Wednesday, 1 February 2017

Metal Nurse: Physical health within mental health

One of the many healthcare areas that hold great interest to me is mental health. Prior to starting my nurse training I had worked in secure services mental health for 6 years. It was an eye opener. It was essentially what lead me to doing my general health training as opposed to mental health training. This article should tie with my previous article on self harm. The focus here is of course on how patients physical health should also be the focus within a mental health setting. What was often not always noted is that physical health problems can manifest as mental health issues. For example infections can and do lead to delirium, especially Urinary Tract Infections. Even constipation will cause confusion and mood swings.

Quitting Smoking
My main interest at the time though was the physical well being for those patients. The lack of physical health care for patients in long term mental health institutes has been recognised for a long time. Patients with schizophrenia are for example known to die from natural causes sooner than the general public. Hence the need for mental health nurses to be trained better in order to recognise and tackle physical health issues. The most common causes for the mortality rates are smoking and obesity.

The rates of smoking are two to three times more common within patients who have schizophrenia than the general public, two out of every five cigarettes are smoked by people who suffer from mental health problems. And people who have bipolar disorder have also been known to be 2 to 3 times more likely to smoke. Not only that but those with mental health problems smoke more than the general public that smoke. So the dangers of smoking are enhanced and the importance of smoking cessation becomes even more important.  The dangers of smoking cannot be over stressed, and the benefits of quitting smoking cannot be underlined often enough. According to a systematic review by the BMJ, quitting smoking has not only physical health benefits but also mental health benefits. And that's across the board. Or as the meta-analysis says itself: 
"Both psychological quality of life and positive affect significantly increased between baseline and follow-up in quitters compared with continuing smokers.  
There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders. " 
Essentially. Anxiety went down, depression went down and stress all significantly decreased AFTER quitting smoking. Which all in all just says to me that mental health care facilities should place a stronger focus on smoking cessation then they already do. What should also be added is that if you are on medication for your psychiatric issues, you take less medication if you quit smoking. The reason being is that smoking increases the body's metabolism of most of those drugs. This is especially apparent in those who take clozapine. For example when the smoking ban came into effect within UK's mental health facilities the plasma serum levels went up, because of patients reduced smoking. But that often wasn't accounted for when considering the patients medication dosages.

Quitting smoking isn't easy, I know that from personal experience, and in I would imagine that those who already have diagnosed mental health problems will find it more difficult hence the need for more robust support during the smoking cessation. Which also just brings the point that nurses should also work as role models in terms of their health promotion. Seeing as there are so many nurses that still smoke. It is pretty difficult to provide good support if you aren't willing to seek out support for it yourself. We also have to smash the preconception that drinking coffee and smoking cigarette first thing in the morning is something that is okay, and think that it is a safe and effective way of getting someone to calm down when they are having a psychological breakdown. Verbal de-escalation works a lot better then the offer of a cigarette and a cup of coffee.
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As mention previously obesity is the other big(no pun intended) issue for mental health patients. It is well known that certain psychiatric medication induce weight gain and in longer term morbid obesity. Obesity leads to several physical health related issues as well as mental health. This would include,  Type 2 Diabetes Mellitus, Stroke, Coronary Heart Diseases, Infertility, Loss of Bladder Control, and many many more.

Regarding T2DM, it becomes a big issue within a hospital setting as often the health care staff looking after patients with diabetes sometimes mistake hypoglycaemic episodes with delirium or psychological breakdown, hence delay of proper treatment. With patients who suffer from schizophrenia they also often suffer from defective glucose tolerance and insulin resistance. Which makes recognising diabetic crisis hard to tell from psychological crisis, for those who are not appropriately trained.

Then there the psychological issues. Being obese can lead to depression, anxiety, body dysmorphia, low self esteem, and many more. Of course if you already do have those issues being obese will exacerbate those issues.

Since weight gain is a very common side effect of psychiatric medication, and well known by mental health care professionals,  I do wonder why rolling out weight management plans alongside starting the drugs isn't done. Because losing weight is not an impossibility like a lot of professionals seem to believe.

 The medications will increase their appetite, but that is not the only reason for it. Whilst in a secure setting patients become more idle, and their diet intake tends to be very poor. I remember watching patients eating increbile amounts of takeaway foods, sweets and gulped vast quantities of soft drinks. But on the flip side I don't remember an awful lot of healthy food stuff being promoted, like the 5 a day fruit and veg intake.Or just the whole Change4Life campaign. Or drink to water. Or even Meat Free Monday's.

In a large study published by NJEM, it was shown that with the right plan and the right intervention, patients with serious mental health problems could lose weight and not just that but keep their weight down following lessening of weight loss sessions. Even with obstructions like hospital attendence's, breakdown in mental health and so forth. Of course like with smoking, it is sometimes hard for nurses to be role models for life style changes when they also feel like they can't tackle the subject due to their own life style.

All in all, what I personally would like to see more of is further physical health training for mental health nurses, and of course vice versa for general nurses. Because all training for either will only improve both professionals healthcare practice.
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