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.     

Nursing students’ attitudes and experiences with mental illness: A cross-sectional study

Almost half (46%) of people will experience a mental health issue in their lifetime and all nurses need mental health knowledge and skills regardless of their area of specialization. Little is known, however, about student attitudes toward people with mental illness on entry to pre-registration nursing programs. The aims were to investigate Australian pre-registration nursing students’ attitudes toward, and prior experience with, people with mental illness on program commencement. This cross-sectional study used the Community Attitudes Toward Mental Illness (CAMI) scale with pre-registration nursing students, and questions on students’ prior experience with mental illness (self, family, friends). There were n = 311 (271 female/40 male) first year, first semester Bachelor of Nursing students at a national Australian university. Students reported prior experience with mental illness with family (49.5%/n = 154) and friends (61.4%/n = 191). Self-reported (36.3% /n = 113) mental illness, particularly anxiety and depression, significantly exceeded national averages. Most students held accepting attitudes toward people with mental illness, except for perceptions of dangerousness. This study provides new findings on nursing student attitudes and experience with people with mental illness on program entry. The high self-reported prevalence of anxiety and depression at program entry indicates a pressing need for early intervention and mental wellbeing strategies for students from commencement of their tertiary education. Fear-reducing education which challenges perceptions of dangerousness in relation to people with mental illness, and supportive mental health clinical placements during their program, may help improve students’ attitudes and reduce fear and mental health stigma.     

Self-Stigma Experiences Among Older Adults with Mental Health Problems Residing in Long-Term Care Facilities: A Qualitative Study

ABSTRACT

Self-stigma is linked with a variety of deleterious consequences for the stigmatised individual. Much of the past research on self-stigma focuses on younger adults; however, little is known about the self-stigma experience among institutionalised older adults with mental health problems. This study aims to explore experiences of self-stigma among older adults with mental health problems in long-term care facilities. Ten semi-structured interviews were conducted. Insight into mental illness was identified as having a key influence upon the self-stigma experiences among this group. Participants shared common understandings, views, and behavioural reactions towards mental health problems. Lacking control, public stigma, sympathy, disinterest, avoidance, and fear were key themes among them. Re-conceptualising self-stigma theories and implementing interventions that aim at reducing stigmatising attitudes among this group are essential.     

Creating supportive environments for mental health promotion in the workplace

Work is both an important resource for mental health, yet it also presents risk factors for mental illness. Consequently, the workplace has been identified as a potential setting for both mental health promotion and mental illness prevention. In the workplace various programs have been implemented which address risk factors for mental illness eg. stress management programs or the introduction of anti-bullying policies. However, few programs have been developed to address mental health promotion. It seems that the potential of mental health promotion is not fully utilised in this setting, nor are programs and initiatives to promote mental health as prolific as those in the physical health area. Furthermore, despite the introduction of legislation and workplace policies, structural changes have been unsuccessful in bringing about environmental modification which fosters mental well-being. This article explores explanations for this and makes recommendations utilising primary health care as an approach by which this situation can be redressed.     

Children of parents with mental illness. I: An overview from a nursing perspective

This paper explores the psychosocial consequences of parental mental illness for child mental health and the implications for mental health nursing. The literature on risk and vulnerability to psychosocial disorder, resilience, child protection, disorder prevention and epidemiological data are reviewed. Based upon a health promotion approach, a model for mental health nursing advocacy for families of adult consumers is proposed as an effective means of preventing disorder in subsequent generations.     

Teaching children about mental health and illness: a school nurse health education program.

A mental health education program designed by school nurses for children ages 10- 12 was developed in 2000-2001 and expanded with broader distribution in 2004-2005. Six classroom sessions, each 45 minutes in length, provided information and activities to increase children's awareness of mental health and illness. Education program content included facts about the brain's connection to mental health, information about healthy ways to manage stress, resources and activities to promote mental health, common mental health problems experienced by children, and how to seek help for mental health problems. Classes included a combination of didactic presentation and open discussion, encouraging students to ask questions and allowing the school nurse to correct misinformation. Analysis of pre- and posttests from 370 elementary and middle school students revealed statistically significant improvements in their knowledge of mental health and mental illness.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.     

A controlled trial of a needs‐based,nurse‐led psychoeducation programme for Chinese patients with first‐onset mental disorders: 6 month follow up

The study reported herein a randomized controlled trial was conducted to test the effectiveness of a nurse‐led, needs‐based psycho‐education program for Chinese patients with first‐onset mental illness over a 6‐month follow‐up. Ninety‐six families of Chinese patients with schizophrenia newly referred to one outpatient clinic in Hong Kong were randomly assigned to a nurse‐led psycho‐education program or usual outpatient care, each comprising 48 subjects. The patients’ mental health, illness insight, self‐efficacy, services utilization, and hospitalization rates were measured at recruitment and at one week and six months post‐intervention. The patients in the psycho‐education program reported significantly greater improvements in mental health, insights into treatment and illness, and hospitalization rates over the 6‐month follow‐up, when compared with those who received usual care. The findings provide evidence that the needs‐based, nurse‐led psycho‐education program can improve the health conditions and treatment insights of Chinese out‐patients with first‐onset mental illness.     

Assessing falls risk in older adult mental health patients: A Western Australian review

Falls are a common and costly complication of hospitalization, particularly in older adult populations. This paper presents the results of a review of 139 falls at two older adult mental health services in Western Australia, Australia, over a 12‐month period. Data were collected from the hospital incident report management system and from case file reviews of patients who sustained a fall during hospitalization. The results demonstrated that the use of different risk assessment and falls management tools led to variations in practice, policies, and management strategies. The review identified mental health‐specific falls risk factors that place older people with a mental illness at risk when admitted to the acute mental health setting. With the expansion of community mental health care, many older people with a mental illness are now cared for in a variety of health‐care settings. In assessing falls risk and implementing falls‐prevention strategies, it is important for clinicians to recognize this group as an ambulant population with a fluctuating course of illness. They have related risks that require specialized falls assessment and management.     

Can Completing a Mental Health Nursing Course Change Students' Attitudes?

Nursing program graduates rarely choose mental health nursing as a career. A quasi-experimental study was conducted to examine attitudes of 310 nursing students towards persons with mental illness. Students completed surveys on the first and last days of their program's psychiatric mental health nursing course. The pre- and post-test survey analysis indicated that students improved their attitude, knowledge and preparedness to care for persons with mental illness. However, students maintained little interest in working as a mental health nurse. Modifications in mental health nursing courses could be made to improve students' interest in choosing a career in mental health nursing.     

To your health: implementation of a wellness program for treatment staff and persons with mental illness

Persons with mental illness often have poor access to both health promotion and primary care services. Consequently, they are at greater risk for earlier mortality, and comorbid health problems that ultimately impact their community rehabilitation. The "To Your Health" program is a health promotion program, based on the states of change model that was implemented as part of a clubhouse rehabilitation program. The program used personal wellness profiles, health assessments, and personal goal setting to assess the relative wellness of clients and staff in order to increase their awareness of health-promoting behaviors. Additionally opportunities were provided to engage individuals in making changes through participation in activities that provided opportunities to try out new behaviors and to set goals that integrated changes into their lives. The initial findings are reported along with the rationale for the involvement of clients and staff, and the role of health promotion in community rehabilitation of persons with mental illness.     

Ethics and care: an ethnographic study of psychiatric community health nursing practice

The purpose of this ethnographic study was to explore, describe, and document the practice of a group of psychiatric community health nurses (CHNs), and to provide a forum through which their voices could be heard. Discovery of the nature of issues CHNs experience in an effort to meet the needs of patients with mental illness was the focus. The paper describes the ethical conflict experienced by many of these nurses who wanted to provide beneficial, high-quality care to patients with mental illness but encountered obstacles in practice. Insight into the difficulties nurses experience in applying an ethic of care in the context of administrative constraints, resulting from the strict regulatory mechanisms imposed by third party insurance payers is provided. The negative impact of increasingly stricter payment restrictions on nursing practice and on quality of care is exposed.     

The Role of the Psychiatric/Mental Health Nurse Clinical Specialist in an Adolescent Coping Skills Group

The psychiatric/mental health nurse clinical specialist is a professional who brings unique skills to the area of mental health prevention. Adolescents are an at-risk population in need of preventive mental health services. This article describes the unique features of a nurse-led adolescent prevention program. A specific Adolescent Coping Skills Group format, which uses the skills of the master's prepared psychiatric nurse, is presented.     

Perceptions of Barriers and Benefits to Physical Activity Among Outpatients in Psychiatric Rehabilitation

PURPOSE: To explore perceived barriers and benefits to physical activity in people with serious and persistent mental illness (SPMI) who were enrolled in community-based psychiatric rehabilitation. DESIGN AND METHODS: Four focus groups, two for men and two for women, were held with a total of 34 outpatients from two program sites. The investigators used a semistructured interview guide to facilitate the discussions. Audiotapes of the discussions were transcribed and analyzed for concepts and themes. FINDINGS: Significant barriers to physical activity were: mental illness symptoms, medications, weight gain from medications, fear of discrimination, and safety concerns. Being in a psychiatric rehabilitation program offered comfort and belonging, but it also had the effect of leaving activity initiation up to the program staff, which some participants perceived was part of required program compliance. However, participants viewed physical activity positively, and they linked being active to improved mental health. CONCLUSIONS: Outpatients in psychiatric rehabilitation valued physical activity, but mental illness symptoms, medication sedation, weight gain, fear of unsafe conditions, fear of discrimination, and interpretations of program compliance were barriers. Confronting how attitudes and barriers specific to this population can affect activity and reframing program compliance to include the independent initiation of activity as part of improving health might help clients of mental health services to become more active.     

Evaluating the clinical efficacy of a primary care-focused, nurse-led, consultation liaison model for perinatal mental health

In Australia, perinatal mental illness is common, although poorly identified and treated. Improved perinatal mental health depends on service provision models that reflect a focus on promotion, prevention, and early intervention, while facilitating improved referral pathways between primary health and specialist mental health services. In 2008, a contemporary community-based model of mental health service provision was developed as an alternative to the pre-existing hospital-based service model. The model is delivered primarily by mental health nurses using a consultation liaison framework. It provides for specialist mental health assessment and brief intervention in collaboration with the general practitioner, who remains the primary health provider. It also aims to raise community awareness and build capacity for the management of perinatal disorders in the primary care sector. Evaluation of the clinical effectiveness of the model, and the improvement in access for primary health providers and women, was conducted at 2 years from its implementation. Clinical effectiveness was evaluated by using comparative data from the Edinburgh Depression Scale and Depression Anxiety and Stress Scale, and the results demonstrated clinical efficacy. Improved attendance rates indicated that women preferred this community-based service model as an alternative to the pre-existing service model.     

Physical health and wellbeing of emerging and young adults with mental illness: an integrative review of international literature

Physical health in people with mental illness is often compromised. Chronic physical conditions and disease risk factors occur at higher rates than in the general population. Although substantial research exists regarding mental-physical comorbidities in middle to older-aged adults and mental illness consequential to childhood physical illness, research addressing physical health in young people/emerging adults of 16-24 years with primary mental illnesses is minimal. Health problems often track from youth to adulthood, indicating a need to better recognize and understand the overall health of young people with mental illness. This paper reports findings from an integrative review of published research investigating physical health of emerging/young adults with mental illness. A total of 18 research papers were systematically analysed. The review found that comorbid mental-physical illness/conditions were evident across a wide age span. Specific physical health problems, including pain, gastrointestinal, and respiratory disorders, were apparent in those 16 years to those in their mid-late 20s, and/or with first episode psychosis. Lifestyle risk factors for cardiometabolic disorders occurred with some frequency and originated prior to adulthood. These findings highlight the need for targeted health screening and illness prevention strategies for emerging/young adults with mental health problems and draws attention to the need for young people to be supported in their health-care behaviours.     

Mental health placements in a general health setting: no substitute for the real thing!

Aim. To determine effectiveness of clinical placements in non‐mental health facilities in producing improvement in attitudes toward people with a mental illness and toward mental health nursing in nursing students. Background. Clinical placements in mental health settings have favourably impacted students’ attitudes and confidence in mental health settings. Placement shortages have created discussion about using non‐mental health settings to gain this experience, as mental illness is common in all health settings. To date, no research findings support or refute the efficacy of non‐mental health settings in influencing confidence and attitudes. Design. A within‐subject design was used. Participants provided self‐report data soon after the beginning and at the conclusion of the mental health component. Methods. A questionnaire was administered to a cohort of undergraduate nursing students (n = 66) to measure attitudes, preparedness for practice and interest in mental health nursing as a career, using a pre‐ and post‐test design. Results. Only 25% of participants completed clinical experience in a mental health facility. Minor improvement in attitudes, confidence and appreciating the nursing role in mental health were identified, but the impact on attitudes was considerably less favourable than when clinical experience was undertaken in a mental health facility. Conclusion. Participants who completed clinical experience in a non‐mental health facility did not demonstrate more favourable views about mental health nursing. Relevance to clinical practice. Clinical placements in mental health are essential preparation for undergraduate students to maximise improvement in attitudes to the care of people diagnosed with a mental illness and to mental health nursing.