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Carney R, Imran S, Law H, Carmichael-Murphy P, Charlton L, Parker S. "If you're struggling, you don't really care" - what affects the physical health of young people on child and adolescent mental health inpatient units? A qualitative study with service users and staff. BMC Psychiatry 2024; 24:498. [PMID: 38982436 PMCID: PMC11234625 DOI: 10.1186/s12888-024-05858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 05/21/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Physical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15-20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care. METHODS We conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14-42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted. . RESULTS Thematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle. CONCLUSIONS Promoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment.
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Affiliation(s)
- Rebekah Carney
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK.
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK.
| | - Shermin Imran
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, M13 3BL, UK
| | - Heather Law
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Parise Carmichael-Murphy
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
| | - Leah Charlton
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
| | - Sophie Parker
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
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Långstedt C, Bressington D, Välimäki M. Nurses' and patients' perceptions of physical health screening for patients with schizophrenia spectrum disorders: a qualitative study. BMC Nurs 2024; 23:321. [PMID: 38734609 PMCID: PMC11088092 DOI: 10.1186/s12912-024-01980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Despite worldwide concern about the poor physical health of patients with schizophrenia spectrum disorders (SSD), physical health screening rates are low. This study reports nurses' and patients' experiences of physical health screening among people with SSD using the Finnish Health Improvement Profile (HIP-F) and their ideas for implementation improvements. METHODS A qualitative exploratory study design with five group interviews with nurses (n = 15) and individual interviews with patients with SSD (n = 8) who had experience using the HIP-F in psychiatric outpatient clinics. Inductive content analysis was conducted. RESULTS Two main categories were identified. First, the characteristics of the HIP-F were divided into the subcategories of comprehensive nature, facilitating engagement, interpretation and rating of some items and duration of screening. Second, suggestions for the implementation of physical health screening consisted of two subcategories: improvements in screening and ideas for practice. Physical health screening was felt to increase the discussion and awareness of physical health and supported health promotion. The HIP-F was found to be a structured, comprehensive screening tool that included several items that were not otherwise assessed in clinical practice. The HIP-F was also considered to facilitate engagement by promoting collaboration in an interactive way. Despite this, most of the nurses found the HIP-F to be arduous and too time consuming, while patients found the HIP-F easy to use. Nurses found some items unclear and infeasible, while patients found all items feasible. Based on the nurses' experiences, screening should be clear and easy to interpret, and condensation and revision of the HIP-F tool were suggested. The patients did not think that any improvements to the HIP-F were needed for implementation in clinical settings. CONCLUSIONS Patients with schizophrenia spectrum disorders are willing to participate in physical health screening. Physical health screening should be clear, easy to use and relatively quick. With this detailed knowledge of perceptions of screening, further research is needed to understand what factors affect the fidelity of implementing physical health screening in clinical mental health practice and to gain an overall understanding on how to improve such implementation.
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Affiliation(s)
- Camilla Långstedt
- University of Turku, Faculty of Medicine, Department of Nursing, Kiinamyllynkatu 10, Medisiina B, Turku, 20520, Finland.
| | - Daniel Bressington
- Professor in Mental Health, Faculty of Health, Charles Darwin University, Casuarina, Australia
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, Sri Phum District, Chiang Mai, Thailand
| | - Maritta Välimäki
- University of Turku, Faculty of Medicine, Department of Nursing, Kiinamyllynkatu 10, Medisiina B, Turku, 20520, Finland
- University of Helsinki, School of Public Health, Helsinki, Finland
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Matete RP, Rathobei LM. Nurses' practice of metabolic monitoring for patients on antipsychotics in Lesotho. S Afr J Psychiatr 2024; 30:2219. [PMID: 38726330 PMCID: PMC11079420 DOI: 10.4102/sajpsychiatry.v30i0.2219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
Background Severe mental illness is associated with higher physical health morbidities and reduced life expectancy, with an estimated 14.3% of global deaths attributed to mental disorders. Antipsychotic medications (APs) used in treatment contribute to physical health issues, including metabolic and cardiovascular effects. Aim The aim of this study was to assess nurses' practices regarding metabolic monitoring for patients prescribed antipsychotic medications at Mohlomi Hospital in Lesotho. Setting The study was conducted at Mohlomi Hospital, the primary psychiatric facility in Lesotho. Methods Using a cross-sectional design, 44 nurses from Mohlomi Hospital participated in the study. A structured questionnaire assessed nurses' metabolic monitoring practices. Results Most of the respondents were female (n = 30, 75%), and minority were male (n = 10, 25%). The academic qualifications of respondents were distributed as follows: 40% (16) held a nursing assistant certificate and 22.5% (9) held an advanced nursing diploma, among others. The average age of all respondents was 39.05 (s.d. 8.9), with an average of 8 years of experience in psychiatry (s.d. 7.6). The overall rate of nurses' practices of metabolic monitoring for patients taking antipsychotic medications showed variability, with a mean score of 2.83 (s.d. 0.524). However, only 20% performed ECG tests, 22.5% measured blood pressure, 27.5% tested for glucose abnormalities and 17.5% conducted lipid profile testing. Conclusion Results revealed a significant gap in the practice of metabolic monitoring among nurses with various aspects of metabolic monitoring, not being adequately monitored. Contribution The study's findings shall inform policy and guidelines for monitoring patients on antipsychotic medications while guiding future research.
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Affiliation(s)
- Relebohile P Matete
- Department of Nursing, Faculty of Health Sciences, National University of Lesotho, Maseru, Lesotho
| | - Libuseng M Rathobei
- Department of Nursing, Faculty of Health Sciences, National University of Lesotho, Maseru, Lesotho
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Gurusamy J, Amudhan S, Menen M, Veerabhadraiah KB, Damodharan D. 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. Issues Ment Health Nurs 2023; 44:1009-1019. [PMID: 37819752 DOI: 10.1080/01612840.2023.2262581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
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.
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Affiliation(s)
- Jothimani Gurusamy
- College of Nursing, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Senthil Amudhan
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Melwine Menen
- Clinical Nursing Services, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | | | - Dinakaran Damodharan
- Center for Psychosocial Support and Disaster Management, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Vancampfort D, Kimbowa S, Ward PB, Onekalit K, Lukwata H, Mugisha J. A 10-hours workshop improves physical activity prescription for mental illness knowledge and confidence in health care professionals: a nation-wide multicentre study from Uganda. Disabil Rehabil 2023; 45:170-175. [PMID: 34779314 DOI: 10.1080/09638288.2021.2003448] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Lack of knowledge about and confidence in physical activity (PA) prescription for people with mental illness are important barriers for clinical practice in low-income countries. The aim of this study was to evaluate whether a 10-hour workshop improved the knowledge and confidence in PA prescription among health care professionals in 13 regional referral hospitals across Uganda. MATERIAL AND METHODS 260 health care professionals (age = 40.4 ± 10.8 years; 48% women; 63.8% nurses, 10% social workers, 8.1% psychologists, 7.3% medical doctors, 5.8% psychiatrists, 5% physical or occupational therapists) completed the Exercise in Mental Illness Questionnaire - Health Professionals Version (EMIQ-HP) pre- and post-workshop. RESULTS The EMIQ-HP PA knowledge score (3.1 ± 0.7 versus 1.3 ± 1.3, p < 0.001, Cohen's d = 1.28, 95% confidence interval, CI = 1.04-1.52, i.e., large effect) and EMIQ-HP confidence in PA prescription score (3.0 ± 0.8 versus 1.2 ± 1.2, p < 0.001, Cohen's d = 1.14, 95% CI = 0.91-1.36, i.e., large effect) improved significantly following training. Significantly more benefits and fewer barriers to prescribing PA in busy low-resourced settings were reported. CONCLUSIONS Training in PA counselling improved the knowledge and confidence in PA prescription in Ugandan health care professionals. Future research should investigate whether PA uptake in people with mental illness can be improved via additional training of health care professionals.IMPLICATIONS FOR REHABILITATIONThe majority of mental health professionals never recommend physical activity to their patients in low-resourced settings and increased awareness is needed to improve rehabilitation programs.Training in prescribing physical activity using the 5A framework improves knowledge about physical activity prescription in mental health professionals at all levels of care.Training in prescribing physical activity using motivational interviewing improves confidence in physical activity prescription in rehabilitation programs.Training in prescribing physical activity reduces perceived barriers for prescribing in rehabilitation programs in low-resourced settings.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,University Psychiatric Centre, KU Leuven, Kortenberg, Belgium
| | - Samuel Kimbowa
- Butabika National Referral Mental Health Hospital, Kampala, Uganda
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Keneth Onekalit
- Faculty of Arts and Social Sciences, Kyambogo University, Kampala, Uganda
| | - Hafsa Lukwata
- Division of Mental Health, Ministry of Health, Kampala, Uganda
| | - James Mugisha
- Faculty of Arts and Social Sciences, Kyambogo University, Kampala, Uganda
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Cohen F. Ecologies of care for serious mental illness in Uganda: A scoping review. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2021; 8:301-315. [PMID: 34926127 PMCID: PMC8673741 DOI: 10.1007/s40609-020-00193-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Flora Cohen
- Brown School at Washington University in St. Louis
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