Hearts and Minds
The connection between physical and mental health is well documented. If you’re mentally ill, chances are you may well also have poor physical health. Sadly, on average people suffering from severe mental illness die significantly younger than the general population – between 8 and 20 year depending on circumstances, and which research is most accurate. (You’ll see below that different researchers have come up with different figures to each other, but all of them are very troubling.)
People with severe mental illness have an increased risk of developing a number of physical health conditions. Coronary heart disease is more prevalent in people with bipolar disorder and schizophrenia, who are also more likely to be clinically obese and at risk of diabetes than the rest of the population. Some of the other physical health conditions encountered by people with mental health problems include high blood pressure and raised cholesterol.
Some of the reasons for this high prevalence include:
- people with mental health problems are more likely to live in poverty, adding more barriers to accessing care and treatment.
- not feeling empowered to seek help with their physical health.
- ‘Diagnostic overshadowing’ – sometimes the focus is primarily on mental health symptoms and not also physical ones.
- lifestyle – i.e smoking, social isolation, low motivation and lack of routine.
- medication – some psychiatric medication may increase the risk and severity of certain physical health conditions.
The Disability Rights Commission called for “accessible and appropriate support to encourage healthy living and overcome physical health disadvantages which come from their conditions or treatments.” And that specialist mental health and learning disability providers should: “Positively promote healthy living, including through options for diet and exercise, in their own services and raise expectations of good health including by access to expert patient programmes, so people can take charge of their own health.”
Being in hospital is a logical place for people to improve patient’s physical well-being and help improve their life expectancy, after all the physical health conditions that people with mental health problems often die from are preventable. Wards are helping patients stay active through a multitude of physical activity groups, offering smoking cessation and providing information and advice on healthy eating, side effects, alcohol consumption and generally how to live a healthy life.
“People with severe and enduring mental health problems are among the heaviest smokers in the UK, and are also often heavy drinkers. Being mentally ill can also cause people to neglect their physical health. They may not be physically active, and may stop eating properly. We must do more than just treat the clinical symptoms of mental illness. All healthcare staff need to understand the complex links between mental and physical health, and make sure that individuals get support for all their physical and mental health needs.”
– Simon Lawton Smith (Head of policy, The Mental Health Foundation) via Healthcare Today
- Patients can meet individually with dietician and/or pharmacist.
- Advice and encouragement for healthy eating and giving up smoking available on all wards.
- Weekly well-being clinics take place on the ward.
- Optional physical health checks are completed (physical exam, blood testing, ECG (if risk factors),
- Lifestyle assessments (diet, BMI, smoking, exercise), allergies, physical observation, other investigations (if needed).
- Lifestyle Gym Instructors provide 5 gym sessions through the local authority, including signposting service users to community provision.
- A gym instructor visits twice a week and they use a ‘personal trainer’ model. It’s lovely to hear of in-patients having access to a very high status resource.
- There is a fully equipped gym in the House, which is available to patients across the site, Occupational therapy assistants have been trained by a qualified gym instructor.
- All gym activities, internal to the hospital are facilitated by an OTA who has qualifications Activity Leadership and a BSc in Health related Exercise and Fitness.
- The patients are registered with a local GP where dietary advice is provided by a dietician.
- Patients have a community gym membership.
- All patients are provided with an individual therapy programme that incorporates exercise plans which will be developed with their community team prior to discharge.
- All patients have a six monthly physical health check, including ECG.
- Medication Education groups take place. Patients can ask questions about how their medication affects their physical health, including side effects and weight gain.
- ‘Total well-being’ sessions are offered.
- Two OTs offer things such as Clozaril weight gain support and personal plans for patients.
- The completion of optional physical health checks and physical health promotion with all acute inpatients.
- Advice to patients on quitting smoking is readily available, as well as nicotine replacement therapy and advice on diet.
- Several staff have attended training on supporting clients to stop smoking.
The Word from the Ward
- “We have introduced a health monitoring form which is used for new admissions for the first 3 days of their admission. This form highlights any physical health problems and provides a helpful baseline. The information it records includes: 24 hour sleep pattern, their food and fluid intake, drug test outcome, urinalysis, as well as a space for physical observations like blood pressure, weight and blood sugar.”
- “We use a ‘lifestyle questionnaire. The questions on the female sheet include on: smoking status, alcohol intake, diet, exercise, drug use, teeth, sexual health, bowels, menstrual cycle, breast care, cervical smear status. Patient’s don’t have to answer any questions they don’t feel comfortable with – in fact, they can opt out completely if they wish.”
- “As part of our regular healthy living group we have a session on what a healthy lifestyle means to the patients. We also explore the question ‘should we be healthy?’ and discuss the advantages of staying healthy, like having more energy and feeling good inside and outside. The consequences of not staying healthy are also explored.”
An (Almost) A to Z of Physical Health
A – Alcohol information
C – Clozapine Clinic, conversations about physical health take place on ward
D – Dietician input, diabetes support
E – E-learning on healthy living accessed on ward
H – Healthy living groups, health check tools
I – Information about medication provided
K – Keeping fit
M – Medication education groups
N – Nutrition information
O – Obesity support
P – Psycho-education and health promotion
Q – Quality and reliable information
R – Role modelling by staff
S – Smoking cessation, side effect information and advice
T – Training for staff on physical health conditions
W – Well-being clinic
Wards are providing the following to help patients learn about and maintain a healthy lifestyle:
- Healthy living groups
- Health education and promotion
- Posters on healthy eating
- Leaflets on weight management (including side effects of medication and how to avoid weight gain)
- Regular well-being clinics
- Benefits of Exercise
- Smoking cessation
- Appointments with the dietician
- Dietician-led sessions, groups and talks
- OT-led cooking groups (like breakfast and lunch club)
- Trips to the supermarket to purchase and then cook groceries
There are obvious benefits in terms of improving nutritional knowledge, which can have a direct impact on patient’s mental as well as physical health.
Healthy living group in a medium secure unit
- The aims of the session are for patients to have a think about their lifestyle. They’re invited to explore and discuss what they like about their current lifestyle and what changes, if any they want to make.
- Together the groups looks at health promotion information and resource which help build up their knowledge of living healthily and the consequences of not.
Structure of Sessions
- The group is run in rotation with another group called ‘Positive Living’.
- The group enables patients to discuss and clarify what a healthy lifestyle consists of.
- Generation of healthy living ideas.
- Participants are offered the chance to write down on a piece of paper one thing that has or would have to happen to make them want to lead a healthier lifestyle. Patients are asked if they want to share this with the rest of the group or they can keep it private if they prefer.
Weekly Well-being Clinic
Here’s an example of the types of “well-being checks” that take place within ward well-being clinics (otherwise known as Health MOTS):
- Blood pressure and pulse
- Saturation levels
- Body Mass Index
- Abdominal Circumference
- Blood Sugars
- The patients’ smoking status and a conversation about if they would like help to quit (a referral can be made to the smoking cessation nurse)
- A conversation about their medical history
- Physical health goals are set if appropriate
- A dietician helped me to make the right choices of food and portion sizes from the ward menu. I have so much more energy now and I have lost some weight too.
- As my appetite returned I made sure I ate regularly as I knew it would help me get better.
- I only drank decaffeinated coffee and herbal teas as I find regular tea and coffee too stimulating. It works for me why don’t you give it a try.
- I had too much energy so rather than taking people’s heads off I used the hospital gym.
- We had just one ward doctor who always did our physical health checkups. It was nice to always see the same person and after a while I felt like I could talk to him about anything.
- The medication I’m on can make you put on weight but the staff are good with encouraging us to go to the hospital gym. I go most days.