Despite evidence that people with mental illness have poor physical health, the healthcare system tends to provide care separately. Integrating mental care and physical care with mental health nurses at the centre could transform patient outcomes.
The connection between mental illness and poor physical health is well recognised. People diagnosed with mental illness are more likely to have poorer physical health outcomes and to die younger than the general population, according to Equally Well, an initiative led by the National Mental Health Commission. Yet despite efforts to bring mental health into the mainstream, the health system continues to function separately.
“Mental health nurses tend to focus on mental health, and in the general healthcare system, the focus tends to be on general health, which leaves a lot to be desired,” said Brenda Happell, professor of mental health on the Faculty of Health at Southern Cross University.
Connecting mental and physical health
Although barriers remain, efforts are being made — with nurses at the centre — to address patients’ mental and physical well-being.
The Australian College of Mental Health Nurses (ACMHN) has established a dedicated entity called the Consultation Liaison (CL) Special Interest Group (SIG), to promote interest in CL nursing.
CL nurses seek to provide mental health care for people in general healthcare settings, such as hospital wards and emergency departments. The CL nurse works with patients and with other healthcare staff to ensure patients have their mental health needs met through proper assessment and intervention and by a guiding generalist staff in the care of patients.
Professor Happell noted that most hospitals in Australia now have mental health liaison nurses to support nursing colleagues in providing appropriate mental healthcare.
“Liaison nurses can help to upskill other healthcare professionals on identified mental health issues; for example, if there is an influx of young people with eating disorders, they may run a session on the causes of eating disorders and how to best relate to patients with such issues,” she said.
Professor Happell, who is also a life member, a fellow, and board director of ACMHN, has been at the forefront of efforts to integrate mental care and physical care. She led a study of the specialist mental health nursing role, the physical health nurse consultant (PHNC). The purpose was to have the PHNC coordinate physical healthcare and offer health-behaviour-change advice to people diagnosed with psychosis. Although the sample size of people involved in the program was small, Professor Happell said there were some promising outcomes, such as people losing weight, not gaining weight, or quitting smoking. Those outcomes are supported in an accompanying qualitative study conducted by Tracy Tabvuma, a board director at Australian College of Mental Health Nurses.
“Quite a few of the people who worked with the PHNC said this was the first time anyone had had a conversation with them about their physical health,” Professor Happell said, noting the pressing need for more such programs to guide people with mental health issues from the outset.
The challenge with connecting mental care and physical care
Despite these promising programs, Professor Happell said, the healthcare system remains compartmentalized, with separate structures and attitudinal barriers to overcome. “Mental health nurses acknowledge the connection between mental illness and poor physical health, but for various reasons, they tend not to address it,” she noted.
“Although some mental health nurses have taken it upon themselves to address the physical health challenges they see — for example, through screening — their initiatives are not embedded into practice and so tend to end if the nurses move into other roles or leave the organisation,” she said.
“Introducing PHNCs into mental health services would likely enjoy results similar to those obtained by CL nurses,” Professor Happell added.
Empowering mental health nurses
Currently, there is no requirement that nurses have specialist qualification to work in the field of mental health. However, the ACMHN is committed to a goal of nurses working in mental health to have credentialed qualifications or be studying for them.
“There needs to be a whole-system approach and a genuine desire to have healthcare of all kinds become more accessible,” Professor Happell said. “And from a nursing perspective, there needs to be an urgent revamp of the undergraduate curriculum to provide a specialist pathway for specialisation in mental health and to lay a good foundation in mental health nursing for RNs, who inevitably will encounter patients with mental illness.”
Nurse leaders can champion efforts to integrate mental health screening and intervention into routine health assessments and when patients present at hospitals and other health centres. Additionally, nurse leaders can foster a culture of understanding and support for patients with mental illness to help reduce stigma on the part of healthcare teams.
Organisations and nurse leaders can also serve by providing mental health nurses with the resources needed to enable mental health nurses to make informed clinical decisions to support patients’ mental well-being and to manage physical health issues.
Recognising those needs, Lippincott® Solutions has partnered with ACMHN to develop health-focused procedures for Australian nurses.
Find out more about how Lippincott® Solutions can support nurses in Australia’s healthcare settings.
