Gaps in health care for the somatic health of outpatients with severe mental illness

The physical health of outpatients with severe mental illness (SMI) can be improved by changes in the health‐care system. Analysis of current practice is necessary to develop these strategies. We compared the number of somatic health problems of outpatients with SMI with the frequency of consulting a general practitioner (GP). This was a cross‐sectional study based on interviews, and records from the GP and the pharmacy. We checked whether Dutch community pharmacies had complete and correct information about the patients' medication. We observed that all patients (n = 118) had somatic problems in need of clinical attention. Patients who visited their GP less than once a year (35%, n = 42), had a mean of 2.8 somatic health problems. This was less than patients who consulted their GP more than once a year (P ≤ 0.01). In 37% of cases, the pharmacy did not have adequate information on the drug use. Many patients with SMI seemed to have insufficient contact with their GP for their somatic health problems. Insufficient information about the patients' medication suggested that the pharmacist and GP should increase exchange of information. Mental health nurses can take a lead in coordinating the care to improve somatic health for their patients.     

Mental Health and Social Care Needs of Older People with Intellectual Disabilities

Background Older people with intellectual disabilities (ID) are a growing population but their age‐related needs are rarely considered and community services are still geared towards the younger age group. We aimed to examine the mental health and social care needs of this new service user group. Methods We identified all adults with ID without Down syndrome (DS) aged 65+ living in the London boroughs of Camden and Islington. The Psychiatric Assessment Schedule for Adults with a Developmental Disability (PASADD) checklist was used to detect psychiatric disorder, the Vineland behaviour scale (maladaptive domain) for problem behaviours and the Dementia Questionnaire for persons with Mental Retardation (DMR) to screen for dementia. Carers reported health problems and disability. Needs were measured with the Camberwell Assessment of Need for adults with Intellectual Disabilities (CANDID‐S). Results A total of 23 older people with ID (13 had mild ID and nine more severe ID) and their carers participated in the survey. In which, 74% had one or more psychiatric symptoms; 30% were previously known with a diagnosis of mental illness. One‐third of the older people screened positive for dementia (range: 17–44%, depending on sensitivity of DMR scores used). Three quarters of the group had physical health problems, 74% had poor sight, 22% had hearing loss and 30% had mobility problems. Carers rated unmet needs for accommodation (22%), day activities, and eyesight and hearing. The people with ID rated unmet needs to be social relationships (44%), information and physical health. Conclusion Older people with ID without DS have considerable prevalence of health problems and psychiatric disorders, including symptoms of functional decline and dementia. Such symptoms are often not recognised and further research into their needs is a priority.     

Effects of the Thai Health Improvement Profile intervention on the physical health and health behaviours of people with schizophrenia: A quasi‐experimental study

Physical health problems and unhealthy lifestyle behaviours are common in people with severe mental illness (SMI), leading to high levels of mortality.There is some evidence that nurse‐led interventions involving comprehensive health checks may be effective in improving physical health in people with SMI. This quasi‐experimental before‐and‐after study investigated the impacts of the Thai Health Improvement Profile (HIP‐T) on the physical health and health behaviours of people with schizophrenia over 1‐year. All 105 service‐users who volunteered to participate completed the study. There were significant reductions in mean BMI (?0.78 kg/m², P < .001) and bodyweight (?1.13 kg, P < .001) at post‐test. There was also a significant decrease in the total number of “red‐flagged” HIP‐T items, suggesting lowered potential health risks (P < .001). Overall, 23 patients (22%) were found to have moved to a healthier BMI classification after 1‐year. The findings suggest that the HIP‐T intervention has potential for improving the physical health of people with SMI when integrated into routine community mental health care.     

Chinese Health Improvement Profile for people with severe mental illness: A cluster‐randomized,controlled trial

The aim of the present study was to establish the feasibility of conducting a full‐scale trial and to estimate the preliminary effect of a Chinese Health Improvement Profile (CHIP) intervention on self‐reported physical well‐being of people with severe mental illness (SMI). The study used a parallel‐group, open‐label, cluster‐randomized, controlled trial (RCT) design. Twelve community psychiatric nurses (CPN) and their corresponding 137 patients with SMI were randomized into the CHIP or treatment‐as‐usual (TAU) groups. After training, the CPN completed the CHIP at baseline and 12 months, and the findings were used to devise an individualized care plan to promote health behaviour change. Patients were assessed at baseline and 6 and 12 months after starting the intervention. There was an observed positive trend of improvement on the physical component subscale of SF12v2 in the CHIP group compared to the TAU group after 12 months, but the difference did not reach statistical significance (P = 0.138). The mental component subscale showed a similar positive trend (P = 0.077). CHIP participants were more satisfied with their physical health care than TAU patients (P = 0.009), and the CPN were positive about the usefulness/acceptability of the intervention. There were significant within‐group improvements in the total numbers of physical health risks, as indicated by the CHIP items (P = 0.005). The findings suggest that it is feasible to conduct a full‐scale RCT of the CHIP in future. The CHIP is an intervention that can be used within routine CPN practice, and could result in small–modest improvements in the physical well‐being of people with SMI.     

Differences in job stress experienced by female and male Japanese psychiatric nurses

In psychiatric nursing, female nurses tend to spend more time building rapport with patients and developing cooperative working relationships with colleagues; they encounter more sexual harassment by patients. In contrast, male nurses respond to aggressive patients and tend to resist physically caring for female patients; they encounter more physical and verbal assault from patients. These gender differences might result in differences in job‐related stress. We quantitatively examined gender differences in psychiatric nurses' job stress. The Psychiatric Nurse Job Stressor Scale and the Stress Reaction Scale of the Brief Job Stress Questionnaire were administered to 159 female and 85 male Japanese psychiatric nurses. The results indicated that female nurses had significantly higher stress levels than males related to psychiatric nursing ability, attitude towards nursing, and stress reactions of fatigue and anxiety. Moreover, the factors affecting stress reactions differed somewhat between sexes. In particular, male nurses reported that greater irritability was affected by patients' attitudes. Their anxiety and somatic symptoms were affected by their attitude towards nursing, and depressed mood was affected by psychiatric nursing ability. Knowledge of these differences can lead to better mental health‐care interventions for psychiatric nurses.     

Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders

Half of all outpatient encounters are precipitated by physical complaints, of which one third to one half are medically unexplained symptoms, and 20% to 25% are chronic or recurrent. Many of the patients suffer from one or more discrete symptoms, whereas others have functional somatic syndromes. Individual symptoms and somatic syndromes are associated with impaired quality of life, increased health care use, and diminished patient and provider satisfaction. This article provides an overview of (1) unexplained symptoms and somatization; (2) limitations of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition in classifying somatoform disorders; (3) predictors of psychiatric comorbidity in patients who have physical symptoms; and (4) measurement and management of symptoms.     

Comparison of inpatients with comorbid mental health disorders and alcohol- and other-substance-use disorders within general hospitals and psychiatric hospitals in NSW,Australia

Aim: To explore the association of mental health disorders and alcohol- and other-substance-use disorders within general hospitals and psychiatric hospitals in NSW.

Method: The data were extracted from the NSW Department of Health Inpatient Statistics Data Collection for the period from 1 July 2006 to 30 June 2007. Statistical analyses were performed using Statistical Analysis System.

Results: Of the 1,814,830 admissions, 1,808,095 were in general hospitals (45.7% males, 54.3% females) and 6716 in psychiatric hospitals (60.8% males, 39.2% females). Most admissions were within age groups 20–29 and 30–39 years. Comorbidity rates in psychiatric hospitals were double those of general hospitals (9.5% in general hospitals, 19.7% in psychiatric hospitals). The highest comorbidity rate for males was in age group 30–39 (18.8% in general hospitals, 25.1% in psychiatric hospitals). For females the highest comorbidity rate was in 40–49 years age group in general hospitals (13.3%) and 30–39 years age group in psychiatric hospitals (20.9%).

Conclusion: Addressing comorbidity of mental health disorders and alcohol- and other-substance-use disorders in both general hospitals and psychiatric hospitals has important clinical implications for both prevention and treatment. This first investigation of its kind provides important information for policymakers to plan adequate policies and interventions targeting these comorbid patients.     

Physical and psychological health and social relations in patients with prolonged musculoskeletal disorders

The purpose of this study was to describe and analyse the relationship between physical and psychological health and social relations in patients with prolonged musculoskeletal disorders in primary care. Seventy-eight patients--64 women and 14 men--were included in the study. Data from a semi-structured interview called addiction severity index (ASI), frequently used in psychiatric and drug abuse research and a visual analogue scale (VAS) symptom list as well were analysed using principal component analysis (PCA). The analysis gave a two-dimensional model with four poles of related variables characterizing the whole group. The first dimension consisted of one pole characterized by present psychiatric symptoms and many somatic symptoms. The second pole on this dimension was characterized by well-being, having work and feeling satisfaction with life. One pole on the second dimension was characterized by severe physical problems, related to sick leave and disability pension. The opposite pole on this dimension was characterized by severe psychiatric symptoms earlier in life and present relationship problems with family and other people. The ASI-instrument was considered to be relevant for describing important problem areas in patients with prolonged musculoskeletal disorders.     

Nurse views on the cardiometabolic health nurse as an approach to improving the physical health of people with serious mental illness in Australia

People with serious mental illness (SMI) die prematurely from common physical illnesses such as cardiovascular disease and diabetes. These cardiometabolic risks are preventable and manageable yet these aspects of health care have been neglected in mental health services. A potential nurse‐based strategy to decisively improve cardiometabolic health of people with SMI is to introduce a cardiometabolic health nurse (CHN) into mental health services. The current study aimed to establish the views of nurses working in mental health care on the potential benefits and limits of CHN to improve physical health‐care standards in Australia. All members of the Australian College of Mental Health Nurses were invited to participate in an online survey and 643 participated. Nurses generally agreed that a CHN role would provide a range of improvements to physical health care, such as increased detection, assessment on, and follow up of cardiometabolic risks, and decreased workload for other nurses. While participants were generally supportive of such a role, they felt it would not be suitable in all health‐care settings in Australia.     

Perceived sleep quality of psychiatric patients

This paper aims at acquiring knowledge about the quality of sleep of adult and elderly psychiatric patients who receive clinical or outpatient nursing care, and identifying key factors in perceiving a sleep problem. To do so, a sample of 1699 psychiatric patients were asked whether they perceived a sleep problem and were invited to fill in the Pittsburgh Sleep Quality Index (PSQI) and additional questions. Five hundred and sixty (33%) questionnaires were returned. As a result, we find that 36% of the patients perceived a sleep problem, while the PSQI assessed 66% of the sample as being 'bad sleepers'. Forty-nine per cent of the respondents used sleep medication one or more times a week. Five items of the PSQI were shown to be predictors of a perceived sleep problem. Four of these are insomnia symptoms, while the fifth is the use of sleep medication. Moreover, the patients who used sleep medication most scored significantly worse on all PSQI components than patients who used sleep medication less than once a week. In conclusion, many psychiatric patients perceive a sleep problem and all nurses could be confronted not only with the night-time consequences of this, but also with daytime consequences. Therefore, sleep problems must not be viewed as an isolated problem but must be seen in relation with social functioning.     

Improving mental health service users' physical health through medication monitoring: a literature review

nash m . (2011) Journal of Nursing Management  19, 360–365
Improving mental health service users’ physical health through medication monitoring: a literature review Aim To explore the importance of improving physical health in mental health service users through medication monitoring. Background Mental health service users’ physical health is frequently poor, although many have contact with health-care services. Adverse drug reactions are a unique risk factor for poor physical health. However, medication monitoring remains inconsistent. Evaluation A literature review was conducted using search terms: medication monitoring, adverse drug reactions, physical health/illness, mental health/psychiatric nursing. Databases searched included PsychINFO, Pubmed, CINHAL and the British Nursing Index. Key issue Structured medication monitoring is required to enhance physical health and reduce the risk of adverse events. Implications for nursing management Nurse managers should promote a culture of evidence-based practice in medication monitoring. Practitioner learning needs and competencies should be assessed to provide relevant education and skills training. Conclusion Nurse managers require strategic leadership to transform practice and enhance mental health service users’ physical health through medication monitoring. Good practice guidelines should be implemented to improve quality of care and reduce the risk of adverse events. Addition to current knowledge This paper illustrates the importance of medication monitoring in improving physical health.     

Australian mental health care practitioners’ practices and attitudes for encouraging smoking cessation and tobacco harm reduction in smokers with severe mental illness

Reducing the burden of physical illness among people living with severe mental illnesses (SMI) is a key priority. Smoking is strongly associated with SMIs resulting in excessive smoking related morbidity and mortality in smokers with SMI. Smoking cessation advice and assistance from mental health practitioners would assist with reducing smoking and smoking‐related harms in this group. This study examined the attitudes and practices of Australian mental health practitioners towards smoking cessation and tobacco harm reduction for smokers with SMI, including adherence to the 5As (ask, assess, advise, assist and arrange follow up) of smoking cessation. We surveyed 267 Australian mental health practitioners using a cross‐sectional, online survey. Most practitioners (77.5%) asked their clients about smoking and provided health education (66.7%) but fewer provided direct assistance (31.1–39.7%). Most believed that tobacco harm reduction strategies are effective for reducing smoking related risks (88.4%) and that abstinence from all nicotine should not be the only goal discussed with smokers with SMI (77.9%). Many respondents were unsure about the safety (56.9%) and efficacy (39.3%) of e‐cigarettes. Practitioners trained in smoking cessation were more likely (OR: 2.9, CI: 1.5–5.9) to help their clients to stop smoking. Community mental health practitioners (OR: 0.3, CI: 0.1–0.9) and practitioners who were current smokers (OR: 0.3, CI: 0.1–0.9) were less likely to adhere to the 5As of smoking cessation intervention. The results of this study emphasize the importance and need for providing smoking cessation training to mental health practitioners especially community mental health practitioners.     

Do mental health consumers want to improve their long‐term disease risk behaviours? A survey of over 2000 psychiatric inpatients

Policies and clinical guidelines acknowledge the role mental health services have in addressing the physical health of individuals with a mental illness; however, little research has explored interest in reducing health risk behaviours or the acceptability of receiving support to reduce such risks among psychiatric inpatients. This study estimated the prevalence of four long‐term disease risk behaviours (tobacco smoking, hazardous alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity); patient interest in reducing these risks; and acceptability of being provided care to do so during a psychiatric inpatient stay. A cross‐sectional survey was undertaken with 2075 inpatients from four inpatient psychiatric facilities in one health district in Australia (October 2012–April 2014). Prevalence of risk behaviours ranged from 50.2% (inadequate physical activity) to 94.8% (inadequate fruit and/or vegetable consumption). The majority of respondents (88.4%) had more than one risk behaviour, and most were seriously considering improving their risk behaviours (47.6% to 65.3%). The majority (80.4%) agreed that it would be acceptable to be provided support and advice to change such behaviours during their psychiatric inpatient stay. Some diagnoses were associated with smoking and hazardous alcohol consumption, interest in reducing alcohol consumption and increasing fruit and/or vegetable consumption, and acceptability of receiving advice and support. The findings reinforce the need and opportunity for psychiatric inpatient facilities to address the long‐term disease risk behaviours of their patients.     

231例住院老年精神患者躯体疾病共病调查

目的：了解重庆市精神卫生中心住院老年精神患者躯体健康状况。方法对重庆市精神卫生中心2012年7月231例住院老年精神患者的病历资料进行调查分析,以了解其身体健康情况。结果231例老年精神患者中,合并有躯体疾病者达216例（93．51％）,平均每例合并病种数为2．51。常见合并的躯体疾病依次为高血压132例（57．14％）、心脏病121例（52．38％）、脑血管病87例（37．66％）、糖尿病69例（29．87％）、慢性阻塞性肺疾病33例（14．29％）。结论老年精神住院患者躯体疾病共病现象相当普遍,且合并病种较多,应加强医务人员内科通科专业培训,与综合性医院建立紧密的会诊网络。     

Motivation for physical activity and exercise in severe mental illness: A systematic review of cross‐sectional studies

Individuals with severe mental illness (SMI) are less physically active than the general population. One important barrier contributing to this inactivity is lack of motivation. The aim of this paper is to systematically review all cross‐sectional literature on motivation for physical activity among people with SMI and to use the results as basis for guidance on how mental health nurses can facilitate motivation for physical activity. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they included participants with SMI and reported data on motivation for physical activity. In total, 21 articles were included and over half them were published in 2011 or later. The present results indicate preliminary evidence of how the motivational processes do not differ between individuals with SMI and the general population, and that they are independent of diagnosis, medication, age, gender, and body mass index. Results from the current systematic review can give some tentative guidance on how to facilitate motivation for physical activity within mental health‐care. However, there is still a great need for developing and examining practical strategies that can enhance adoption and adherence of physical activity among people with SMI.     

The development of the serious mental illness physical Health Improvement Profile

People with serious mental illness (SMI), such as schizophrenia and bipolar disorder, are more likely to suffer from a range of long-term physical conditions including diabetes and cardiovascular disease. Consequently they will die 10–15 years earlier than the general population. Health services have failed to address this major health inequality because of a lack of consensus about the type and frequency of monitoring people with SMI require and a lack of knowledge and skills in the mental health workforce. We developed the SMI physical Health Improvement Profile to help mental health nurses profile the physical health of the SMI patients they work with and direct them towards the evidence base interventions available to address identified health problems.     

A well-being programme in severe mental illness. Baseline findings in a UK cohort

Introduction: Patients with severe mental illness (SMI) have higher rates of cardiovascular disease (CVD) morbidity and mortality than the general population. In the UK, data were limited regarding the known prevalence of physical health screening of SMI patients. Aims: A total of 966 patients with SMI from seven geographically varied regions in the UK agreed to participate in a 2‐year nurse‐led intervention (Well‐being Support Programme), designed to improve their overall physical health by providing basic physical health checks, health promotion advice, weight management and physical activity groups in secondary care. Results: At baseline, only 31% of participants had undergone a recent physical health check. There were high rates of obesity (BMI > 30 in 49%), glucose abnormalities (12.4%), hypertension/prehypertension (50%), hyperlipidaemia (71%), poor diet (32%), low exercise levels (37.4%) and smoking (50%). Conclusions: Patients with SMI where healthcare professionals have concerns regarding their physical health, have potentially modifiable risk factors for CVD, which remain undiagnosed. Programmes designed to address the physical health problems in SMI need to be implemented and evaluated in this already marginalised group of people.