Physical health care in mental health care

Chat details

This chat will be held on the 13th of March 8-9pm.

We will be using our regular hashtag- #wemhns and a transcript of the chat will be available afterward.

Make sure you use #ebp for evidence based practice tweets with links to projects or articles.

As with all our chats, everyone is welcome to join the conversation. Whether you are a Mental Health Nurse, other Health Care Professional, Academic, Service User, Carer or Citizen with an interest in the subject, we would like to hear your thoughts!

Background

Case study one: Irene is a 62-year-old woman who attended her local GP surgery after having chest palpitations. She works full time, not wanting to retire just yet. She had been unable to go to work due to the palpitations. During this appointment Irene is prescribed an antidepressant and advised she had been experiencing panic attacks. She has experienced depression and anxiety most of her life and has been on antidepressants before. After a number of months off and no improvement she again attends her GP. She is put on a 24-hour heart monitor which identifies she has extremely high blood pressure which requires treatment and a few lifestyle changes. Irene’s palpitations soon reduce and she is able to return to work, she wishes she had the physical health investigations first, instead of her mental health problems being identified as the cause of the palpitations.

Case study two: Christopher is 53 years old. He was diagnosed with a schizophrenic type illness when he was in his early twenties. He was dabbling with Class A drugs at the time and it is thought that this brought on a psychotic illness, though he's got a family history of psychosis too. As he is getting older, periods of wellness have become more infrequent and he has been plagued by voices for as long as he can remember. The voices are often persecutory in nature and cause him much distress. He has tried numerous types of antipsychotic medication over the years as well as other less conventional treatments. He is currently on Clozapine which he says has kept him more well than anything he's tried before and for the first time in a long time, he says he feels happy with life. However, he still drinks alcohol excessively as he finds it helps with the voices and other troubling thoughts which though quieter are still there. He also tends to neglect himself, because he struggles with a lack of motivation and energy, preferring to stay in bed some days. It's better than it used to be, but he still finds looking after himself a struggle. He's had most of his teeth removed because of decay and he doesn't have any interest in his appearance. He was diagnosed with type 2 diabetes a few years ago but doesn't really pay much attention to this, other than that he knows that he gets really thirsty and has to get up a lot through the night to go to the toilet, which he finds annoying. He lives in supported accommodation and most of the other residents are much older. He says this suits him as it's peaceful and so he keeps himself to himself except for meal times which he spends with the other residents. Last week , he collapsed while out at the local shop. He was rushed into hospital and it transpired that he had had a massive heart attack.

Evidence: High quality physical health care is vitally important for service users with mental health problems. The National Institute for Health and Clinical Excellence (NICE) recommends annual physical health checks for people with mental health problems. Evidence shows that people with mental health problems die up to twenty years younger than the population without. Preventable cardiovascular disease is the major cause of death, along with endocrine disease and respiratory failure. Evidence also suggests that people with mental health problems receive a lesser standard of health promotion and physical health care and despite national awareness and guidelines early mortality rates have not improved (taken from- Yorkshire and Humber Academic Health Science Network).

Questions

1) Is physical health care important in mental health care? Why?

2) How have you seen/ experienced physical health care being addressed?

3) Who do you think should be responsible/ best placed to look after physical health care?

4) What role do you think antipsychotics play in physical health problems?

5) What do you think about diagnostic overshadowing- missing/ misdiagnosing physical health problems as mental health problems?

6) What do you think professionals can do to ensure physical health care is addressed?

7) What can be done to improve physical health care in mental health services?

8) Have you seen/ experienced good practice/ projects to support good physical health care?

9) Are there any other important questions?

Useful articles and links

Dale, K. (2015). Achieving parity of esteem. Retrieved from http://www.independentnurse.co.uk/professional-article/achieving-parity-of-esteem/88575/

Department of Health (DOH). (2006b) Choosing health: supporting the physical health needs of people with severe mental illness. commissioning framework.

Naylor, C, Das, P, Ross, S, Honeyman, M, Thompson, J. and Gilburt, H. (2016) Bringing together physical and mental health: a new frontier for integrated care. London: The Kings Fund.

NHS England- Improving the physical health of patients with serious mental illness – a practical toolkit

Royal College of Psychiatrists (RCPsych).(2013b). Whole-person care: from rhetoric to reality. Achieving parity betweenmental and physical health.

RoyalCollege of Psychiatrists (RCPsych). (2013b). Whole-person care: fromrhetoric to reality. Achieving parity between mental and physical health.Occasional paper OP88. Available at: www.rcpsych.ac.uk/usefulresources/publications/collegereports/op/op88.aspx

The Kings Fund. (2016). Bringing together physical and mental health – a new frontier for integrated health.

Tosh G, Clifton A, Mala S, Bachner M. (2010) Physical health care monitoring for people with serious mental illness. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD008298. DOI: 10.1002/14651858.CD008298.pub2.

Tosh G, Clifton A.V, Xia J, White M.M. (2014) General physical health advice for people with serious mental illness. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD008567. DOI: 10.1002/14651858.CD008567.pub3.

Yeomans, D., Dale, K., & Beedle, K. (2014). Systematic computerised cardiovascular health screening for people with severe mental illness. Psychiatric Bulletin, 38(6), 280-284.

Mind Set resources

http://mindsetqi.net/index/

http://mindsetqi.net/physical-health/case-for-change/national-policy/

http://mindsetqi.net/physical-health/case-studies/physical-health-monitoring/

http://mindsetqi.net/physical-health/case-studies/

Helpful video- https://vimeo.com/112911582

Projects

Improving the Physical Health of those with Serious Mental Illness Project- Yorkshire and Humber Academic Health Science Network

IMPARTS run by Kings College Partners – see @IMPARTSP - this project looks at mental health for those with physical health problems

Thanks

A number of people have been involved in developing this #wemhns chat; Kate Dale @katedalesmi, Val Rhodes, Alexa Drake, Jeni Deighton @jenniferdeight3, Jayne Firestone @amisja and the @wemhnurses team.