Introduction:
Reducing premature mortality of patients with mental illness and
improving their physical health care outcomes is a major priority area
presented in the Fifth National Mental Health and Suicide Prevention Plan.
According to the Mental Health Commission of New South Wales (2016),
mental illness is very common, with nearly half of all Australians developing a
mental illness, such as schizophrenia, bipolar disorder and depressive
psychosis, at some point in their lives. It is a common knowledge that physical
and mental well being are inextricably linked. Laursen (2011) mentioned that
the death rates in patients with mental health issues such as schizophrenia or
bipolar disorder are higher compared to the general population. A study
conducted by Lawrence, Hancock & Kisely (2013) further emphasised that
almost 80% of excess deaths are associated with physical health conditions
which include cardiovascular disease, respiratory illness, cancer and diabetes
mellitus. Thus, the significance of ameliorating the physical health of patients
with mental illness will greatly reduced early death. In this essay, the author will
critically discuss the above stated priority area relevant to the work area setting
(Acute Older Person Mental Health) and will examine how nursing practice has
developed or needed to develop in order to reflect the values communicated.
Discussion:
Firstly, Regular physical well being checks including lifestyle, family
medical history and routine tests, for example weight, blood pressure, blood
test to check for glucose, cholesterol and lipid profile, can identify potential
issues before they evolve into serious medical conditions. Kristiansen, et. al.
(2015) emphasised that there is a need for implementation of routine physical
health checks with patients suffering from mental health issues. Similarly,
COAG Health Council (2017) agreed that a quality physical and mental health
care promotes longer life expectancy and a better quality of life when provided
in the early period of patient management. However, the Mental Health
Coordinating Council (2016) indicated that the physical health care needs of
patients with mental illness have been neglected for decades and due to this,
they are more inclined to develop chronic illness and other co morbidities at a
much younger age due to untreated health care conditions. This is an eye
opener for us nurses working in Mental Health, especially with these vulnerable
groups of patient, allowing us opportunity to make a major difference to their
health and well being. A study presented by Happell, et al. (2015) mentioned
about inconsistent policy implementation of a regular physical health check of
people with mental illness and I do disagree in this aspect as I can attest that
the unit I am working with consistently provides physical health monitoring as
per workplace policy and procedure. Several medical and nursing tools and
check list have been developed to address the physical needs of patients. Any
abnormalities presented and observed during collaborative assessment of both
nursing and medical team will be discussed among the healthcare team either
during handover or case reviews and appropriate intervention will be agreed
upon.
Secondly, physical health screening is considered a gold standard of
care in every patient with mental illness as this is an effective method in
recognising certain conditions which can benefit from early diagnosis. Some
examples that can be provide would be early metabolic testing for diabetes, pap
smear or a bowel cancer testing. As defined by Emerson, Williams & Gordon
(2014), physical health screening is an extensive approach incorporating health
promotion and disease prevention for clients with mental illness thus affecting
patients outcomes and health interventions. In the same way, Haddad et. al.
(2016) mentioned that screening is not only an essential prerequisite for
interventions but it also provide a medium of integrating people in the initial
steps of behaviour change and also enabling health care teaching opportunities,
goal setting and self management. In my ward setting, going over patients
notes, Electronic Medical Records and history is vital as these will give
information on screening test that can be done for the patient. My co-student,
April Lane (April, 2018) posted about difficulties in following up patient as the
Mental Health Metabolic Monitoring assessment forms are incorrectly filled up
despite of in-services in the ward. I agree that this will cause an issue in the
continuity of patient care as information collected are not being utilise to
improve patient care. This issue should be addressed as soon as possible.
Moving forward, follow up of the results of the screening test, if done earlier
prior to admission provides early intervention when when a non favourable
result of test is known. Evidenced base recommendations can be made to
improve patient outcomes in collaboration with attending health care team and
the patient himself. For instance, data collected from the screening process can
help the client and the family understand and adhere to treatment regimens
such as decrease smoking, improvement of blood sugar, increase physical
activity and healthy dietary choices. Although Morgan et. al. (2009) strongly
advocate screening of patients before they commence anti-psychotic treatment
and, at the minimum, 3-monthly monitoring of all patients on any anti-psychotic
medication regardless of the diagnosis or specific drug, I often encounter
patient in my ward not adhering to the process. The GP dispense anti-psychotic
medications and advised patient to do some blood test but some patient don’t
bother going back for follow up and blood testing. As a result, patient presents
to the ward with other medical concerns such as high glucose level. Holt &
Mitchell (2015) agrees that Diabetes Mellitus affects approximately 12 percent
of people mental illness taking anti-psychotic medications. However, in my
workplace, patient being admitted in the ward have to be medically cleared first
and so before being in the mental health ward, the patient may have spent a
