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Call for mental health nurses to recognise patients' poor physical health


Poor physical health is common among people with serious mental illness in the UK, recent research has revealed.

High levels of diabetes, heart disease and obesity were uncovered among 782 patients who had conditions such as bipolar disorder and schizophrenia.

This explains why their life expectancy is significantly reduced, according to the researchers from the University of East Anglia.

Past studies have suggested that the life expectancy of those with severe mental illness can be up to 25 years shorter than that of the general population.

The most recent work, published in BMC Psychiatry, offers more evidence that physical health rather than mental health issues, such as suicide, are primarily responsible.

Researchers discovered that inactivity, smoking, excessive alcohol consumption and poor diet were often the norm.

Lead researcher Professor Richard Gray, of UEA’s School of Nursing and Midwifery, said: “Mental health nurses do a tough job and are compassionate and highly committed.

“But they do not tend to be skilled at managing the physical health of their patients.”

Professor Gray said: “Since mental health workers tend to have sustained one-to-one relationships with their patients over many years, those who smoke, have a poor diet and fail to take regular exercise are having a negative influence on the lives of already vulnerable people.

“We urgently need to train our mental health workers to lead by example and intervene if their patients’ physical health is deteriorating.

Chief executive and general secretary of the Royal College of Nursing Dr Peter Carter said: “Mental health nurses will recognise that too often, patients can suffer twice over because of a combination of poor mental and physical health.

“There are some complex reasons behind this, such as the side effects of prescription drugs, lifestyle limitations and social and economic problems.

“However, we also know that there are some excellent nurse led initiatives which can really make a difference to people.”

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Readers' comments (14)

  • This is where the EU directives fail. Adult branch nurses are expected to have experience of other branches of nursing but MH, LD and child don't.
    Either the EU Directives should change and take this on board or we need to get back to a generic training to ensure all nurses have skills in all aspects!

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  • how about the psychiatrist whose patient enquired about the contraindications of an antidepressant he suggested prescribing. he must have been too busy looking at the computer screen as he asked her if she had a history of prostate problems! true story which doesn't inspire too much confidence in therapeutic relationships.

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  • H'mm another dig at lifestyles of both patients and staff- suggesting that because the CMHT might smoke or is overweight than this would encourage the patients to be. Sounds terribly niave and a little bit fascistic to me.

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  • It was only a decade or so ago that RMN students had to undertake a three month acute adult nursing placement in order to complete their formal basic education - I'm not surprised that 'mental health nurses fail to recognise poor physical health.'

    Undergrad nurse education has become over specialised - resulting in care deficits. How many general nurses fail to identify potentially important mental health concerns in their patient group? The same can be said for adult general nurses no longer having placements in paediatrics.

    Mike Paynter

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  • it always used to baffle us on a general medical ward as to why patients were transferred to us as soon as they had the hint of a medical problem and then we had to nurse their, somethimes complex, mh problems as well with only the support of a psychiatrist for perhaps one or two consultations. it seems that we were better as generalists at coping with mh problems than mh nurses are with medical problems. we even had one depressed patient who was bed bound transferred to us for care of a pressure sore.

    we used to have at least three months psych. in our training and had some rudimentary knowledge which we managed to develop on our ward due to the experience we gained with quite a wide range of psychopathologies. we were also good at detecting problems in our medical patients and referring them for consultation to the appropriate services or, with our medical team, treating them ourselves until their medical condition had stabilised and they could move on in the knowledge that if they also had a medical condiiton there was no chance of transferring them to a psychiatric unit.

    actually i enjoyed the challenge and all the knowledge and insight gained from the experience. our only problem was often lack of the time this group of patients usually needed, on a busy acute medical ward.

    I think my training in the late 1970s was very broad and prepared me to undertake most of the challenges we were confronted with on an acute and chronic medical ward of an international university hospital and we also learned on the job.

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  • has alaways been curious to me how we separate the brain from the body (below neck in MH) and vice versa

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  • why does everyone feel the need to make themselves out to be whiter than white.

    i'm a realist and with greatest of respect you see as many adult nurses who smoke and are very overweight as any other.

    to be fair with some of the most terrible things that are happening in peoples minds with mental illness, not smoking and not eating crappy foods arent really that high on the priorities when people are in acute phases of illness....just the fact that a cigarette might give them 2-3 minutes of relaxation or that the burger they are eating is better than eating nothing.

    and lets not be PC some people with mental illness can be little buggers with no fear of consequence of drug taking, binge drinking, no matter what i do as a nurse until they want to change they wont.

    if only those of you who cast such judgement hoe emotionally draining being an RMN can be you would not critisize...when i was a student nurse i thought i was on a good fiddle working less hard than the adult students, then i found someone who had killed wasnt the sight of a dead body, it was that i knew that person and it hurt they didnt tell me they felt like that, i racked my brains and ultimatley you cant stop fate and that is painfull.....when soemone you have known for years suddenly becomes unwell and destroys their dont know what it is to "deal" with mental health as the relationships are over much longer and much deeper, mental health comes out of the equation and you remember people by people...what you "deal" with is the obvious symptoms of mental health you see at that time.
    I get really annoyed with stuff like this...everything in mental health is geared up for people taking responsibility for themselves which means that bad choices should be respected as well as success stories.
    When i have to sit with mental health patients in general hospitals i very often am underwhelmed with what i see and think id much rather be ill in a mental health unit than a general hospital.

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  • When will the NMC wake up and see that splitting nursing three ways in the initial nurse training. I have always been so frustrated being an RMN where I can only treat anything related to mental health but Physical health even if it contributes to worsening mental health is not accepted? I pursued my interest in the long -term conditions that affect the severe and chronic mentally ill long before it became the buzz word.
    Generic training for all nurses is needed then we can specialise, that is the way forward to stop the mind body split in nurse training. I agree with the general nurses comments, that often even without training they are equally able to nurse someone with MH issues but often don't feel confident thinking it is a specialist skill. It should be in everyone's training.

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  • Training in physical assessment is part of nurse training esp. during the first year. As a RMN and as part of the admission process in my Trust, physical health assessment is mandatory and this includes nutrition and physical assessment on each new admission. A referal is made to other professionals if deemed necessary, ie dietician, tissue viability nurse, etc. I therefore do not understand the "palava" of RMNs not been able to do physical assessments adequately. Moreover, it is now a requirement in my Trust to undertake an update training in Physical Examination assessment which is gradually being introduced in all units starting with acute in-patient wards.

    Pls. do not condemn RMNs. We do excellent jobs, putting in extra hours without pay and I'm glad I trained in that speciality. I sometimes wonder how an adult nurse will cope if after nursng a SU for 6 months, you suddently hear he/she has commited suicide. Pls. let us all appreciate each other - we all provide an excellent service irrespective of our fields.

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  • we had three suicides on my medical ward but because they were all medical cases their conditions could not be cared for on the psychiatric wards. we also had other mh cases such as anorexia nervosa, bulemia, schizophrenia, bipolar depresison, depressive disorders, drug addiction, bpd, alcholism and drug dependence and even a substance dependent fire eater and sword swallower who had bronchoaspirated his fuel! some of the cases were young and the doctors did not wish to stigmatise them by sending them to psychiatry, but for us it was quite a challenge and were not able to provide much of the therapy some required, and also had little time to talk to them as we were an acute medical ward with intake from ICU and we did have quite a few medical emergencies.

    In fairness, only one of the patients who committed suicide was under the care of a psychiatrist and we did have prior warning when he prepared a noose with his dressing gown cord in his cupboard but this was not enough to convince the medical staff and consultant psychiatrist that he might have been better in the psychiatric unit. the other two, we had absolutely no warning of their inntention. one was suffering from copd and the other had terminal cancer and they had just had enough. the first one mentioned here jumped out of the window of a seven-room male ward on the 7th floor at 6 am before the day staff came on duty. there was a strange atmosphere on the ward but not a single patient said they had seen anything or expressed any desire to talk about it so we are not sure whether anybody did witness it and we did not wish to cause any upset by mentioning it in case they hadn't and there is the possibility that they had all been asleep at the time and unaware of what had happened.

    Our main concern was for what might have gone on in the minds of these patients and also the hca coming on duty at 7 am was taken straight by the police to identify him as one of our patients on the flat roof below and our very emotive Italian maid who was unfortunate to find the other patient. The former was very stoic about it all and the other far more expressive, but both were reluctant to talk about it, and we did not wish to press the matter as none of us, as generalists, felt at that time that we had enough experience in giving any support needed.

    Although paradoxically, as generalists, our employers expected us to get on with our work no matter what the speciality and we had to prepared to fill in if necessary in any other area of the university hospital which covered most specialities. Good experience but we did have our limits to which management closed a deaf ear. Accept the assignment or you were out on yours! Rather insultingly to our patients, our two medical clinics were known as the dustbin of the hospital - mainly for reason that nurses did not want to work there. I was one of the few there by choice and found my work fascinating because of the infinite variety of people and cases.

    I admire mh nurses, I do not condemn them at all but I am curious as to why we were expected to look after mh patients on a medical ward and they were not able to carry out even basic medical care on an mh ward - and this probably had to do with the medical staff as well. Maybe it depends on the organisation, but I have plenty of evidence of this happening.

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