Medical co‐morbidity risk factors and barriers to care for people with schizophrenia

Abstract

The management of risk is a fundamental component of the work of mental health nurses and is most commonly associated with aggressive, violent and suicidal behaviours exhibited by those suffering from mental illness. However, people with severe mental illness are increasingly at risk of experiencing a number of related and complex health problems that include obesity, diabetes and cardiovascular disease. This group also has much higher rates of morbidity and mortality than that of the general population resulting in high social, economic and individual costs. Some of the barriers to receiving prompt and appropriate physical health care include lack of recognition by health professionals and the difficulties faced by consumers of mental health services in negotiating the health care system. Establishment of comprehensive (addressing both physical and mental health issues) programmes of care can address this need and offer additional opportunities for closer and more collaborative nurse-patient relationships. This paper explores risk factors for medical co-morbidity for people living with schizophrenia and suggests strategies that can facilitate better health outcomes.

Managing Risk: Clinical Decision-Making in Mental Health Services

“…Risk assessment and management are major components of contemporary mental health practice. Risk, described as "the likelihood of an adverse event happening" (Muir-Cochrane & Wand, 2005, p. 5), can include patient aggression (Daffern & Howells, 2009), suicide and self-harm (Thompson, Powis, & Carradice, 2008), absconding (Muir-Cochrane, Mosel, Gerace, Esterman, & Bowers, 2011), substance abuse (Thomson, 1999), and diverse concerns, such as medical comorbidity, exploitation, social exclusion, victimization, and poverty (Kelly & McKenna, 2004;Muir-Cochrane, 2006). The increasing importance placed on risk assessment and management is reflected in not just policy, but also the daily care of consumers by health care professionals worldwide (de Nesnera, & Folks, 2010;Department of Health, 2007;Langan, 2010;Oordt, Jobes, Fonseca, & Schmidt, 2009).…”

Efficacy of a Pharmacist‐Led Cardiovascular Risk Reduction Clinic for Diabetic Patients With and Without Mental Health Conditions

“…These results are important since previous studies have shown that patients with MHCs ranging from depression to schizophrenia are less likely to achieve diabetes performance measures, while our findings suggest that they can achieve similar outcomes, just over a longer period of treatment. Potential explanations for poor diabetes control in the population with MHCs are difficulties assessing and engaging with health care services, 19 prevalence of a larger number of cardiovascular risk factors, 3 higher risk of glucose dysregulation and lipid abnormalities secondary to antipsychotic agents, 20 and nonadherence with medication regimens. 21 Study results have reported that treatment of cardiovascular risk in patients with MHCs is difficult, 22,23 since primary care providers are not comfortable in the management of MHCs and antipsychotic medication side effects, while mental health care providers' interventions in patients with severe MHCs are mostly focused on treating the MHC.…”

General practitioner management of chronic diseases in adults with severe mental illness: a community intervention trial

“…[9][10][11] For example, physical ill health goes unrecognised and is under-diagnosed among those with SMI by both psychiatrists and general practitioners (GPs). [12][13][14][15] This is because GPs do not feel well equipped to deal with people with SMI, whereas psychiatrists tend to underestimate physical health complaints and nurses in mental health settings tend to undervalue clinical physical care. 16 Even if physical health problems are diagnosed, this population may be less likely to receive or adhere to adequate treatment.…”