Hidden care: Revelations of a case‐note audit of physical health care in a community mental health service

Abstract

People with severe mental illness (SMI) are widely reported to be at an increased risk of morbidity and premature death due to physical health conditions. Mental health nurses are ideally placed to address physical and mental health comorbidity as part of their day-to-day practice. This study involved an audit of hardcopy and electronic clinical case-notes of a random sample of 100 people with SMI case managed by community mental health service in metropolitan South Australia, to determine how well physical health conditions and risk factors, screening, and follow-up are recorded within their service records. Every contact between 1 July 2015 and 30 June 2016 was read. One-way ANOVA, Scheffe's test, and Fisher's exact test determined any significant associations across audit variables, which included gender, age, income, living arrangement, diagnosis, lifestyle factors, recording of physical health measures, and carer status. A focus on physical health care was evident from everyday case-note records; however, because this information was 'buried' within the plethora of entries and not brought to the fore with other key information about the person's psychiatric needs, it remained difficult to gain a full picture of potential gaps in physical health care for this population. Under-reporting, gaps and inconsistencies in the systematic recording of physical health information for this population are likely to undermine the quality of care they receive from mental health services, the ability of mental health service providers to respond in a timely way to their physical healthcare needs, and their communication with other healthcare providers.

Safety attitudes, perceived organizational culture and knowledge of the physiologically deteriorating patient among mental health nurses: Cross‐sectional, correlational study

“…A hierarchical culture with its emphasis on policies, coordination and efficiency may be helpful in larger organizations aiming for standardized practices'. Certainly, this accords with evidence from studies of mental health services which have concluded that standardized practices in relation to consumers’ physical healthcare in particular are lacking (Lawn et al, ; Ratcliffe et al, ; Vasudev & Martindale, ) and a previous large study using the SAQ in which mental health employee respondents’ facilities had some of the poorest scores across a range of clinical facilities sampled (Gallego et al, ). It also accords with findings made in a qualitative focus group study conducted in conjunction with the current investigation where one of three key emergent themes was a recognition among participants of the need for greater procedural clarity in physical healthcare (Brunero et al , in press).…”

NDIS Participants with Psychosocial Disabilities and Life-Limiting Diagnoses: A Scoping Review

“…People living with SPMI have increased somatic risks, higher cancer mortality rates [ 42 ], poorer clinical outcomes [ 43 ], and die significantly earlier due to factors attributable to their mental illnesses. These factors include the side effects of psychotropic medications, unhealthy lifestyles [ 38 ], alcohol and other drug use, poor health monitoring [ 44 , 45 , 46 ], and reduced health prevention and screening, leading to under-detection and late diagnosis of disease [ 18 , 22 , 25 , 26 , 39 , 40 , 45 , 46 , 47 , 48 ]. People with SPMI are particularly vulnerable to shorter life expectancy [ 40 , 49 ] as they are often victims of violence [ 50 ], healthcare system neglect [ 25 , 45 ], and can be excluded from mainstream service support due to barriers such as homelessness [ 26 , 27 , 51 ], cultural insensitivity [ 52 ], poverty, and stigmatisation [ 5 , 14 , 15 , 17 , 18 , 21 , 22 , 24 , 25 , 26 , 27 , 39 , 47 , 49 , 51 , 53 , 54 , 55 ].…”

Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review

“…An objective of EHRs is the standardization of health information to allow for health information exchange and data analytics [ 122 , 123 ]. In comparison, mental health care involves the documentation of a large amount of narrative information, much of which resists standardization [ 16 , 51 ]. An increasing focus on recovery models of mental health care that prioritize service user–defined measures and outcomes may create further tensions with standardized data collection [ 124 ].…”

“…Coiera [ 15 ] outlined that a health record has many functions, including enabling communication among staff through the information in the record, providing a central source of information for care, acting as an informal workspace for capturing ideas, and being a historical archive that can inform future care. Mental health records are especially complex because many entries can be included in the record [ 16 , 17 ].…”