After engaging with these elearning materials you should have:

  • An increased understanding of the physical health needs in a person with a mental health problem.
  • An increased understanding of mental health nurses’ role and skills required to improve physical health among people with a mental health problem.
  • Developed an awareness of the attitudes necessary to overcome obstacles to improving physical health among people with a mental health problem.

As all the materials are at master's level, you are expected to have some prior knowledge about physical health and mental health problems. The preceding unit provides information on the impact of mental health problems on physical health. To be better positioned to comprehend and use this e-learning material it is expected that you are aware of current operational procedures in mental health services in your country.

People with significant mental health problems have significantly poorer physical health compared to the general population and their life expectancy is 16–25 years shorter than among the average population. Main reasons for the shorter life expectancy among people with a serious mental illness are:

  • Side effects of antipsychotic medication
  • Inactive lifestyle
  • Poor diet
  • Smoking
  • High alcohol consumption

(Comptom et al., 2006; De Hert, Schreurs, Vancampfort, & Van Winkel, 2009; Ösby et al., 2000)

In Europe there have been large public health benefits during the last 20 years in terms of survival in common diseases such as cardiovascular diseases, obesity and diabetes but individuals with significant mental health problems have not benefitted to the same extent as others and consequently the gaps between population groups have increased (De Hert et al., 2011). Improved access to delivery of physical health care is a major public health issue in order to improve the mordibity and mortality in those with a mental health problem and ultimately improve quality of life (Ösby, 2000).

Individuals with significant mental health problems are not routinely provided with physical health assessment and care (Ösby, 2000), nor are they guided on physical health promotion and illness prevention activities to the same extent as the rest of the population (De Hert et al., 2009). In addition, there has been an increase in the number of prescriptions for psychotropic medication in the past decade which as identified in the previous unit can adversely affect weight gain, blood lipid disorders and diabetes (Gothefors et al., 2010) thereby adversely affecting general quality of life among people with a mental health problem (Verhaeghe et al., 2013). General physical health care is often overlooked for those with a mental health diagnosis, such as schizophrenia or bipolar disorder (Gothefors et al., 2010) and there is evidence that they are also less likely to be offered antihypertensive and lipid-lowering medications when compared to those with no mental health problems (Ösby, 2000). Promisingly however, research has shown that people with significant mental health problems can have very positive physical health outcomes when provided with the right support and training (Blythe & White, 2012).

Mental health nurses are in a prime position to respond to the physical health needs of people with a mental health problem. Nurses, as a major professional group in mental health care, are also critical in re-organizing health care services to better support people with a mental health problem in recovery and wellbeing (Happell et al., 2012). Physical activity has been shown to have positive effects on weight in addition to mental health symptoms such as depression and anxiety among persons diagnosed with schizophrenia (Pelham, et al., 1993; Beebe, et al., 2005; Acil, Dogan & Dogan, 2008). A systematic review by was conducted by Happell, Platania‐Phung, & Scott (2014a) on nurse-led physical health care programmes for clients with a serious mental illness. Although evaluation of the programmes was not yet complete, the review consistently demonstrated that such programmes had health benefits for the participants.

The distribution of types of care was (Happell, Platania‐Phung, & Scott. 2014a):

  • Health education (47 %)
  • Screening and or monitoring (33.3 %)
  • Coordination and management of care (33.3 %)
  • Lifestyle programme delivery (30.5 %)
  • Follow-up actions to screening results (25 %)
  • Registers and data administration (5.5 %)

Nurses’ contributions to improving health care in mental health services are not limited to only one area of care. It is crucial that general health care offered to individuals with a serious mental health problem is equivalent with the health care offered to the general population (De Hert et al., 2009). The role of the mental health nurse is essential in implementing the holistic approach which is needed in the care of clients with a severe mental health problem to provide care that is equivalent with the care offered to the general population (De Hert et al., 2009; Happell, Platania‐Phung, & Scott, 2014)

Mental health nurses need to be able to help motivate people with a mental health problem to attend to their physical health. A useful concept is called motivational interviewing (MI). To see an example of active listening please press here.

  • Reflect on your experiences of how people with a significant mental health problem are supported in relation to their physical health. Take screening and health promoting interventions into account when reflecting on this topic.
  • Is motivational interviewing (MI) and/or active listening related to supporting lifestyle improvement often used in dialogue with persons with a significant mental health problem?
  • Is it your experience that individuals with a significant mental health problem are provided with equivalent health education, screening, monitoring, coordination of care and access to lifestyle programmes to the same extent as the general population?
  • Have you ever felt hesitation in using active listening when counselling people with a significant mental health problem? If so, identify what you were hesitant about.
  • Is there anything in this film you have tried or would like to try in dialogue with a person with an SMI regarding lifestyle changes?

Traditionally mental health nurses have not seen service users' physical health as their main concern. In addition, physical problems are often unrecognised by nurses and have been mistaken for symptoms of the mental illness (Blythe & White, 2013). Mental health nurses need to acknowledge that holistic health promotion is an integral part of their role (Hardy & Thomas, 2012). There is a tradition of stigma and discrimination in society directed at people with mental health problems however all service users need access to appropriate health services (Verhaeghe et al., 2013). Mental health nurses need to make themselves and their knowledge more visible to other caregivers as a resource for support and education regarding general health issues (Blythe & White, 2013).

According to Happell, Platania‐Phung and Scott (2014b) mental health nurses may have to work with service users who lack motivation or energy to focus on healthy lifestyle behaviour as a result of the severity of their mental health problems. Mental health nurses may also be confident in carrying out routine physical health checks but less confident with regard to screening and interpreting physical health results (Happell, Platania‐Phung, & Scott, 2014a)

It has been questioned to what extent lifestyle choices are the responsibility of the patients themselves and the mental health nurse (Happell et al. 2012). Accordingly mental health nurses may hold a traditional view on the nurse/doctor power relationship whereby nurses are viewed as being subordinate to doctors resulting in nurses not taking full responsibility for their patients’ physical health (Happell, Platania‐Phung, & Scott, 2014a). According to Blythe and White (2013) mental health nurses can also experience a conflict between the patients’ process of defining their health-related needs and desires and the standards of treatment policies.

Mental health nurses commonly report lack of time as an impediment to implementing physical health interventions. In addition however they also report lacking the knowledge and skills to effectively support physical health care among mental health service users (Hardy & Thomas, 2012). Stigmatising views and attitudes in society have also been described as a possible barrier when trying to integrate individuals with a significant mental health problem into sport clubs or other leisure organizations and activities in society which might have a positive impact on mental health.

Having mental health nurses equipped with the knowledge and skills to effectively promote physical health among service users is essential for holistic health promotion. The following knowledge and skills are required:

  • Accomplishment of screening and monitoring of signs of physical health issues as well as follow-up actions to the screening results
  • Development and implementation as well as carrying out of health education and lifestyle programmes among people with a mental health problem and their families and caregivers
  • Coordination and cooperation between care organizations as well as management of care to promote and maintain overall health from a holistic perspective in mental health services
  • Understand the potential of motivational interviewing to inspire hope and help motivate people with a mental health problem to prioritise their physical health

Master's-level mental health nurses are required to have knowledge across organizational boundaries to support holistic health among persons with a significant mental health problem. The knowledge is shaped and developed through a wide range of activities. The following are some critical questions with relevance to mental health nurses at master´s level:

  • What kind of knowledge, skills and attitudes are necessary to support physical health among people with mental health problems?
  • In what way could organizational development support and improve use of these competences among mental health nurses?
  • In what manner could mental health nurses’ competences be useful across organizational boundaries to reduce negative views and attitudes in society towards individuals with a mental health problem?

Acil, A.A., Dogan, S. & Dogan, O. (2008). The effects of physical exercises to mental state and quality of life in patients with schizophrenia. Journal of psychiatric and mental health nursing, 15, 808-815.

Beebe, L.H., Tian L., Morris, N., Goodwin, A., Allen, S.S. & Kuldau, J. (2005). Effects of exercise on mental and physical health parameters of persons with schizophrenia. Issues in Mental Health Nursing, 26, 661-676.

Blythe, J. & White, J. (2013). Role of the mental health nurse towards physical health care in serious mental illness: An Integrative Review of 10 years of UK Literature. International Journal of Mental Health Nursing, 21(3), 193-201.

Comptom M, Daumit G.L. & Druss B.G.(2006). Cigarette smoking and overweight/obesity among individuals with serious mental illness. A preventive perspective. Harvard Review of Psychiatry, 14: 212-222.

De Hert M., Schreurs V., Vancampfort D., & Van Winkel R. (2009). Metabolic syndrome in people with schizophrenia: a review. World Psychiatry, 8, 15-22.

Gothefors D., Adolfsson R., Attvall S., Erlinge D., Jarbin, H., Lindström, K. et al. (2010). Swedish clinical guidelines - Prevention and management of metabolic risk in patients with severe psychiatric disorders. Nordic Journal of Psychiatry, 00:1-9.

Happell, B. Platania‐Phung, C., & Scott, D. (2014a). Proposed nurse‐led initiatives in improving physical health of people with serious mental illness: a survey of nurses in mental health. Journal of Clinical Nursing, 23(7-8), 1018 – 1029.

Happell, B., Platania‐Phung, C., & Scott, D. (2014b). A systematic review of nurse physical healthcare for consumers utilizing mental health services. Journal of Psychiatric and Mental Health Nursing, 21 (1), 11 – 22.

Happell, B., Scott, D., Platania-Phung, C. & Nankivell, J. (2012). Should we or shouldn’t we? Mental health nurses’ views on physical health care of mental health consumers. International Journal of Mental Health Nursing, 21 (3), 202-210.

Hardy, S., & Thomas, B. (2012). Mental and physical health comorbidity: Political imperatives and practice implications. International Journal of Mental Health Nursing, 21(3), 289 – 298.

Verhaeghe, N., De Maeseneer, J., Maes, L., Van Heeringen, C., & Annemans, L. (2013). Health promotion in mental health care: perceptions from patients and mental health nurses. Journal of clinical nursing, 22(11-12), 1569 – 1578.

Ösby U., Correia N., Brandt L., Ekbom A. & Sparén P. (2000). Time trends in schizophrenia mortality in Stockholm County. BMJ, 321:19-26.

The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.