Treating the physical health of people with severe mental illness
Dr Sheila Hardy, Independent Healthcare Consultant, blogs about the new guideline she helped to create with The Royal College of Nursing’s Mental Health Steering Group on the topic of physical health in mental illness.
Dr Sheila Hardy is a dual trained nurse who researched physical health in severe mental illness for her PhD.
People with severe mental illness have a 15-20 year shorter life expectancy than the rest of the population, often due to cardiovascular disease. This group of people are also more likely to have a preventable physical condition. In the last 10 years there has been a plethora of guidance, tools and payment targets to incentivise healthcare professionals to promote physical health. Despite this, and the fact the general population is living longer, people with severe mental illness are dying even earlier. This remains a significant concern for healthcare professionals, those experiencing the long-term effects of mental health problems, and most policy makers. Whilst we have plenty of initiatives, we are still some way to addressing the health gap.
Improving the physical health of people with severe mental illness
Just as the concept of mental health is viewed in terms of mental illness by many, the physical health of people with severe mental illness is often interpreted by healthcare professionals in the terms of physical illness alone. Having a mental illness can make it more difficult to engage in behaviours which promote physical health. The guidance, tools, and payment targets have concentrated very much on an illness focus such as performing a ‘physical health check’, such as, screening for cardiovascular risk. In reality, this check is often carried out by staff who have limited time, expertise or understanding of health promotion and how to support behaviour change. To meet the payment targets, questions are asked, measurements are taken and boxes ticked, but this does not necessarily improve the health of patients. Additionally, there is still a general attitude from many healthcare professionals working in all areas of care delivery that people with severe mental illness cannot or do not want to make healthy changes. Some professionals will argue that the unhealthy behaviour is a choice which should be respected without exploring this any further with the patient.
Physical Health in Mental Health Resource
The Royal College of Nursing’s (RCN) Mental Health Steering group consider that staff looking after people with mental illness need support to navigate the guidance, resources and education available to them. The steering group also believe that there is a need for all staff to see health promotion as a priority, and encouraging and supporting patients as central to their role. With funding from the Charlie Waller Memorial Trust and support from the RCN they have created an online resource Physical Health in Mental Health as a way of shifting the focus to health promotion and providing resources to support opportunities for behaviour change for those with long term mental health problems.
There are three short parts to the resource. The first explains why looking after physical health is essential for overall wellbeing and why people with mental illness may need more help than the general population. The second aims to encourage nurses to think about what they can do to enhance the physical health of people with mental illness in their care. The third explains the guidance, policies, payment incentives, research, tools and education available to nurses to assist them. These documents are made available through a drop box link.
It is anticipated that by using the resource nurses and managers will be encouraged to assess and enhance the care delivered by themselves and colleagues. Snippets of the sessions can be used to stimulate discussion in team meetings or training events and nurses can complete the sessions as they would eLearning. All the correct information required is accessible in one place making it easy to utilise. It is a small step, but one we believe will help bring about a more holistic perspective for those with serious mental health problems. This year the RCN at its annual congress debated Parity of Esteem, the debate focused on ensuring that those with the most serious mental health problems have access to the same level of physical health care as the general population. Whilst we need to continue to hold governments to account for delivering the resources required to make this happen, we too, as health professionals, hold the responsibility to work with others in the most collaborative, proactive and positive way around their physical health.
The Royal College of Nursing’s Mental Health Steering group has collaborated with the charity, the Charlie Waller Memorial Trust to create this resource for nurses.
To find out more about what we're doing to join up mental and physical healthcare visit our Mind and Body Programme page.