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Catching those who slip through the net

Story Code: 08-011111
High mortality rates and the poor physical health of people with serious mental illness is overlooked in policy, writes Brenda Happell.

"There has never been a mental health equivalent to the likes of Slip, Slop, Slap; 30 Minutes a Day; or 10,000 Steps.  The reality is that mental health is not yet really on the radar."

On October 10, the first day of Mental Health Week, CQUniversity officially announced my position as the Engaged Research Chair for Mental Health Nursing.  The strategy behind this chair is to improve the research performance of the university through strategic and focused research with demonstrable outcomes for our broader professional and public communities.

Engagement is key - the research must involve collaboration with and clear benefits outside the university walls. My appointment reflects an important recognition that mental health is equally important to physical health and that nursing has an important role in the promotion and restoration of mental health within our community.

As a mental health nurse, and particularly throughout my academic career, I have been motivated by the desire to see a substantial improvement in what must be one of the worst health inequalities in contemporary Australian society.

To suggest that mental health is equally important to physical health sounds pretty reasonable, but despite some gains in raising public awareness, stigma and discrimination against people diagnosed with a mental illness continues to pervade society. Often it is subtle, almost unconscious. Most people would not be surprised to know that people with mental illness are less likely to be employed, have affordable housing, fulfilling relationships and a sense of well-being and happiness.

Most would agree that the availability of mental health services is insufficient to meet demand and many people are simply not able to access what they need to promote their recovery from the potentially debilitating effects of mental illness. Yet significant gaps remain in how we address these issues at broader policy levels.

We hear so much about the road toll but how many are surprised to hear the number of people who commit suicide is significantly higher? And that is the known and successful suicides, not accounting for unsuccessful attempts and those deaths officially recorded as accidental.  Health promotion activity aimed at mental health is sporadic, there has never been a mental health equivalent to the likes of Slip, Slop, Slap; 30 Minutes a Day; or 10,000 Steps. The reality is that mental health is not yet really on the radar.

If attention to mental health is problematic, attention to the physical health of people diagnosed with a mental illness is diabolical.  I expect many of you will be shocked to know that a diagnosis of mental illness equates to a reduced life expectancy of 20 to 25 years as a direct result of treatable physical health conditions.  In my experience very few people, even those working in mental health are aware of this, in itself an alarming revelation.  A problem needs to be known before it can be addressed.  In what other area of health would this silence remain and these figures be tolerated? Sadly, far from improving, this silent problem is worsening over time.

Addressing the physical health needs of people diagnosed with mental health is a fundamental research priority for my new role, with the support of fellow team members Dr David Scott, Chris Platania-Phung and Janette Nankivell, and clinical support from my colleagues from the Central Queensland District Mental Health Service, a strong research agenda will be developed.  This will build on work already underway.

To date, the team has undertaken an extensive search of the literature for information to help us understand the nature and extent of the problem as well as looking for possible strategies for change. The identified problems are both numerous and complex.  What did become clear though was despite claiming holistic care as the ethos of nursing practice, there is a limited contribution by nurses to identifying and addressing this problem in the published literature.

Because nurses have so much capacity to influence mental health practice, solutions to improving physical healthcare for people with mental illness must start with them. With the support of CQ District Mental Health Service we have recently completed data collection for a qualitative exploratory study of the views of nurses in mental health settings to physical health issues and the provision of physical healthcare.

Focus groups were conducted with 38 nurses, employed across inpatient, community and specialist settings.  The nurses described a common co-occurrence of physical problems and mental illness such as obesity, diabetes, sexually transmitted diseases and infections. It was suggested these high rates of physical illness resulted from the side effects of anti-psychotic medication, lifestyle factors, access (or more accurately lack of access) to doctors, stigma, geographic distance and socio-economic disadvantages.

Interestingly, while some nurses felt the physical care role of mental nurses could be increased and more systematic approaches to prevention were called for, others were ambivalent. It was consistently stressed that resources and better quality communication among stakeholders would be fundamental to improving services, health outcomes for consumers, and nurses' capacity to contribute to those outcomes. The participants made it really clear that they don't want yet another task added to their already heavy workloads, or yet another form to complete and file.  Most of all, they don't want to establish a system of detection and referral if the services to refer to simply don't access.

Of course we never expected the answers to be easy, but this work has strengthened our resolve that nurses are well equipped to make a difference to this health inequality, thankfully they have reminded us of the systemic nature of the problem and the need to focus at an organisational level rather than looking for a quick fix that simply won't go the distance.  So the challenge lies ahead.

The appointment of Engaged Research Chair in Mental Health Nursing is an exciting opportunity to collect energies towards a common goal - watch this space.

Professor Brenda Happell is the Engaged Research Chair in Mental Health Nursing and director of the Institute for Health and Social Science Research, CQUniversity.

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