After engaging with these elearning materials you should have:
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:
(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):
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.
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:
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:
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