Working on a physical health placement, mental health student nurse Emma was soon confronted with the disparity between mental and physical health services, the lack of mental health services and the difference in attitudes of mental and physical health nurses.
As World Mental Health day passed again on 10th October, it acted as another acknowledgement that mental health isn’t quite treated on par with physical health. But what can I do as a student? I will explore this in my article with my experience over the past 18 months on placement.
I was invited to The Future MHN Conference in Huddersfield this year, and the main focus of the event was looking at discrimination towards mental health and inequality. It is widely known within the mental health community that people with severe mental illness have a life expectancy of 10-17 years lower than average. This is due to a very complicated combination of medication, life style choices and lack of support in both the social and psychological spheres of life for those with severe mental health conditions, such as schizophrenia. In 2011, mental health service users over the age of 19 were over three times more likely to die than physical health service users; I was shocked by this figure when it was presented to me in Huddersfield last month. But this figure also highlights the disparity between both the services.
Over the past 18 months, I have been pursuing a four-week ‘general/insight placement’ on a ward that specialises mainly in gastroenterology. I aimed to learn physical skills in relation to this specific area and refine my skills, such as wound management, medicines and injection techniques amongst others. However, I have learnt so much more than what I could have learnt in an ordinary class room setting. As I was a mental health student nurse, it was immediately assumed that I did not know how to implement a number of tasks, like taking blood pressure. Some were surprised that I had chosen this specialty and some truly didn’t understand my role as a nurse in this placement or what useful information and knowledge I was hoping to gain. I was in fact directed to spend some outreach time on a psychiatric ward that was on site; I politely declined. My objectives on my outreach placement were to learn about physical health and be able to take that back with me to mental health wards as a mental health nurse. As time went by I observed the differences between treatments, processes, the running of the ward and attitudes/behaviours.
My biggest observation was that some of the staff feared patients who appeared to have a psychiatric condition compared with someone who was bedbound. The comparison being that the bedbound patient had something that could be seen, diagnosed, treated and explained. However, the patient who might have a psychiatric condition alongside his or her physical symptoms, was seen to be more of a challenge due to unforeseen problems which they couldn’t physically treat. Where it was the opposite, ‘easy patients’ were unconsciously preferred.
Looking back at my placement on the medical ward I would, of course, highly rate the quality of care provided. However, in terms of specialist support for patients who had a comorbid mental health problem, perhaps there is still scope for improvement. Within the mental health community, there are a number of patients that have type 2 diabetes, which is becoming increasingly common due to a range of reasons, including specific types of medications. Mental health nurses are aware of how to manage diabetes through training, but with the rising occurrence of diabetes, especially within our patient population, advanced training would be beneficial. I had a patient who had very poorly managed type 1 diabetes. A local specialist saw him, however he came away confused from the appointment. Perhaps a specialist who is also trained in mental health could have assisted my patient and aided him to understand and manage his diabetes more effectively.
To conclude, for the treatment of physical health we have developed screening programmes and immunisations. But mental health services for physical health patients have not improved since the 1950s. We need to be more inclusive in all our practices within communities, ensuring that we don’t work in isolation and instead communicate with other practices, so that we can contribute uniquely to service users’ lives. As students, we have the luxury of engaging more with service users and so we should incorporate the lessons learnt into our learning and training. ‘When mental health nurses change, everything changes.’ Therefore, as mental health nurses, it is time for us to promote good mental health in communities, develop more trials, bridge the gap between physical and mental health and help with the prevention of mental health conditions.
Emma Pott is a current mental health student nurse at Kingston and St Georges (University of London)