“Somebody else’s business”: The challenge of caring for patients with mental health problems on medical and surgical wards

Abstract

Introduction: Evidence shows that patients with mental health problems have poorer physical health outcomes, increased mortality and experience poorer care during surgery and medical admissions. Issues related to lack of training, stigmatising attitudes, fear or hopelessness may help understand these poor outcomes. Aim: To explore the experiences of staff in providing care for people with mental health problems. Method: A qualitative service evaluation approach was used. Participants working in an acute care hospital in inner city London were recruited across professions and job levels using a self-selection sampling method. A total of thirty participants took part in semi-structured interviews (n=17) and two focus groups (n=13), and data were thematically analysed. Relevant organisational documents and service use data was utilised to inform the evaluation. Results: Key themes were organised across the macro, meso and micro levels to understand the levels of disconnection and silence around mental health in acute care. Themes include systemic factors surrounding the institutional culture, ward cultures and collaborative working, and individuals' sensemaking of mental health and personal well-being. Implications for Practice: These findings signpost the growing need for greater mental health nursing input on medical and surgical wards and within these teams to provide informed knowledge, support and supervision. Accessible Summary What is known on the subject? People with mental health problems have higher rates of physical health concerns and hospital admissions than those without mental health problems. These patients have poorer outcomes from surgery and have worse experiences of care when admitted for medical or surgical procedures. What the paper adds to existing knowledge? This paper looks to understand why care may be poorer for patients with mental health problems by speaking to staff providing care in these settings. We spoke to 30 general hospital staff about mental health on the wards and found that a lack of leadership and ownership for prioritising mental health led to people not seeing it as their job, and that it was somebody else's business to manage that side of care. We also found that the emotional effect of caring for people who had attempted suicide or had self-harm injuries was difficult for staff, impacting on staff well-being and leading them to distance themselves from providing care in those cases. What are the implications for practice? There is a need for staff to be supported from the top-down, with management providing clear leadership around issues and pathways for mental health needs so they know the best way to provide care and encourage collaborative working. In addition, bottom-up support is needed to help staff personally manage their own well-being and mental health, including supervision and debriefing from mental health specialists to improve understanding from the patient's perspective and to provide emotional support to manage difficulties. Relevance Statement: This paper ...

The impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions: An integrative literature review

“…2018) and unique pressures on staff (Foye et al . 2020). It has been found repeatedly that nurses not specifically educated in mental health care struggle to identify the mental health needs of patients and when they do, lack the confidence and expertise to intervene (Alexander et al .…”

“…Mental health conditions in GH patients are associated with increased mortality (Karim et al 2019) and added distress for patients and relatives (Clissett et al 2013). The additional complexity of care results in increased resource usage (Jansen et al 2018;Wolff et al 2018) and unique pressures on staff (Foye et al 2020). It has been found repeatedly that nurses not specifically educated in mental health care struggle to identify the mental health needs of patients and when they do, lack the confidence and expertise to intervene (Alexander et al 2016;Bird 2018;Brunero et al 2018;Weare et al 2019).…”

A qualitative study to investigate Swiss hospital personnel’s perceived importance of and experiences with patient’s mental–somatic multimorbidities

“…This strong focus on somatic health conditions leading to insufficient access to mental health services in general hospitals was even stated by patients diagnosed with a personality disorder ( 39 ). Previous studies described that health professionals working in a general hospital do not see mental health conditions as belonging to their competencies and tasks ( 19 , 40 ). On the one hand, this could be triggered by the high workload, reducing the time available for such tasks.…”

“…While these factors can lead some physicians to be hesitant to talk about mental health in general hospital settings, other physicians might be reluctant to integrate mental health issues at all. The physicians’ strong focus on the patient’s medical condition ( 44 ) and differences in the duration of work experience ( 19 ), might lead to see mental health not as part of their business ( 40 ) and, in turn, to physicians’ hesitancy in integrating mental health in somatic hospital settings.…”

“…The frequency of interactions and time constraints build different ward cultures that, in turn, influence collaboration ( 47 ). Time pressure, unclear role and task descriptions, and poor organization were barriers to interprofessional collaboration between nurses and physicians ( 46 ) as well as between somatic and mental health specialists ( 40 ). This might amplify challenges in communication, further leading to unrecognized mental health conditions.…”