Serious mental illness and physical health problems: A discussion paper

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Abstract

People with serious mental illness have higher morbidity and mortality rates of chronic diseases than the general population. This discussion paper explores the complex reasons for these disparities in health, such as limitations of health services, the effects of having a serious mental illness, health behaviours and the effects of psychotropic medication. Physical health can be enhanced by improved monitoring and lifestyle interventions initiated at the start of treatment. There are opportunities for mental health nurses to play a significant role in improving both the physical and mental health of people with serious mental illness.

Section snippets

What is already known about the topic?

  • People with serious mental illness have increased rates of physical illness compared with the general population and have a reduced life expectancy. Reasons for increased morbidity and mortality include factors relating to having a mental illness, the fragmentation of health care, health behaviours such as smoking and physical inactivity and the effects of psychotropic medication.

What this paper adds

  • This paper summarises and synthesises the current literature on the physical health of people with serious mental illness and adds to the debate about the role of the mental health nurse in monitoring physical health and promoting healthy lifestyles.

Cardiovascular disease

Cardiovascular disease (CVD) currently causes 16.7 million, or 29.2% of all deaths globally. By 2010, CVD will be the leading cause of death in developed countries (WHO, 2003) and is rapidly becoming the leading cause of death in the developing world (WHO, 2005). In addition to risk factors such as age, gender and family history that can not be modified, CVD is also associated a number of other risk factors including: obesity, hypertension, smoking, diabetes, hyperlipedemia, lack of exercise and

Reasons for poor physical health in people with SMI

There are a number of reasons why people with SMI may experience physical health problems.

The monitoring of the physical health of people with SMI

There is no consensus about the type and frequency of physical health assessment and monitoring in people with SMI, although a number of guidelines exist that may inform practice (Marder et al., 2004; NICE, 2002). Generally poor levels of knowledge and skills about physical health monitoring in the workforce may contribute to the poor physical health of people with SMI. For example, in a survey of 640 practice nurses in the UK (Gray et al., 1999), 61% were involved in delivering mental health

Conclusion

The causes of poor physical health in people with a severe mental illness are complex and interactive. Whilst adverse effects of medication have a significant impact, health behaviours of people with SMI and the lack of training health professionals receive have a part to play. Mental health nurses have an opportunity to improve the physical and mental health of people with SMI through systematic monitoring and collaborative health promotion interventions initiated at the onset of people's

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