Nursing needs its leaders to respond to Francis
Share
Do people with mental health problems miss out on essential care?
A study by researchers from John Hopkins University has found that people with conditions like schizophrenia and bipolar disorder were 2.6 times more likely to develop cancer than the rest of the population. They raised questions about whether people with serious mental illness were getting appropriate screening and preventive care related to cancer risks, such as advice on stopping smoking.
This is backed by a recent review published in Nursing Times which examined the issue of discrimination against people with mental health problems. The author found that service users encountered discrimination when accessing services such as GPs. They reported professionals as being dismissive or assuming that physical presentations were “all in the mind”. This is especially significant, as evidence suggests people with mental illness are at greater risk from physical health problems, including cardiovascular disease, diabetes, obesity and respiratory disease; they also have a higher risk of premature death.
Have your say
You must sign in to make a comment.
From Behind the Rituals
Why do you do the things you do? How much of nursing practice is based on ritual and myth and how much on sound evidence? If you have a ritual you’d like to discuss here, email nursingtimescomments@emap.com
Readers' comments (18)
Anonymous | 3-Sep-2012 8:49 am
the problem is they could get the right screening but majority does not attend appoinments for this,
Unsuitable or offensive?
Anonymous | 3-Sep-2012 10:15 am
"The author found that service users encountered discrimination when accessing services such as GPs. They reported professionals as being dismissive or assuming that physical presentations were “all in the mind”. "
no excuses for discrimination - poor attitudes and/or lack of adequate training!
Unsuitable or offensive?
Anonymous | 3-Sep-2012 10:44 am
Yes I do believe that people with mental health illnesses miss out, partly due to discrimination by others and health workers. There is also the issue of smoking being allowed in mental health units.
They are very vulnerable, as are the homeless, drug users, alcohol users, street workers - all people who society likes to pretend don't exist but who make up a very large group of people.
Having worked in a community drop-in health centre I have seen how well people can be treated and respected, in hospitals I have encountered a lot of prejudice from staff which is very unkind and unneccessary.
There is an increase in unemployment and all the problems that brings with it and we should all remember that mental health problems, alcoholism, drug addiction, homelessness could happen to any one of us.
Unsuitable or offensive?
Anonymous | 3-Sep-2012 11:25 am
Anonymous | 3-Sep-2012 10:44 am
excellent post. somehow the message has to be spread. there is no place for healthcare professionals who discriminate against those with MH disorders. if they do they should be sent off for further training and their problems dealt with.
"There is an increase in unemployment and all the problems that brings with it and we should all remember that mental health problems, alcoholism, drug addiction, homelessness could happen to any one of us."
it is sad how much we take for granted in life and consider our rights - until some of these are lost or we are confronted by others who have to go without.
Unsuitable or offensive?
Anonymous | 3-Sep-2012 6:04 pm
The time has come for everyone to show respect to those who have fallen on hard times.
Nurses are supposed to care for others without discrimination.
Unsuitable or offensive?
Anonymous | 3-Sep-2012 6:07 pm
Anonymous | 3-Sep-2012 6:04 pm
would be good if they could extend this to each other and to their other interdisciplinary colleagues as well.
Unsuitable or offensive?
Anonymous | 3-Sep-2012 6:17 pm
Yes.
As someone who's seen from both RN & service user side, stigma, fear & lack of understanding are rife & hinder people with MH issues accessing appropriate care. Some of the problems are due to financial issues/service cuts that are affecting all areas (but UK Govt report highlighted low levels of commissioning of MH services), but the vast majority feel like they aren't. (Admittedly because my MH issues worsened when an RGN saw my equal ops form & shared the info around, justifying by stating 'anyone who ticks chronic MH box is a risk to other people'. As a result I admit I have developed stronger opinions about the issues people face)
I believe there would be a role for a MH liaison nurse/team within 'physical care' environments, not just to do psych assessments, but on similar model to Learning Disability nurses. I've seen problems caused by e.g. sudden withdrawal of MH meds when someone is nil by mouth for surgery & withdrawal side effects being attributed to pain/drug reaction & thus person left with neither MH condition nor withdrawal treated. I've regularly seen psych meds changed to one in the same group due to lack of availability of prescribed meds in acute hospital without apparent understanding of the differences/impact on service user. Whereas, when it's e.g. a long-acting BP med, it is drummed into staff improtance of finding out exactly which make used (even when generic drug content the same)
Similarly, I know an insulin-dependant diabetic threatened with sectioning when a voluntary MH inpatient for refusing to take prescribed fixed dose of insulin when his usual regime was dose-adjustment to food intake & he knew prescribed dose would cause him a hypoglycaemic attack. Access for the MH team to an equivalent 'physical health liaison team' could have mediated the issue.
Personally, when complaining of exhaustion/shortness of breath, was told by MH team that it was in the mind, motivation & lack of fitness & to go to the gym more (I was doing sport 3 times a week already). It transpired I had an Hb=8 so following their advice had been exacerbating the problem.
In my area, the community dietitians will not see MH patients as 'outside their competence', but the MH dietitian is only for psych hospital inpatients or those with eating disorders. So where does that leave the majority of MH patients who are managed in the community & as per article can be at increased risk of diabetes/heart disease/obesity?
It would be unreasonable to expect all RMNs to have indepth knowledge of all physical health conditions & their up-to-date treatment, or for all RGNs to have in-depth knowledge of MH conditions & their treatment. But....that's why there's bit in Code of Conduct about referring to others if outside your sphere of knowledge/competence. However, a basic awareness of conditions should not be unreasonable.
However, the majority of what I've seen in acute care sector is stigma/labelling of those with mental health problems. Compassion/empathy & communication/listening should not be beyond _any_ registered nurse. That means realising someone's pain issues are not 'all in the mind' because they have a long-term MH condition too, that disruption to their usual routine/coping mechanisms may have a larger impact than you'd expect for someone without an underlying condition (& yes, that may include the odd cigarette) & someone with a MH condition may need more explanations/time to be listened to, that impact of an apparently minor physical problem may be bigger because of level of coping (e.g. the sprained ankle that leaves them isolated in their house, unable to do the exercise that keeps them stable etc)...... It does not mean dismissing their issues, talking about them (including in handover/on breaks) as the 'mad' or 'bonkers' person who's 'a problem'.
Unsuitable or offensive?
Anonymous | 4-Sep-2012 10:42 am
There should be at least one psych liason nurse in each hospital and 24/7 access to a psychiatrist. Every nurse that works in the NHS knows how difficult it is to get a psych referral done and for a patient to be seen.
Psychiatry, learning disabilities, substance misuse, homelessness are all specialities and with the cuts in jobs these poor people are getting a sub-standard service.
Unsuitable or offensive?
Anonymous | 4-Sep-2012 10:54 am
I don't know what it is with people in Britain who seem to treat others in what they consider 'out groups' differently from how they would be expected to be treated themselves and especially among the so-called 'caring' professions. it seems to be an Anglo-Saxon trait not experience in other parts of Europe.
what ever happened to respect and professionalism which should be applied even if people have no experience of a particular area. it is their duty to make sure their patients or anybody who consults them are seen by those who have the expertise needed. it is not their job to pass judgement on them and their needs.
Unsuitable or offensive?
Harold Maio | 4-Sep-2012 1:26 pm
Do people with mental health problems miss out on essential care?
Some do, the statement is overbroad.
For those who do, is professional discrimination a factor? Likely. Whatever prejudices a society holds are held by/practiced by many of its members.
Missing from this article is what specific people miss out. Without that piece of information, solutions are not possible.
Missing from this article are what specific people do not miss out. Without that piece of information, solutions are not possible.
I have not missed out, fully covered by insurance, my health care needs are fully met.
A study by researchers from John Hopkins University has found that people with conditions like schizophrenia and bipolar disorder were 2.6 times more likely to develop cancer than the rest of the population
This narrows down the opening statement, but still does not identify what specific people. Nor who specifically fails them. Without specifics, address is not possible.
Harold A. Maio, retired mental health editor
Unsuitable or offensive?
Anonymous | 4-Sep-2012 5:44 pm
it all boils down to neglect it is for the health minister to put it in context on paper in parlement for all specific people effectedit is a matter of life and death and nobody cares
Unsuitable or offensive?
Anonymous | 5-Sep-2012 9:31 am
1 in 4 general patients suffer from some form of mental illness so there are an awful lot of patients not receiving the care they should.
we focus a lot on care for the elderly at the expense of others groups of society which is unfair, everyone is entitled to respect, dignity, food, fluids, etc. etc.
with a right wing govt now in place I suspect that many will suffer.
Unsuitable or offensive?
Anonymous | 6-Sep-2012 3:56 pm
'Anonymous | 3-Sep-2012 6:04 pm
The time has come for everyone to show respect to those who have fallen on hard times.'
That doesn't seem to be the current goverment's approach to anything - it seems to believe in 'treat yourself, and if you can't do that, then hard luck and good riddance' so far as I can see. It says 'We want good NHS treatment for everyone' but that doesn't seem to square with what it actually does.
Unsuitable or offensive?
Anonymous | 7-Sep-2012 8:26 am
this govt don't like anyone except the far right daily fail readers. they will cut benefits (except pensions) and 'encourage people to go back to work' even though there is no work available, depression is increasing and many feel totally hopeless.
don't worry though you can build an extension on your house now, that will solve all the countries problems, perhaps those rich enough to build an extension will take in a homeless person, no didn't think so somehow
Unsuitable or offensive?
tinkerbell | 7-Sep-2012 12:07 pm
the many empty homes in UK could also be used. There's enough room for everyone to probably have a home in the UK if these were utilised.
Unsuitable or offensive?
Anonymous | 9-Sep-2012 11:10 am
Harold Maio | 4-Sep-2012 1:26 pm
Well written and measured post, Harold. The most insightful and sensible comment made here on the subject.
Unsuitable or offensive?
Anonymous | 9-Sep-2012 6:42 pm
anon 11.10 - what are your thoughts on this subject?
Unsuitable or offensive?
Anonymous | 9-Sep-2012 10:23 pm
Anonymous | 9-Sep-2012 6:42 pm
from
Anonymous | 9-Sep-2012 11:10 am
What's your problem?
Unsuitable or offensive?