Improving the physical health of people with severe mental illness in a low secure forensic unit: An uncontrolled evaluation study of staff training and physical health care plans

Abstract

The life expectancy of people with severe mental illnesses is substantially reduced, and monitoring and screening for physical health problems is a key part of addressing this health inequality. Inpatient admission presents a window of opportunity for this health‐care activity. The present study was conducted in a forensic mental health unit in England. A personal physical health plan incorporating clearly‐presented and easily‐understood values and targets for health status in different domains was developed. Alongside this, a brief physical education session was delivered to health‐care staff (n = 63). Printed learning materials and pedometers and paper tape measures were also provided. The impact was evaluated by a single‐group pretest post‐test design; follow‐up measures were 4 months’ post‐intervention. The feasibility and acceptability of personal health plans and associated resources were examined by free‐text questionnaire responses. Fifty‐seven staff provided measures of attitudes and knowledge before training and implementation of the physical health plans. Matched‐pairs analysis indicated a modest but statistically‐significant improvement in staff knowledge scores and attitudes to involvement in physical health care. Qualitative feedback indicated limited uptake of the care plans and perceived need for additional support for better adoption of this initiative. Inpatient admission is a key setting for assessing physical health and promoting improved management of health problems. Staff training and purpose‐designed personalized care plans hold potential to improve practice and outcomes in this area, but further support for such innovations appears necessary for their uptake in inpatient mental health settings.

The Impact of co-morbid severe mental illness and HIV upon mental and physical health and social outcomes: a systematic review

“…Nine studies examined various factors related to ART use. Three out of four studies found no evidence of a difference in ART use between people living with SMI and HIV and those living with HIV alone [23,9 | P a g e 29,45]. The exception to this was a small study carried out in Italy (n=27) which found that those with new-onset psychosis were less likely to be using ART than those with HIV only [46].…”

“…Some of the same barriers apply to adherence to medication for both conditions: alcohol and substance use; side effects; lack of social support; difficulties accessing treatment; transportation; resources to buy medication; patient experience of the health services including relationships with staff [6,8]. Although people with SMI have much higher rates of death from 4 | P a g e suicide and other unnatural causes, the vast majority of excess mortality is due to those conditions which are the most common cause of death among the general population [9,10]. Similarly, although AIDS-related causes account for around a third of deaths among people living with HIV/AIDS [11], PLHA are at higher risk of non-communicable diseases (NCDs) such as cancers, liver disease and cardiovascular disease which account for 40% of deaths [11].…”

“…Similarly, although AIDS-related causes account for around a third of deaths among people living with HIV/AIDS [11], PLHA are at higher risk of non-communicable diseases (NCDs) such as cancers, liver disease and cardiovascular disease which account for 40% of deaths [11]. As in the general population, risk factors are multifactorial and include lifestyle factors such as smoking, alcohol and drug-use [9]. However, both long-term ART use and use of anti-psychotics are associated with metabolic changes linked to NCDs.…”

“…Given the challenges associated with the management of each condition; additional complexity associated with co-morbidity is likely to be significant. However, excess risk associated with co-morbidity is likely to be modifiable [9]. The aim of this systematic review is to synthesize existing evidence, using the syndemic paradigm to frame our work providing a platform for further research and possible guideline development.…”

Offering physical activity advice to people with serious mental illness: The beliefs of mental health professionals

“…More than 80% of nurse respondents reported they would like further training on the management of diabetes, cardiovascular health, and nutrition. This barrier was noted by nearly 90% of mental health staff in a more recent UK M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 3 study with in-patients indicating that despite staff training, additional support is perceived necessary in order to facilitate uptake of personalised health care plans (Haddad, Llewellyn-Jones, Yarnold & Simpson, 2016).…”