Physical Health Risk Behaviours in Young People with Mental Illness

Comorbid physical health conditions, commonly associated with mental illness, contribute to increased morbidity and reduced life expectancy. The trajectory to poorer health begins with the onset of mental illness. For young people with mental illness, health risk behaviours and poor physical health can progress to adulthood with long-term detrimental impacts. Using a cross-sectional survey design, self-reported health risk behaviours were gathered from 56 young (16–25 years) Australians who had been hospitalised for mental illness and taking psychotropic medication. Smoking, alcohol use, minimal physical activity, and lack of primary health care were evident. While these behaviours are typical of many young people, those with mental illness have substantially increased vulnerability to poor health and reduced life expectancy. Priority needs to be given to targeted health promotion strategies for young people with mental illness to modify their risky long-term health behaviours and improve morbidity and mortality outcomes. Nurses in mental health settings play a vital role in promoting young peoples’ well-being and preventing poorer physical health outcomes. Implementation of a cardiometabolic health nurse role in inpatient settings for young people with mental illness could facilitate prevention and early intervention for health risk behaviours.     

Mental health problems in childhood and adolescence

The emotional health and wellbeing of children and young people is of fundamental importance. Unmet mental health needs during childhood lead to difficulties in adolescence and problems in adulthood. The need to develop comprehensive prevention, early recognition and timely intervention services is essential. Despite this, many mental health problems go unnoticed or are only treated when advanced. Late intervention can often be associated with severe impairments for children and young people as well as their families. This article aims to improve nurses' understanding of children's emotional wellbeing and mental health, and identifies some of the risk and protective factors that combine to produce positive or negative outcomes. Individual and family-based psychological treatments that are available to support children are summarised. The learning activities offer nurses helpful interpersonal and practical strategies to promote emotional wellbeing and mental health in children.     

Experiences of primary care among young adults with mental illness – A systematic literature review

Background

Mental illness, such as depression, anxiety disorders, attention deficit hyperactivity disorder and different addictive diseases, has increased among young adults over the last decade. Mental illness is associated with distress and problems functioning in social activities. Healthcare centres, that is, primary care, serve as the first point of contact with healthcare professionals for those young adults and provide outpatient medical and nursing care covering both physical and mental illness.

Objective

To explore experiences of primary care among young adults with mental illness.

Methods

A systematic literature review was conducted that followed the method of Bettany–Saltikov and McSherry. A keyword search was performed in various databases, and after a quality assessment 23 articles were included in the review.

Results

Young adults' experiences from primary care are described in four categories – Facing difficulties to accept help, relational preconditions, structural and organisational hindrances and satisfaction with youth-focused mental health interventions. Young adults with mental illness experience many difficulties in accessing and receiving proper help from primary care. Further, they did not believe in recovery from mental illness, and they also expressed a lack of mental health literacy.

Conclusion

While being the first contact with healthcare professionals, primary care needs to adjust its services to address the growing group of young adults suffering from mental illness. It is necessary to provide tailored guidelines and interventions in primary care for young adults with mental illness, and the Tidal Model may improve the contacts with young adults in primary care.     

Hospitalized mental health patients and oral health

The purpose of this review of the literature is to present a contemporary perspective related to the nursing care of hospitalized mental health patients who have risk of developing oral health issues. Mental illness is a major health concern worldwide. Compounding this health issue, mental health patients/clients demonstrate avoidant behaviours related to oral health, and the symptoms of mental illness can be a compounding factor. Oral health and oral inflammatory disease are the result of lifestyle and behaviour and mental disorders affect both lifestyle and behaviour. The search used the search terms oral health AND nursing AND mental illness AND Published Date 2005 to 2010. For those who experience mental illness oral health assessment is not routinely practised by clinicians. The importance of special attention to dental problems for people with mental disorders has also been stressed by researchers since the lifespan of people with serious mental disorders is shortened compared to the general population. Oral health care is an important part of treatment. Routine oral care for hospitalized patients is imperative, and this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow.     

Mental health and functional mental disorder in older adults

The available literature on mental health and older people tends to focus on dementia rather than functional illness, despite the greater prevalence of the latter. This review analyses articles published on mental health in nursing journals and considers their content. The author suggests that those working with older adults need to hear more about the experiences of those who suffer with mental health problems.     

Meeting the needs? Perceived support of a nurse‐led lifestyle programme for young adults with mental illness in a primary health‐care setting

Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle‐related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse‐led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16–25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse‐led programme provides health information‐management strategies that could easily be integrated in a primary health‐care setting.     

Listening to young voices: challenges of research with adolescent mental health service users

Young people who have mental health problems and use the mental health services need to be consulted about their views regarding their experiences of care and treatment in the same way as adults do. Doing research with children and young people is relatively new but it is becoming more common and recent literature highlights a need to balance respect for their voices with responsibility for their best interests. This can be achieved by paying close attention to ethical and methodological issues throughout the course of every study. This paper reviews some of the issues involved in consultation research with adolescent mental health service users, and illustrates them with examples taken from an ongoing study into the experiences of young people in three Scottish child and adolescent mental health services.     

Systematic screening for metabolic syndrome in consumers with severe mental illness

The high prevalence of metabolic syndrome (MetS) in people with a mental illness has been reported recently in the literature. Gaps have emerged in the widespread use of systematic screening methods that identify this collection of critical risk factors for cardiac and metabolic disorders in people with severe mental illness. A sample (n = 103) of consumers with severe mental illness was screened for MetS using the Metabolic Syndrome Screening Tool and compared to a sample (n = 72) of consumers who were not receiving a systematic approach to screening for MetS. The results demonstrated ad hoc screening of consumers for MetS in the comparison group, potentially leaving patients at risk of cardiac and metabolic disorders being untreated. Mental health nurses are well placed to show leadership in the screening, treatment, and ongoing management of MetS in people with severe mental illness. A potential new speciality role entitled the ‘cardiometabolic mental health nurse’ is proposed as a means leading to improved outcomes for consumers who have both the complication of physical health problems and a severe mental illness.     

Folk concepts of mental disorders among Chinese-Australian patients and their caregivers

AIM: This paper reports a study of (a) popular conceptions of mental illness throughout history, (b) how current social and cultural knowledge about mental illness influences Chinese-Australian patients' and caregivers' understanding of mental illness and the consequences of this for explaining and labelling patients' problems. BACKGROUND: According to traditional Chinese cultural knowledge about health and illness, Chinese people believe that psychotic illness is the only type of mental illness, and that non-psychotic illness is a physical illness. Regarding patients' problems as not being due to mental illness may result in delaying use of Western mental health services. METHODS: Data collection took place in 2001. Twenty-eight Chinese-Australian patients with mental illness and their caregivers were interviewed at home, drawing on Kleinman's explanatory model and studies of cultural transmission. Interviews were tape-recorded and transcribed, and analysed for plots and themes. FINDINGS: Chinese-Australians combined traditional knowledge with Western medical knowledge to develop their own labels for various kinds of mental disorders, including 'mental illness', 'physical illness', 'normal problems of living' and 'psychological problems'. As they learnt more about Western conceptions of psychology and psychiatry, their understanding of some disorders changed. What was previously ascribed to non-mental disorders was often re-labelled as 'mental illness' or 'psychological problems'. CONCLUSION: Educational programmes aimed at introducing Chinese immigrants to counselling and other psychiatric services could be made more effective if designers gave greater consideration to Chinese understanding of mental illness.     

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.     

Medical co-morbidity risk factors and barriers to care for people with schizophrenia

The management of risk is a fundamental component of the work of mental health nurses and is most commonly associated with aggressive, violent and suicidal behaviours exhibited by those suffering from mental illness. However, people with severe mental illness are increasingly at risk of experiencing a number of related and complex health problems that include obesity, diabetes and cardiovascular disease. This group also has much higher rates of morbidity and mortality than that of the general population resulting in high social, economic and individual costs. Some of the barriers to receiving prompt and appropriate physical health care include lack of recognition by health professionals and the difficulties faced by consumers of mental health services in negotiating the health care system. Establishment of comprehensive (addressing both physical and mental health issues) programmes of care can address this need and offer additional opportunities for closer and more collaborative nurse-patient relationships. This paper explores risk factors for medical co-morbidity for people living with schizophrenia and suggests strategies that can facilitate better health outcomes.     

Utilization of mental health and substance abuse services among homeless adults in Los Angeles

OBJECTIVES: Even though psychiatric disorders are disproportionately present among the homeless, little is known about the extent to which homeless people receive treatment for those problems or the factors that are associated with receiving treatment. This article examines utilization and predictors of mental health and substance abuse treatment among a community-based probability sample of homeless adults. METHODS: The data analyzed here were collected through face-to-face interviews with 1,563 homeless individuals. Bivariate analyses examined differences between homeless men and women in (1) the prevalence of major mental illnesses and substance dependence and (2) utilization of inpatient and outpatient treatment services for those with specific diagnoses. Logistic regression analyses identified predictors of mental health treatment among those with chronic mental illness and substance abuse treatment among those with recent substance dependence. RESULTS: Two-thirds of these homeless adults met criteria for chronic substance dependence, whereas 22% met criteria for chronic mental illness, with substantial overlap between those two disorders: 77% of those with chronic mental illness were also chronic substance abusers. Only one-fifth of each of those two groups reported receiving treatment for those disorders within the last 60 days. Mental health service utilization was predicted largely by factors related to need (eg, diagnosis, acknowledgment of a mental health problem), whereas substance abuse service utilization was predicted by myriad additional factors, reflecting, in part, critical differences in the organization and financing of these systems of care. CONCLUSIONS: More attention must be directed at how to better deliver appropriate mental health and substance abuse services to homeless adults.     

"Not always smooth sailing": mental health issues associated with the transition from high school to college

Students who transition from high school to college are often excited by the new phase of their lives. However, they are exposed to circumstances and expectations which place them at risk for psychiatric disorders or that may exacerbate pre-existing problems. In this paper, we discuss risk factors and other issues associated with students transitioning to college or university life, identify challenges for health professionals, and suggest possible strategies to improve the mental health of young adults on college campuses. Academic staff and health care providers need to be aware of how best to engage and assist students during an important phase of their life. Processes and care pathways also need to be easily understood, user friendly, and appropriately resourced. It is anticipated that staff, students, and industry health care providers will benefit from a greater awareness of some of the mental health issues that may occur in higher education.     

The Physical Health of Individuals Receiving Antipsychotic Medication: A Qualitative Inquiry on Experiences and Needs

Individuals with a mental illness are reported to have a reduced life expectancy and a greater risk of being affected by preventable physical illnesses such as cardiovascular disease and Type 2 diabetes. This inquiry sought to identify the physical health beliefs, experiences and needs of individuals with mental health problems in receipt of antipsychotic medication who live in the community. A qualitative inquiry was undertaken using three focus groups in a community mental health service in Ireland with 21 participants with mental health problems who were treated with antipsychotic medication. The participants were clear about the importance of good physical health as well as good mental health. They disliked the adverse effects of antipsychotic medication and experienced many barriers in accessing general practitioners/primary care services. They also preferred to receive health advice and self-management advice from the mental health services. The participants in this study were aware of the need to engage in health protective behaviours but were often overwhelmed by their comorbid health issues and the organizational and communication barriers in accessing their general practitioners.     

Models of mental health care for older adults: a review of the literature

Aim.  This paper reviews literature that draws on models of mental health care for older adults.
Background.  It is predicted that as a consequence of the aging of the population the incidence of mental health disorders, common in older populations, will also rise. Many such disorders can be successfully managed if detected early. Assessment and management requires collaboration between health professionals who are skilled and educated in the management of older adults with mental illness and the use of models of care appropriate to this population.
Results.  The paucity of research in this area is demonstrated.
Conclusion.  The need for mental health nurses to challenge current models of mental health care for older adults is identified so that they take on an expanded and developed specialist role in care of older adults with mental illness.     

Responding to the needs of carers of people with schizophrenia

As more people with a serious mental illness such as schizophrenia live in the community, often with their own families, carers need increasing support. A small research study found a link between carers' knowledge of the condition and their ability to manage problems and between their sense of satisfaction with services and their communications with the mental health team.     

山东省聊城市第三次精神疾病流行病学调查

目的:了解聊城市≥18岁人群各类精神疾病的患病水平、分布特征、致残情况,掌握近三十年来精神疾病流行的动态资料。方法:采用多阶段分层整群随机抽样方法,对聊城市≥18岁的人群进行入户调查。使用一般健康问卷将调查对象分为患精神疾病高、中、低危险组,以DSM-IV轴Ⅰ障碍用临床定式检查量表、美国精神学会诊断手册第四版和精神发育迟滞/痴呆诊断量表为诊断工具,依次对高危组中的100%,中危组中的40%,低危组中的10%为调查对象进行定式检查,对各类精神障碍进行诊断。结果:4788人完成筛选,1568例完成诊断。精神疾病终生患病率为15.10%,现患病率为14.20%,最常见的疾病为心境障碍、酒精使用障碍和焦虑障碍。男性高于女性,且以40～55岁年龄组发病率最高。结论:聊城市精神疾病患病率明显上升,已成为常见病和迫切需要解决的重大公共卫生问题。     

Health problems of women with severe mental illness

PURPOSE: To provide a review of the health problems of women with severe mental illness (SMI) that are related to their psychiatric disorders and disabilities, prolonged use of psychotropic medications, and high-risk lifestyle practices. DATA SOURCES: Review of current literature uncovered through MEDLINE, Cumulated Index to Nursing and Allied Health, and Psychological Abstracts as well as the authors' clinical experiences. CONCLUSIONS: Women with SMI are at increased risk for obesity as well as cardiovascular, endocrine, and infectious disorders. They also experience psychotropic medication-related disorders such as amenorrhea, galactorrhea, sexual dysfunction, breast cancer, and osteoporosis. High-risk lifestyle practices, excessive weight gain, low physical activity, substance abuse and unprotected sexual activity increase risk for health problems. The mental illness, residual disabilities, sequelae of childhood abuse, poverty, limited social support and health knowledge deficits affect their ability to maintain optimum health. IMPLICATIONS FOR PRACTICE: Knowledge about women with SMI and their health problems will enable nurse practitioners to better meet the needs of this vulnerable population.     

Swedish Young Adults’ Experiences of Psychiatric Care during Transition to Adulthood

The number of young adults with mental illness and the need of psychiatric care has increased during the last decades. The aim of the study was to explore young adults’ experiences of psychiatric care during transition to adulthood. Individual interviews were conducted with 11 young adults and analysed according to Grounded Theory. The analyses results showed that support was a prerequisite for transition to adulthood and striving to reach recovery. By being encountered as a person and with a supportive environment, young adults can be motivated to continue care and be encouraged to express feelings.     

Improving links between CAMHS and primary care

Only a small percentage of children and young people with mental health problems reach child and adolescent mental health services (CAMHS) (Young Minds 2003). Government policy, voluntary organisation reports and research all support the need for improved links and open communication between health services in order to address the mental health needs of children and young people.