Healthcare of People with Serious Mental Illness: A Cross-Sectional Study of Nurses' Involvement, Views, and Current Practices

Background: Based on the poor physical health and unhealthy lifestyle behaviors, people with serious mental illness (SMI) have a high risk for long-term disorders such as diabetes, cardiovascular and respiratory diseases. Aims: This study examined nurses' current practices and views regarding the physical health of people with SMI. Methods: Cross-sectional study was conducted among nurses working in acute wards in large mental health hospital in Istanbul, Turkey. Convenience sample of 184 nurses agreed to participate in the study. Data collection was based on the self-reported responses. Descriptive statistics and comparison tests were used to describe the sample's characteristics and identify associations amongst the participants' characteristics. Findings: The results showed that nurses considered the patients' physical health important, particularly female nurses. Monitoring blood pressure, assessing physical health status at admission, and helping self-care needs were common practices. Believing in the importance of physical health was correlated with high knowledge and self-confidence levels in delivery of physical healthcare. Discussion: These findings are useful for implementing integrated nursing care in acute psychiatric care and improving patients' mental and physical well-being.

Effectiveness and experiences of mental health nurses in cases of medical emergency and severe physiological deterioration: A systematic review

BACKGROUND

From a baseline of near zero, there has in recent years been a growing number of empirical studies related to mental health nurses' delivery of healthcare for severely physically deteriorating patients or in medical emergency situations. To date, this evidence-base has not been systematically identified, appraised, and integrated.

OBJECTIVES

To systematically identify, appraise and synthesise the available empirical evidence about mental health nurses, medical emergencies, and the severely physiologically deteriorating patient.

DESIGN

A systematic review in accordance with relevant points of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Multiple electronic databases (CINAHL; PubMed; MedLine; Scopus, ProQuest Dissertations and Theses) were searched using comprehensive terms.

REVIEW METHODS

Inclusion criteria: English language papers describing empirical studies (any design) about i) the effectiveness of interventions to improve any outcome related to mental health nurses' delivery of emergency medical care or care for the severely deteriorating patient; or ii) mental health nurses' emergency medical care-related knowledge, skills, experience, attitudes, or training needs. Further information was sought from study authors. Included studies were independently assessed for quality. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative synthesis of study findings was conducted.

RESULTS

A total of 22 studies, all but one published since 2011, met inclusion criteria. Ten were intervention studies and twelve were cross-sectional observational or qualitative studies. Intervention studies were all of weak quality overall and utilised pre- post designs mostly with limited post intervention follow-up time. Observational and qualitative studies were generally of good quality but only parts of the evidence from these studies were relevant to emergency physical care since most focused on mental health nurses and their routine physical healthcare practice.

CONCLUSIONS

There are currently no validated instruments to investigate mental health nurses' emergency medical care-related attitudes. More rigorous controlled trials of interventions are needed to better establish an evidence-base for educational interventions to improve this groups' emergency care-related practice.

Mental health care professionals' accounts of actions and responsibilities related to managing physical health among people with severe mental illness

BACKGROUND

Life expectancy of people with severe mental illness (SMI) is greatly shortened compared to the general population, and despite extensive research, this issue is unsolved. Although it is widely recognised that people with SMI need support from health care services to manage health related issues, profound health inequalities exist within provision of health care. The aim of this study was to examine how mental health care professionals accounted for their actions and responsibilities related to managing physical health issues among people with SMI.

METHODS

Three focus groups were conducted with 22 mental health care professionals, employed at three mental health care locations. Participants' situated accounts were subjected to discourse analysis.

RESULTS

Participants accounted for actions and responsibilities in three typical ways; 1) by positioning people with SMI as difficult to motivate and actively resisting intervention, 2) by positioning people with SMI as so impaired that intervention was futile, and 3) by arguing they are undertreated for physical conditions and might have physical illnesses that staff are not aware of because of prominent mental illness. These discursive strategies seemed to legitimise situations where participants described not responding to physical health issues, and to downplay potential trouble in situations where participants described not succeeding in facilitating lifestyle changes or promoting compliance to treatment of physical conditions.

DISCUSSION AND CONCLUSION

Mental health care professionals need to increase their awareness of latent discriminating attitudes towards people with SMI. Such attitudes are suggested to reinforce barriers for people with SMI receiving physical health care.

Supporting patients with serious mental illness during physical health treatment

People with serious mental illness (SMI) are more likely to experience severe health conditions, such as cardiovascular disease, respiratory disease and stroke, and are likely to die earlier, than the general population. This article explores the reasons for such disparities, using a case study approach to outline the ways that general nurses can support people with SMI when they access general healthcare services. It identifies five areas of learning from the case study: diagnostic overshadowing and stigma; developing the therapeutic relationship; the ward environment; inclusion of family members and carers; and integration of physical and mental health services.

Modeling Health Disparities and Outcomes in Disenfranchised Populations

The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.

Modification and Initial Psychometric Evaluation of the Physical Health Attitude Scale for Use in the Canadian Mental Health and Addictions Context

INTRODUCTION

The Physical Health Attitude Scale (PHASe) tool was developed to better understand mental health nurses' attitudes towards their involvement and confidence in physical health care. This tool has been used in the United Kingdom and Australia; however, it has not been used in Canada.

AIM

This study aims to modify and provide an initial psychometric evaluation of the PHASe tool for use in a Canadian mental health and addictions context.

METHODS

In Phase 1, clinical experts (n = 8) were consulted to provide feedback on the content and face validity of the PHASe tool. In Phase 2, the PHASe tool was piloted with nurses at a large urban mental health and addiction organization in Ontario, Canada (n = 77).

RESULTS

In Phase 1, 4 items were added and 5 items were removed from the tool based on feedback provided by experts. In Phase 2, 12 poorly correlated items were removed. A two-factor solution was identified, with subscales "confidence" and "barriers and attitudes".

DISCUSSION

Initial psychometric evaluation suggests that a revised 15-item version of the PHASe tool is valid and reliable in a Canadian mental health and addictions context; however, more testing is recommended in larger, more diverse samples.

From alienation to the nursing clinic: care of patients with psychiatric comorbidity

OBJECTIVE

to understand how nurses of mental health care for psychiatric patients with clinical comorbidities.

METHOD

qualitative study based on the referential of historical and dialectical materialism. Interviews with nurses were conducted using semi-structured script. Sample determined in snowball. The interviews were recorded and transcribed in full. The data were analyzed through content analysis, including: organization and exhaustive reading of the material, exploration, grouping data into thematic units, processing of results, and interpretation.

RESULTS

the role of nurses is marked by the dialectic between knowing and not knowing, a movement that revealed two categories: clinic of psychiatric nursing, and alienation and subordination of nurse in the care process.

FINAL CONSIDERATIONS

the development of the nursing clinic, based on the therapeutic relationship, favors integral care towards the patient, whereas alienation/subordination distances the nurse from care and impairs care.

Can We Improve Physical Health Monitoring for Patients Taking Antipsychotics on a Mental Health Inpatient Unit?

BACKGROUND

Patients with severe mental illness are at risk of medical complications, including cardiovascular disease, metabolic syndrome, and diabetes. Given this vulnerability, combined with metabolic risks of antipsychotics, physical health monitoring is critical. Inpatient admission is an opportunity to screen for medical comorbidities. Our objective was to improve the rates of physical health monitoring on an inpatient psychiatry unit through implementation of an electronic standardized order set.

METHODS

Using a clinical audit tool, we completed a baseline retrospective audit (96 eligible charts) of patients aged 18 to 100 years, discharged between January and March 2012, prescribed an antipsychotic for 3 or more days. We then developed and implemented a standard electronic admission order set and provided training to inpatient clinical staff. We completed a second chart audit of patients discharged between January and March 2016 (190 eligible charts) to measure improvement in physical health monitoring and intervention rates for abnormal results.

RESULTS

In the 2012 audit, thyroid-stimulating hormone (TSH), blood pressure, blood glucose, fasting lipids, electrocardiogram (ECG), and height/weight were measured in 71%, 92%, 31%, 36%, 51%, and 75% of patients, respectively. In the 2016 audit, TSH, blood pressure, blood glucose, fasting lipids, ECG, and height/weight were measured in 86%, 96%, 96%, 64%, 87%, and 71% of patients, respectively. There were statistically significant improvements (P < 0.05) in monitoring rates for blood glucose, lipids, ECG, and TSH. Intervention rates for abnormal blood glucose and/or lipids (feedback to family doctor and/or patient, consultation to hospitalist, endocrinology, and/or dietician) did not change between 2012 and 2016.

CONCLUSIONS

Electronic standardized order set can be used as a tool to improve screening for physical health comorbidity in patients with severe mental illness receiving antipsychotic medications.

Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

Compared to the general population, people with pre-existing serious and persistent mental illness (SPMI) have higher rates of physical illness and die at an earlier age, raising questions about their palliative and end-of-life care needs when they are diagnosed with an incurable physical illness. In the present study, we explored access to specialist palliative care services within one New Zealand health district. Routinely-collected, de-identified patient information on a cohort of people diagnosed with SPMI, and receiving specialist palliative care services from the Capital and Coast District Health Board (CCDHB), was compared to the general population from the same health district. People with SPMI are 3.5 times less likely to receive specialist palliative services compared to the general population from the Capital and Coast District Health Board. The proportion of people identifying as Māori is 1.2 times higher in the SPMI cohort than the general CCDHB population. The SPMI cohort experiences a higher level of deprivation compared to the general population in the CCDHB. The present study confirms that those diagnosed with an SPMI are less likely to use specialist palliative care services at the end of life. Research using a national dataset is needed to determine whether the study findings are applicable to the national population.

Enabling healthy living: Experiences of people with severe mental illness in psychiatric outpatient services

It is well known that people with severe mental illness have a reduced life expectancy and a greater risk of being affected by preventable physical illnesses such as metabolic syndrome, cardiovascular disease and type 2 diabetes. There are still, however, only a few published studies focusing on what enables healthy living for this group. This study thus aimed to describe what enables healthy living among people with severe mental illness in psychiatric outpatient services. The data were collected in qualitative interviews (n = 16) and content analysis was used to analyze the data. The interviews resulted in an overall theme "Being regarded as a whole human being by self and others", which showed the multidimensional nature of health and the issues that enable healthy living among people with severe mental illness. Three categories emerged: (i) everyday structure (ii), motivating life events and (iii) support from significant others. The results indicate that a person with severe mental illness needs to be encountered as a whole person if healthy living is to be enabled. Attaining healthy living requires collaboration between the providers of care, help and support. Health care organizations need to work together to develop and provide interventions to enable healthy living and to reduce poor physical health among people with severe mental illness.

Master's level mental health nursing competencies, a prerequisite for equal health among service users in mental health care

PURPOSE

This discussion paper aims to explore the need of a clarified definition of master's level mental health nursing competencies in terms of knowledge, skills and attitudes in a European context. Mental health service users have, in spite of their right to equal overall health, higher rates of physical illness and are more likely to experience premature death than the general population. Implementation of a holistic concept of health comprising mental, physical and social aspects of health in mental health services has previously proved to be challenging.

METHODS

Master's level mental health nursing competencies in recent literature are discussed and illuminated in terms of knowledge, skills and attitudes in order to enable the promotion of equal overall health among service users in mental health services.

RESULTS

The discussion show contents, values and utility of master's level mental health nursing competencies in mental health services and contribute to reduced role ambiguity by distinguishing master's level responsibilities from undergraduate nursing tasks and obligations of other professionals in mental health care.

CONCLUSION

This discussion paper shapes implications for developments in master's level mental health nursing education curricula.

The Validity and Reliability Characteristics of the M-BACK Questionnaire to Assess the Barriers, Attitudes, Confidence, and Knowledge of Mental Health Staff Regarding Metabolic Health of Mental Health Service Users

Background

Addressing the burden of poor physical health and the subsequent gap in life expectancy experienced by people with mental illness is a major priority in mental health services. To equip mental health staff with the competence to deliver evidence-based interventions, targeted staff training regarding metabolic health is required. In order to evaluate the effectiveness of staff training regarding metabolic health, we aimed to develop a succinct measure to determine the barriers, attitudes, confidence, and knowledge of health practitioners through the development and test–retest reliability of the Metabolic-Barriers, Attitudes, Confidence, and Knowledge Questionnaire (M-BACK).

Methods

The M-BACK questionnaire was developed to evaluate the impact of specialized training in metabolic health care for mental health nurses. Content of the M-BACK was developed from a literature review and refined by an expert review panel and validated via a piloting process. To determine the test–retest reliability of the M-BACK, 31 nursing students recruited from the University of Notre Dame, Sydney completed the questionnaire on two separate occasions, 7 days apart. Intraclass correlation coefficients (ICCs) were calculated for the total score, as well as each of the four domains.

Results

Pilot testing was undertaken with a sample of 106 mental health nurses with a mean age 48.2, ranging from 24 to 63 years of age, who participated in six training courses. Questionnaire development resulted in a 16-item instrument, with each item is scored on a five-point Likert scale ranging from “strongly disagree” to “strongly agree.” Test–retest reliability of the M-BACK was completed by 30 of 31 nursing students recruited, ICCs ranged from 0.62 to 0.96.

Conclusion

The M-BACK is a reliable measure of the key elements of practitioner perceptions of barriers, and their knowledge, attitudes, and confidence regarding metabolic monitoring in people with mental illness. It can be used to assess the effectiveness of interventions aimed at increasing uptake of metabolic monitoring, a key component of programs to reduce the life expectancy gap in people living with severe mental illness.

Implementation in action: how Australian Exercise Physiologists approach exercise prescription for people with mental illness

BACKGROUND

Accredited Exercise Physiologists (AEPs) are trained to deliver exercise and physical activity interventions for people with chronic and complex health conditions including those with mental illness. However, their views on exercise for mental illness, their exercise prescription practices, and need for further training are unknown.

AIMS

To examine the way in which Australian AEPs prescribe exercise for people with mental illness.

METHODS

Eighty-one AEPs (33.3 ± 10.4 years) completed an online version of the Exercise in Mental Illness Questionnaire. Findings are reported using descriptive statistics.

RESULTS

AEPs report a high level of knowledge and confidence in prescribing exercise for people with mental illness. AEPs rate exercise to be at least of equal value to many established treatments for mental illness, and frequently prescribe exercise based on current best-practice principles. A need for additional training was identified. The response rate was low (2.4%) making generalisations from the findings difficult.

CONCLUSIONS

Exercise prescription practices utilised by AEPs are consistent with current best-practice guidelines and there is frequent consultation with consumers to individualise exercise based on their preferences and available resources. Further training is deemed important.

Family carers: A role in addressing chronic disease risk behaviours for people with a mental illness?

People with a mental illness experience greater chronic disease morbidity and mortality compared to those without mental illness. Family carers have the potential to promote the health behaviours of those they care for however factors which may influence the extent to which they do so have not been reported. An exploratory study was conducted to investigate carers': 1) promotion of fruit and vegetable consumption, physical activity, quitting smoking, and reducing alcohol consumption; 2) perceptions of their role and ability to promote such behaviours; 3) and the association between carer perceptions and the promotion of such behaviours. A cross-sectional survey was conducted with mental health carers (N = 144, 37.6% response rate) in New South Wales, Australia in 2013. Associations between current promotion of health behaviours and carer perceptions were explored through multivariate regression analysis in 2016. A majority of respondents promoted fruit and vegetable consumption (63.8%), physical activity (60.3%), quitting smoking (56.3%), and reducing alcohol consumption (56.2%) to the person they cared for. A perception that it was ‘very important’ to have a positive influence on these behaviours was positively related with promotion of each of the four behaviours, with those holding such a view being more likely to promote such behaviours, than those who did not (odds ratio: 9.47–24.13, p < 0.001). The majority (56.2%–63.8%) of carers reported promoting the health behaviours of those they cared for, demonstrating a need and opportunity to build the capacity of carers to contribute to reducing the health risk behaviours among people with a mental illness.

•

A majority of carers reported current promotion of all four health risk behaviours.

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Carer capacity to influence behaviours may be limited by several factors.

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Carer capacity may also be limited differentially for different behaviours.

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Carers were more likely to promote health behaviours if they perceived it important.

An exploratory investigation of sexual health screening in the first 12 weeks of case management in populations with severe mental illness

The sexual health of people with mental illness is commonly overlooked, neglected or inadequately addressed in mental health care, despite evidence showing that people with severe mental illness are more vulnerable to sexually transmitted infections (including HIV), sexual side-effects, and sexual dysfunction than the general population. This article reports a study that investigated sexual health screening in five community mental health clinics within a large a regional health service in Victoria, Australia. The aim of the study was to examine the extent to which sexual health screening is currently undertaken on newly admitted case-managed consumers, and to identify the types of screening undertaken. An exploratory design using retrospective file audit was used in the study. A total of 186 medical records met the study inclusion criteria. The study found that less than 40% of consumers were provided with sexual health screening during their first 12 weeks of case management. The study also found that sexual side-effects, issues of fertility, sexual self-esteem, safe sexual practices, and sexual dysfunction were rarely screened for. Poor sexual health screening has implications for the safety and quality of mental health care and requires targeted research to improve understandings and approaches to care.

Opportunities for Integrating Physical Health Within Assertive Community Treatment Teams: Results from Practitioner Focus Groups

This qualitative study assessed the experiences of assertive community treatment (ACT) team members regarding the integration of physical and mental health self-management for persons with serious mental illness. Three focus groups elicited information from participants concerning barriers, strategies, and recommendations. Findings from inductive analyses revealed six overarching themes: (1) collaboration with primary care, (2) improvements in engagement, (3) team-focused roles, (4) education and training, (5) recommendations for system level barriers, and (6) systems collaboration. Participant recommendations suggest that ACT teams are well positioned to integrate mental and physical health treatment, but further research is needed to support integrated care.

Barriers and Facilitators to Smoking Cessation Among People With Severe Mental Illness: A Critical Appraisal of Qualitative Studies

BACKGROUND

People with severe mental illness (PWSMI) die 15-20 years earlier than people in the general population and this is often due to preventable smoking-related health conditions. Studies that identify barriers and facilitators to smoking cessation are crucial for policy makers and health care professionals.

AIMS

This appraisal aims to identify and critically appraise qualitative studies which explore smoking experiences and barriers to smoking cessation among PWSMI.

METHOD

Articles were retrieved from electronic health related databases including Web of Science, Scopus, PubMed, Sage, Biomed, Medline, Embase, and electronic hand searches of bibliographies from key articles.

RESULTS

Eleven papers were identified. Although the overall quality of studies were sufficient, most had limited information relating to trustworthiness and sociodemographic details. Cost savings and health benefits were frequently cited as facilitators to quitting, however may be of limited impact as smoking for existential purposes, social inclusion, and mental health management appear to be considered highly important among PWSMI.

CONCLUSIONS

Findings were restricted to predominantly individual barriers to smoking cessation which may be more resistant to change as service users rely on smoking to manage their mental health and smoking is embedded in the culture of mental health settings.

IMPLICATIONS

This critical appraisal identifies qualitative evidence regarding which factors facilitate or prevent individuals with severe mental illness from engaging with smoking cessation. Healthcare professionals and policy makers should address external barriers to quitting smoking as this may increase participation in intervention studies, inform policy and assist in the development of a feasible and acceptable smoking cessation intervention among PWSMI. Methodological considerations highlight that future research should include sociodemographic and contextual factors to improve utility and applicability of findings.

Refocusing on physical health: Community psychiatric nurses' perceptions of using enhanced health checks for people with severe mental illness

In the present qualitative, descriptive study, we explored Hong Kong community psychiatric nurses' (CPN) perceptions of using comprehensive physical health checks for service users diagnosed with severe mental illness (SMI). Research interviews were conducted with a purposive sample of 11 CPN in order to explore their perceptions about the use of the Health Improvement Profile (HIP) over a 1-year period. Interview data were analysed using inductive thematic analysis. The analysis revealed that the majority of CPN appreciated the comprehensive focus on the physical health of their clients and reported positive changes in their clinical practice. Many of them observed an increase in the motivation of their clients to improve their physical health, and also noted observable benefits in service users' well-being. The use of the HIP also helped the CPN identify implementation barriers, and highlighted areas of the tool that required modifications to suit the local cultural and clinical context. To our knowledge, this is the first study conducted in an Asian mental health service that explores nurses' views about using comprehensive health checks for people with SMI. The findings suggest that such approaches are viewed as being acceptable, feasible, and potentially beneficial in the community mental health setting.

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.

Physical health and mental illness: listening to the voice of carers

BACKGROUND

Shortened life expectancy of people with mental illness is now widely known and the focus of research and policy activity. To date, research has primarily reflected perspectives of health professionals with limited attention to the views and opinions of those most closely affected. The voice of carers is particularly minimal, despite policy stipulating carer participation is required for mental health services.

AIM

To present views and opinions of carers regarding physical health of the people they care for.

METHODS

Qualitative exploratory. Two focus groups and one individual interview were conducted with 13 people identifying as carers of a person with mental illness. Research was conducted in the Australian Capital Territory. Data analysis was based on the thematic framework of Braun and Clarke.

RESULTS

Two main themes were interaction between physical and mental health; and, carers' own physical and mental health. Participants described the impact of mental illness and its treatments on physical health, including their own.

CONCLUSIONS

Carers are acknowledged as crucial for the delivery of high quality mental health services. Therefore they have an important role to play in addressing the poor physical health of people with mental illness. Hearing their views and opinions is essential.

Use of an electronic metabolic monitoring form in a mental health service - a retrospective file audit

BACKGROUND

People with severe mental illness have poorer physical health, experience disparities in physical health care, and lead significantly shorter lives, compared to the general population. Routine metabolic monitoring is proposed as a method of identifying risk factors for metabolic abnormalities. Efforts to date suggest routine metabolic monitoring is both incomplete and ad-hoc, however. This present study reports on the recent implementation of a routine metabolic monitoring form at a mental health service in regional Australia.

METHODS

A retrospective file audit was undertaken on 721 consumers with electronic health records at the mental health service. Descriptive statistics were used to report the frequency of use of the metabolic monitoring form and the range of metabolic parameters that had been recorded.

RESULTS

Consumers had an average age of 41.4 years (SD = 14.6), over half were male (58.4%), and the most common psychiatric diagnosis was schizophrenia (42.3%). The metabolic monitoring forms of 36% of consumers contained data. Measurements were most commonly recorded for weight (87.4% of forms), height (85.4%), blood pressure (83.5%), and body mass index (73.6%). Data were less frequently recorded for lipids (cholesterol, 56.3%; low density lipoprotein, 48.7%; high density lipoprotein, 51.7%; triglycerides, 55.2%), liver function (alanine aminotransferase, 66.3%; aspartate aminotransferase, 65.5%; gamma-glutamyl transpeptidase, 64.8%), renal function (urea, 66.3%; creatinine, 65.9%), fasting blood glucose (60.2%), and waist circumference (54.4%).

CONCLUSIONS

The metabolic monitoring forms in consumer electronic health records are not utilised in a manner that maximises their potential. The extent of the missing data suggests that the metabolic health of most consumers may not have been adequately monitored. Addressing the possible reasons for the low completion rate has the potential to improve the provision of physical health care for people with mental illness.