Improving the physical health assessment of people with serious mental illness

Abstract

Individuals with severe mental illness (SMI) die on average 20 years younger than the general population.
The aim of the review described in this article was to examine relevant literature on the physical health
of those with SMI and identify areas for improvement. Four electronic databases were searched and
areas identified included side effects of psychotropic medications, obesity, cardiovascular diseases
and diabetes, risky sexual behaviour, poor dietary intake and physical inactivity. The authors conclude
that physical care of people with SMI can work well when physical health needs are assessed. Additional
training is required for mental health nurses in physical health care.

Full text

primaryhealthcare.com
28 / December 2016 / volume 26 number 10
evidence & practice / mental health
LITERATURE REVIEW
Improving the physical health assessment
of people with serious mental illness
Bardi J, Moorley CR (2016) Improving the physical health assessment of people with serious mental illness. Primary Health Care. 26,10, 28-33.
Date of submission: 5 April 2016; date of acceptance 3 May 2016. doi: 10.7748/phc.2016.e1149
Abstract
Individuals with severe mental illness (SMI) die on average 20 years younger than the general population.
The aim of the review described in this article was to examine relevant literature on the physical health
of those with SMI and identify areas for improvement. Four electronic databases were searched and
areas identified included side effects of psychotropic medications, obesity, cardiovascular diseases
and diabetes, risky sexual behaviour, poor dietar y intake and physical inactivity. The authors conclude
that physical care of people with SMI can work well when physical health needs are assessed. Additional
training is required for mental health nurses in physical health care.
Keywords
assessment tools, mental health nurses, physical health, mental health nurses, primary care,
psychotropic medications, screening, serious mental illness
THE PHYSICAL health of people with
severe mental illness (SMI) is a global public
health concern (Maj 2009). The term ‘serious
mental illness’ refers to individuals with
specific mental health conditions such as
schizophrenia, schizoaffective disorder and
bipolar disorder who have received care from
primary and secondary mental health services
in the last two years (National Institute for
Health and Care Excellence (NICE) 2006,
Department of Health 2011).
Those with SMI die on average 20 years
before the general population (World
Health Organization (WHO) 2012) due to
lifestyle choices such as poorer diet, low
physical activity (McCreadie et al 2005),
smoking (Robson and Haddad 2012), unsafe
sex (Ratcliffe et al 2011), side effects of
psychotropic medication including obesity,
cardiovascular diseases and diabetes (Healy
2008), poor integrated care pathways between
primary and secondary health care services
(Blythe and White 2012), and lack of physical
health knowledge among registered mental
health nurses (Nash 2010).
People with SMI, particularly those with
schizophrenia, schizoaffective disorder and
bipolar disorder, are vulnerable to poorer
physical health, which results in higher rates
of mortality and morbidity when compared
to the general population (De Hert et al
2011). Norman and Ryrie (2009) reported
that approximately 40% of SMI deaths
Josephine Bardi
PhD student , School of Health
Sciences, University of
Nottingham, Nottingham
Calvin Ray Moorley
PhD senior lecturer, London
South Bank University, Faculty
of Health and Social Care,
London
Correspondence
moorleyc@lsbu.ac.uk
Conflict of interest
None declared
Peer review
This article has been subjec t to
external double-blind review
and has been checked for
plagiarism using automated
software
are from suicide and accidents, while 60%
are due to unequal access to healthcare for
conditions such as cardiovascular diseases,
some cancers, diabetes, chronic lung diseases
such as tuberculosis, respiratory disease
including asthma, musculoskeletal disorders,
gastrointestinal problems, poor diet,
nutritional and vitamin deficiency, blood-borne
diseases such as HIV/AIDS and hepatitis B and
C, sexually transmitted diseases and alcohol
and substance misuse.
A thematic and narrative review was
undertaken of published work on the physical
health of individuals with SMI. The review
aimed to:
»Identify and examine relevant literature on
the physical health of individuals with SMI.
»Identify examples of physical health tools
that have been evaluated.
Methodology
Literature search
Four electronic databases were searched
from 2005 to 2013: CINAHL, MEDLINE,
PsycINFO and NHS Evidence. An additional
search was carried out for grey literature and
references were hand-searched.
Search strategy
Limiters and the Boolean operators AND and
OR were used to combine, exclude, include
and narrow the search, with variation of
keywords including: serious mental illness
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primaryhealthcare.com volume 26 number 10 / December 2016 / 29
Write for us
journals.rcni.com/r/
phc‑author‑guidelines
AND physical health care; mental health
nurses AND physical health provision;
psychotropic medications AND serious mental
illness; physical health monitoring AND
interventions; physical health assessment tools;
physical health assessment OR physical health
monitoring.
Inclusion criteria
Studies were selected if they were directly or
indirectly relevant to the research topic: the
physical health of individuals with SMI.
Search outcome
The search yielded 124 studies from 2005 to
2013. Of these, 17 were selected and a further
10 of these were excluded as five were reviews
and five were qualitative studies (Figure 1).
Seven units of analysis were used for the review
and can be seen in Table 1.
Quality appraisal
Two reviewers independently assessed
the articles using a pre-designed checklist
specifically developed for the review.
Data abstraction
A pre-designed sheet was developed to extract
the relevant data. Two reviewers independently
extracted data, which was cross-checked
and any conflicting views were settled by the
reviewers.
Synthesis
A narrative synthesis of the result was
undertaken, which provided the themes for the
results section.
Results
Four areas of physical health were identified
from the papers reviewed: side effects
of psychotropic medications; obesity,
cardiovascular disease and diabetes; risky
sexual behaviour; poor dietary intake and
physical inactivity.
Side effects of psychotropic medications
People with SMI experience metabolic issues
including weight gain, diabetes and CVD due
to long-term use of psychotropic medications
(Ohlsen et al 2005, Smith et al 2007). The
Clinical Antipsychotic Trials of Intervention
Effectiveness (CATIE) (Lieberman et al 2005)
revealed that antipsychotic medications help
to improve the quality of life for individuals
with SMI (McEvoy et al 2006, Meltzer et al
2010). Some studies showed adverse effects
of antipsychotic medication (Citrome and
Yeomans 2005, Healy 2008, Nash 2010,
Howard and Gamble 2011), with over-
sedation and extrapyramidal reactions –
movement disorders that are drug induced
and include symptoms such as dystonia and
parkinsonism (Gray et al 2009, Meltzer et al
2010) - key factors in these metabolic issues.
Additionally, antipsychotic medication can
cause reduction in saliva, leading to gingivitis
and dental problems (Gray et al 2009).
Antipsychotic medications and mood stabilisers
such as lithium and carbamazepine can cause
gastrointestinal problems; a need for frequent
use of the toilet; excessive thirst (Newell and
Gournay 2009), sexual dysfunction as a result
of raised prolactin levels in men and increased
oestrogen and anovulation in women; renal
failure and decreased psychomotor speed
(Happell et al 2011). Drugs prescribed for
bipolar disorder, including carbamazepine,
valproate, topiramate, lamotrigine and
zonisamide, are associated with weight gain,
insulin-resistant diabetes, dyslipidemia, and
reproductive and metabolic dysfunction in
women (Kenna et al 2009).
Tailoring medication regimens to individuals
helps with concordance (Gray et al 2010), and
the National Institute of Mental Health (2005)
IDENTIFICATION
SCREENING
ELIGIBILITY
INCLUDED
Total records identified
124
Total record of abstracts and titles screened for eligibility
124
Total number of full-text
articles screened
124
Full-text articles assessed
for eligibility
17
Articles included
7
Full-text articles excluded
107
Full-text articles excluded
for minimal information on
the topic
10
Figure 1. Flow chart of search results
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primaryhealthcare.com
30 / December 2016 / volume 26 number 10
evidence & practice / mental health
noted that alternative medication routes such
as weekly or monthly depot injections can also
improve concordance.
A lack of patient insight is the strongest
influence on non-concordance, which can
cause rebound psychosis – a sudden return of
the symptoms of the original illness, leading
toreadmission.
A population-based cohort study by
Happell et al (2011) found a reduction in
relapse when individuals with SMI were given
adequate information about medication and
were involved in the decision making regarding
their preferred treatment plan.
Howard and Gamble (2011) suggests
that side effects can be ameliorated with
anticholinergic medication monitored using
the Liverpool University Neuroleptic Side
Effects Rating Scale. Rethink (2014) argues
that although anticholinergic medicines
such as procyclidine, orphenadrine and
trihexyphenidyl alleviate side effects of
psychotropic medications (Central and North
West London NHS Foundation Trust 2012),
TAB LE 1. Units of analysis
Author and
year
Purpose Type of
study
Data collection Key findings
Happell et al
2011
A role for mental health
nursing in the physical
healthcare of consumers with
severe mental illness.
Qualitative Semi-structured
interviews
Focs group
discussions
Mental health nurses were
ambivalent about their role in
providing physical healthcare.
Howard and
Gamble 2011
To investigate mental health
nurses’ views and practice of
physical health assessment
and care management for
adults with SMI.
Qualitative Semi-structured
interviews
Questionnaires
Mental health nurses are willing to
take responsibilities for physical
care roles, therefore physical skills
appraisal, training and supervision
should be provided for them.
Schuel et al
2009
To determine whether the SMI
Health Improvement Profile
(HIP), facilitated by mental
health nurses, has the clinical
potential to identify physical
morbidity and inform future
evidence-basedcare.
Qualitative Semi-structured
interviews
HIP intervention impacts positively
on the physical health of individuals
with SMI.
Mental health nurses require
additional training to improve their
use of the HIP and how to ask
sensitive questions about sensitive
subjects.
Olsen et al
2005
To assess the levels of
physical health in an SMI
population, and to identify
any physical health problems
in individuals in this group.
Qualitative Case notes
entered into a
computerised
database
Nurse-led wellbeing support
programme should be incorporated
into clinical practice as it improves
the physical health of people with
SMI.
White et al
2009
To provide trainees with in-
depth knowledge of physical
health in SMI.
Qualitative Keynote
presentations
If mental health nurses complete a
HIP during assessment, individuals
diagnosed with SMI could have their
physical health needs assessed and
treated within a year.
Nash 2010 Examining the knowledge
of mental health nurses in
relation to basic facets of
physical need for clients
with SMI.
Qualitative Observational
and quiz-based
assessment
Most mental health nurses need
additional training to meet the
emerging physical health agenda for
clients with SMI.
Smith et al
2007
A service evaluation of a
programme designed to
improve overall wellbeing in
patients with SMI.
Quantitative Physical health
screening tool
Physical health problems are
common in individuals with SMI.
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primaryhealthcare.com volume 26 number 10 / December 2016 / 31
the side effects can include constipation, dry
mouth, blurred vision and difficulty in passing
urine (Healy 2008).
Without antipsychotic medication,
individuals with SMI might experience serious
and disabling symptoms (Meltzer et al 2010)
such as hallucinations, delusions and impaired
cognitive and social functioning (Newell and
Gournay 2009).
Obesity, CVD and diabetes
Individuals can put on 5-6kg within two
months of starting antipsychotic medications
(Foley and Morley 2011). A body mass index
(BMI) ≥ 25 is considered overweight (NICE
2006). Individuals with SMI are predisposed
to being overweight due to the adverse effects
of psychotropic medications, having a higher
percentage of body fat and lack of physical
activity (Smith et al 2007). Life-threatening
diseases can occur as a result, including type2
diabetes (Diabetes UK 2016), CVD and
hypertension, breast and colon cancer, and
stroke (Smith et al 2007).
Screening for diabetes rarely occurs in
people with SMI (Newcomer and Hennekens
2007) even though mortality outcomes
are three times higher in this population
(Ohlsen et al 2005, Smith et al 2007) with the
danger that diabetes remains undiagnosed,
unreported and untreated (Holt 2005).
Roberts and Bailey (2011) advocate the use of
metformin and statins to improve weight loss
in those with SMI.
Risky sexual behaviour
Compared to those without SMI, people with
SMI have disproportionately higher rates of
sexually transmitted infections and diseases
such as chlamydia, syphilis, genital herpes,
genital warts, trichomoniasis, pubic lice,
scabies and HIV (Hughes and Gray 2009).
Reasons for this include multiple partners,
unprotected sex and sex paid for in money
or illegal drugs (Meade and Sikkema 2005).
Individuals with SMI may be unable to
communicate effectively about safer sex
with their partners, and may have poor
interpersonal and assertiveness skills often
attributed to limited social interaction (Senn
and Carey 2008).
Poor dietary intake and physical inactivity
People with SMI are prescribed central nervous
system medications such as olanzapine and
clozapine (Bishara and Taylor 2008), which
are linked to food craving, binge eating, weight
gain and hypertriglyceridemia (McEvoy et al
2006, Meltzer et al 2010).
Physical activity is internationally recognised
as a vital illness-prevention and health-
management strategy (WHO 2007) that
improves self-esteem, decreases the risk of
long-term physical illnesses (Scott and Happell
2011), stimulates the release of acetylcholine,
which calms individuals (Callaghan 2004)
and increases cerebral blood flow, muscle
relaxation and body temperature. But people
with SMI are less likely to participate in
physical activities (McCreadie et al 2005,
Park et al 2011) and this contributes to poorer
physical health outcomes, partly due to self-
neglect and poor integrated care pathways
between mental health nurses and other health
providers (Happell et al 2011).
Mental health nurses may not discuss
these areas during assessments of individuals
with SMI due to a lack of understanding,
limited knowledge, low confidence and
role ambivalence (Hyland et al 2003,
Tosh et al 2011).
Discussion
The mortality rate in people with SMI is
3.6times higher than the general population
– 4,008 deaths in 100,000 compared to 1,122
deaths in 100,000 (NHS Digital 2013). It is
paramount that mental health nurses conduct
holistic and comprehensive assessments in
collaboration with individuals with SMI so
that health needs can be identified, goals set
and interventions implemented (Happell et al
2011, Robson and Haddad 2012).
Several studies (Gray et al 2009, White et al
2009, Nash 2010) found irregularities in the
competencies of mental health nurses in the
assessment and recording of physical health
data, which can result in poorer physical health
outcomes for people with SMI even when
they access physical healthcare. Mental health
nurses may lack some of the skills to effectively
monitor the physical health of individuals with
SMI as a result of the relative lack of emphasis
on physical health during their training
compared with adult nursing.
Aspects of physical health that mental health
nurses monitor in individuals with SMI include
blood pressure, BMI, blood sugar, prolactin
and lipid levels. They also arrange dental
and optical checks (Robson and Gray 2007),
andmonitor thyroid function, lipid profile,
weight and height (NICE 2006). They arrange
blood tests and urinalysis, and assess tobacco
and alcohol use (Ratcliffe et al 2011), and
the side effects of psychotropic medications
(Howard and Gamble 2011).
Holistic and comprehensive assessment
must be carried out in collaboration with the
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primaryhealthcare.com
32 / December 2016 / volume 26 number 10
evidence & practice / mental health
individual who has SMI so needs are identified,
goals set and interventions implemented. Care
needs to be planned, documented (Nursing and
Midwifery Council 2008) and communicated
between primary and secondary mental health
services (Shuel et al 2010).
The use of assessment tools is documented
in evidence-based literature as the basis for
measuring the level, frequency and duration
of risk (Fortinash and Holoday-Worret
2007). Two monitoring tools used by mental
health nurses to identify physical health
needs are the Wellness Support Programme
(WSP) (Ohlsen et al 2005) and the HIP
(White et al2009).
Although both provide strong evidence
supporting an integrated care pathway, the
HIP is favoured by most mental health nurses
(Gray et al 2009, Shuel et al 2010, Howard
and Gamble 2011) as it enables them to carry
out 28 physical health risk assessments in
collaboration with the person who has SMI to
plan care based on the level of risks identified.
The WSP is mostly used to screen for CVD
risk factors and the impact of antipsychotic
medications as a contributor to CVD
(Smith et al 2007).
Assessment tools are one step in supporting
individuals with SMI, but it is vital that mental
health nurses develop the skills to recognise
and differentiate between mental and physical
health symptoms so that appropriate physical
health care interventions are implemented
(Gray et al 2009).
Bishara D, Taylor D (2008) Upcoming agents for the
treatment of schizophrenia: mechanism of action,
eicacy and tolerability. Drugs. 68, 16, 2269-2292.
Blythe J, White J (2012) Role of the mental health
nurse towards physical health care in serious
mental illness: an integrative review of 10 years of
UK literature. International Journal of Mental Health
Nursing. 21, 3, 193-201.
Callaghan P (2004) Exercise: a neglected
intervention in mental health care? Journal
of Psychiatric and Mental Health Nursing.
11, 4, 476-483.
Central and North West London NHS Foundation
Trust (2011) In view: The Community Edition.
www.cnwl.nhs.uk/wp-content/uploads/2012/09/
Inview-April-2011-Final-artwork.pdf
(Lastaccessed: 5 July 2013.)
Citrome L, Yeomans D (2005) Do guidelines for
severe mental illness promote physical health
and well-being? Journal of Psychopharmacology.
19, 6 Suppl, 102-109.
De Hert M, Correll C, Bobes J et al (2011) Physical
illness in patients with severe mental disorders. I.
Prevalence, impact of medications and disparities
in health care. World Psychiatry. 10, 1, 52-77.
Department of Health (2011) The NHS
Outcomes Framework 2012/13. www.gov.
uk/government/uploads/system/uploads/
attachment_data/file/213711/dh_131723.pd f
(Last accessed: 12 August 2016.)
Diabetes UK (2016) Recommendations for Type 2
Diabetes Medicines. Available at: www.diabetes.
org.uk/About_us/News/SGLT2-inhibitors-
recommendations-to-minimise-risk-of-diabetic-
ketoacidosis/ (Last accessed: 25 October 2016.)
Foley D, Morley KI (2011) Systematic review of
early cardio-metabolic outcomes of the first
treated episode of psychosis. Archives of General
Psychiatry. 68, 609–616.
Fortinash K, Holoday-Worret P (2007) Psychiatric
Nursing Care Plans. Mosby/Elsevier. St. Louis, Mo.
Gray R, Hardy S, Anderson K (2009) Physical
health and severe mental illness: if we don’t do
something about it, who will? International Journal
of Mental Health Nursing. 18, 5, 299-300.
Gray R, White J, Schulz M et al (2010) Enhancing
medication adherence in people with
schizophrenia: an international programme of
research. International Journal of Mental Health
Nursing. 19, 1, 36-44.
Happell B, Platania-Phung C, Gray R et al (2011)
A role for mental health nursing in the physical
health care of consumers with severe mental
illness. Journal of Psychiatric and Mental Health
Nursing. 18, 8, 706-711.
Hyland B, Judd F, Davidson S et al (2003) Case
managers’ attitudes to physical health of their
patients. Australian and New Zealand Journal of
Psychiatry 37, 710–714.
Healy D (2008) Psychiatric Drugs Explained. Fifth
edition. Churchill Livingstone, London.
Holt R (2006) Review: severe mental illness,
antipsychotic drugs and the metabolic syndrome.
British Journal of Diabetes & Vascular Disease. 6,
5, 199-204.
Howard L, Gamble C (2010) Supporting mental
health nurses to address the physical health
needs of people with serious mental illness in
acute inpatient care settings. Journal of Psychiatric
and Mental Health Nursing. 18, 2, 105-112.
Hughes E, Gray R (2009) HIV prevention for people
with serious mental illness: a survey of mental
health workers’ attitudes, knowledge and practice.
Journal of Clinical Nursing. 18, 4, 591-600.
Kenna H, Jiang B, Rasgon N (2009) Reproductive
and metabolic abnormalities associated with
bipolar disorder and its treatment. Harvard Review
of Psychiatry. 17, 2, 138-146.
Lieberman J, Stroup T, McEvoy J et al (2005)
Eectiveness of antipsychotic drugs in patients
with chronic schizophrenia. New England Journal
of Medicine. 353, 12, 1209-1223.
McCreadie R, Kelly C, Connolly M et al
(2005) Dietary improvement in people with
schizophrenia: randomised controlled trial. British
Journal of Psychiatry. 187, 4, 346-351.
McEvoy J, Lieberman J, Stroup T et al (2006)
Eectiveness of clozapine versus olanzapine,
quetiapine, and risperidone in patients with
chronic schizophrenia who did not respond to
prior atypical antipsychotic treatment. American
Journal of Psychiatry. 163, 4, 600-610.
Maj M (2009) Physical health care in persons with
severe mental illness: a public health and ethical
priority. World Psychiatry. 8, 1, 1-2.
Meade C, Sikkema K (2005) Voluntary HIV
testing among adults with severe mental illness:
frequency and associated factors. AIDS and
Behavior. 9, 4, 465-473.
References
Downloaded from RCNi.com by ${individualUser.displayName} on Jan 24, 2017. For personal use only. No other uses without permission.
Copyright © 2017 RCNi Ltd. All rights reserved.

primaryhealthcare.com volume 26 number 10 / December 2016 / 33
Meltzer H, Bobo W, Lee M et al (2010) Randomized
trial comparing clozapine and typical neuroleptic
drugs in non-treatment-resistant schizophrenia.
Psychiatry Research. 177, 3, 286-293.
Nash M (2010) Assessing nurses’ propositional
knowledge of physical health. Mental Health
Practice. 14, 2, 20-23.
National Institute for Health and Care Excellence
(2006) Obesity Prevention. www.nice.org.uk/
guidance/cg43 (Last accessed: 2 November 2016.)
National Institute of Mental Health (2005) Clinical
Antipsychotic Trials of Intervention Eectiveness
(CATIE). nimh.nih.gov/funding/clinical-research/
practical/catie/index.shtml (Last acces sed: 12
August 2016.)
Newcomer J, Hennekens C (2007) Severe mental
illness and risk of cardiovascular disease.
Journal of the American Medical Association.
298, 15, 1794-1796.
Newell R, Gournay K (2009) Mental Health Nursing:
an Evidence-based Approach. Second edition.
Churchill Livingstone, Edinburgh.
NHS Digital (2013) Mortality Rate Three Times as
High Among Mental Health Service Users Than
in General Population – NHS Digital. content.
digital.nhs.uk/article/2543/Mor tality-rate-
three-times-as-high-among-mental-health-
service-users-than-in-general-population
(Last accessed: 25 October 2016.)
Norman I, Ryrie I (2009) The art and science
of mental health nursing: reconciliation of two
traditions in the cause of public health. International
Journal of Nursing Studies. 46, 12, 1537-1540.
Nursing and Midwifery Council (2008) The Code:
Standards of Conduct, Performance and Ethics
for Nurses and Midwives. www.nmc.org.uk/
globalassets/sitedocuments/standards/nmc-old-
code-2008.pdf (Last accessed: 6 May 2013.)
Ohlsen R, Peacock G, Smith S (2005) Developing
a service to monitor and improve physical health
in people with serious mental illness. Journal
of Psychiatric and Mental Health Nursing. 12, 5,
614-619.
Ratclie T, Dabin S, Barker P (2011) Physical
healthcare for people with serious mental illness.
Clinical Governance: An International Journal.
16, 1, 20-28.
Rethink (2014) Physical Health Check
(PHC). www.rethink.org/media/1137219/
Physical%20Health%20Check%202014.pdf
(Last accessed: 12 September 2016.)
Roberts S, Bailey J (2011) Incentives and
barriers to lifestyle interventions for people
with severe mental illness: a narrative
synthesis of quantitative, qualitative and mixed
methods studies. Journal of Advanced Nursing.
67, 4, 690-708.
Robson D, Gray R (2007) Prescribing psychotropic
medication: what nurse prescribers need to know.
Nursing Prescribing. 5, 4, 148-152.
Robson D, Haddad M (2012) Mental health
nurses’ attitudes towards the physical health
care of people with severe and enduring mental
illness: the development of a measurement
tool. International Journal of Nursing Studies.
49, 1, 72-83.
Robson D, Gray R (2007) Serious mental illness
and physical health problems: a discussion paper.
International Journal of Nursing Studies. 44, 3,
457-466.
Scott D, Happell B (2011) The high prevalence
of poor physical health and unhealthy lifestyle
behaviours in individuals with severe mental
illness. Issues in Mental Health Nursing.
32, 9, 589-597.
Senn T, Carey M (2008) HIV, STD, and sexual risk
reduction for individuals with a severe mental
illness: review of the intervention literature.
Current Psychiatry Reviews. 4, 2, 87-100.
Shuel F, White J, Jones M et al (2010) Using the
serious mental illness health improvement profile
(HIP) to identify physical problems in a cohort
of community patients: a pragmatic case series
evaluation. International Journal of Nursing
Studies. 47, 2, 136-145.
Smith S, Yeomans D, Bushe C et al (2007)
A well-being programme in severe mental
illness. Reducing risk for physical ill-health: a
post-programme service evaluation at 2 years.
European Psychiatry. 22, 7, 413-418.
Tosh G, Clifton A, Bachner M (2011) General
physical health advice for people with serious
mental illness. Cochrane Database of Systematic
Reviews. Issue 2. CD008567.
White J, Gray R, Jones M (2009) The development
of the serious mental illness physical health
improvement profile. Journal of Psychiatric and
Mental Health Nursing. 16, 5, 493-498.
World Health Organization (2012) NCD
Mortality and Morbidity. www.who.int/gho/
ncd/mortality_morbidity/en/inde x.html
(Last accessed: 12 August 2016.)
Mental health nurses are in a position to
support people with SMI to participate in
physical activities to reduce cardiovascular
mortality (Happell et al 2011). Individuals
can be encouraged to participate in smoking
cessation, nutrition counselling, weight
management and supervised exercise
programmes. Mental health nurses should
encourage health promotional activities
around CVD, where a potential for change
in modifiable risk factors, such as physical
activity, smoking and diet, has been shown
(Robson and Haddad 2012). The studies
reviewed indicated that mental health nurses
lacked the skills and knowledge to meet the
physical health needs of individuals with SMI.
They favoured additional physical healthcare
training so that interventions are targeted
towards advice on healthy lifestyle choices.
Conclusion
Appropriate and effective physical care of
people who have SMI can work well when
physical and mental health care providers and
primary and secondary mental health services
work towards an integrated care pathway
and reducing inequality in care. Improved
access to physical care can be achieved
through additional physical health training
for mental health nurses, implementation of
the HIP, monitoring of the adverse effects
of psychotropic medications, screening for
physical illnesses andhealth promotion advice
on lifestyle choices.
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