Mental health network

Hope not hopelessness: Improving physical healthcare for individuals with severe mental illness | Linda Nazarko

MHN 19

To help those with mental illness live long and healthy lives, Linda Nazarko, nurse consultant physical healthcare at West London NHS Trust, argues a culture change is needed so staff in mental health give the same attention to a person’s physical health as they do to mental health.

The NHS has come a long way since its inception in 1948. The average life expectancy in the UK is now 80, an increase of over ten years during the NHS’s lifetime. Then, infant and perinatal mortality were high and people were dying of infectious diseases. Now immunisation programmes protect people from illnesses such as diphtheria, polio and shingles and the introduction of antibiotics has reduced mortality rates for communicable illnesses. The NHS is now able to treat diseases that would once have killed. We are able to offer treatments such as renal dialysis, in vitro fertilisation, joint replacements and organ transplants, all free at the point of delivery.

The NHS faces unique challenges, some as a result of the innovations that have transformed illnesses that were once life-threatening, such as heart failure, into manageable long-term conditions. Some of the challenges that the NHS faces are because, although it has succeeded in treating illness, it has failed to promote health. This is a particular issue for people with severe mental illness. The life expectancy of someone living with schizophrenia in the UK is some 15-20 years shorter than someone without a mental illness: it is equivalent to the average life expectancy in the UK in the 1950s.

Despite the NHS’s progress, the health of the nation is poor and is getting worse, not better. A minority of British adults are of normal weight while most are overweight or obese and therefore at increased risk of illness. Adiposity and inactivity increase the risks of ill health caused by conditions such as hypertension, type two diabetes, osteoporosis, vascular dementia, renal, circulatory and ophthalmic problems while inactivity increases the risk of falls in older age. Improving the prognosis can be relatively simple: losing excess weight can reduce blood pressure and eliminate or delay the need for joint replacement.

People with mental health problems experience greater levels of ill health than the general population, including increased risk of: ·        

  • hypercholesteraemia (500%)
  • hypertension (300%)
  • diabetes (2-400%)

Our task as a health service is to help people to live long and healthy lives. Many conditions that cause ill health are preventable. Currently there are 3.59 million people in the UK living with type two diabetes; most of those cases could have been prevented. Diabetes increases the risk of cardio metabolic diseases such as stroke, heart attack and increases the risk of blindness and kidney failure.

Adults need to maintain a healthy weight, remain active, eat a healthy diet, abstain from smoking and limit the amount of alcohol consumed. This requires NHS, government, public health, town planners and employers to work together to promote health.

Those of us working with people with people with mental health problems can screen and intervene when we identify physical health problems and work with our patents to help them prevent illness, or, when conditions have developed, to manage them well.

Although we’ve known about the mortality gap for some time it can be difficult for organisations to move from aspiration to implementation. Education alone is not enough. What is required is a culture change so that staff working in mental health give the same attention to a person’s physical health as they do to mental health. Leadership at the highest level is required and change must be supported by systems and processes to make physical health visible in mental health settings. My presentation at the Mental Health Network 2019 annual conference and exhibition will outline our journey in West London NHS Trust and what we have learnt.

Linda Nazarko is nurse consultant physical healthcare at West London NHS Trust. You can follow the trust on Twitter @westlondonnhs

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