What’s the problem?

People are increasingly aware of what it means to face a mental health crisis, or to live with an ongoing mental health problem. However, it is less widely known that rates of physical illness among people with long-term mental health conditions are among the highest of any group in society. It may shock you to learn that according to World Health Organization figures, the lifespan of a person with severe mental health problems is as much as 20 years shorter than that of someone without. This morbidity can mostly be accounted for by physical health conditions such as heart disease, cancer, and diabetes.

We know that these conditions are influenced by modifiable lifestyle factors such as smoking, substance misuse, and obesity, and that some of these factors are far more common among people with mental health conditions. For example, people with schizophrenia are between 3 and 4 times more likely to be heavy smokers than people who are not affected by such disorders. Inequalities of outcome, like shorter lives and frequent ill-health, are unlikely to change without effective lifestyle interventions, but these interventions are rarely considered across mental healthcare settings as part of an individual’s treatment.

So what are mental health nurses doing about this?

Mental health nurses often have a trusted role, developed from building long-term therapeutic relationships with their patients. They can make significant contributions to reductions in physical ill-health burdens for those with severe mental health problems by addressing several common lifestyle risk factors. However, nurses working in the specialty have traditionally focused only on mental health issues, and may have lacked the knowledge and skills necessary to make an impact on physical health.

What did we do?

We wanted to know if mental health nurses across the globe are ready for the challenge of improving their physical healthcare skills. We conducted a systematic search for published studies discussing mental health nurses’ attitudes and knowledge of routine physical healthcare interventions that can contribute significantly to improving the health of people suffering from mental health conditions. We wanted to determine what nurses know about these issues and their attitude towards them. Specifically, we investigated whether nurses saw physical healthcare as a key part of their role. We also aimed to determine if they felt they had the knowledge and skills to provide routine physical healthcare, and to identify which methods of training show the greatest improvement in the provision of physical healthcare. We rated the quality of each study to ensure the strongest research was given the most consideration.

Going forward, we need to determine the most effective ways of training mental health nurses to deliver physical healthcare.

What did we find? 

This is a fast-growing area of research interest: we found that more than 40 studies have been carried out over the last 25 years, with 31 of these published since the year 2010. The studies we reviewed included over 7,500 mental health nurses internationally. To the best of our knowledge, this represents the largest accumulation of research about mental health nurses’ experiences of any single subject ever published.

We found that mental health nurses were generally positive about their need to be involved in meeting the physical health needs of the service users they worked with. They saw it as a central part of their role, but some lacked confidence and specific skills. Perhaps unsurprisingly, those with more positive attitudes were inclined to deliver more physical healthcare. However, studies investigating the effectiveness of training mental health nurses to deliver effective physical healthcare interventions lack rigor, and more work is needed on this.

Interestingly, of all the studies we investigated, UK-based nurses were most positive in their attitudes – more so than those in Australia and some Asian countries. This may be considered surprising as mental health nurse training in the UK is considered more specialized than in many other countries, with more time spent focusing on mental health than physical health.

What does this mean?

These findings are good news insofar as nurses in this specialist field recognize and value the role they can and should play in improving health outcomes for this marginalized population group. However, there is still work to be done to improve their knowledge, confidence and skills. There is much less research about how we can do this successfully. Going forward, we need to determine the most effective ways of training mental health nurses to deliver physical healthcare. Further, specialist pre-registration in mental health, like that observed in the UK, does not seem to disadvantage nurses in terms of their self-rated physical healthcare skills.

What would be the benefit for patients? 

Mental health nurses require more skills in the delivery of interventions to address lifestyle issues. If they felt better prepared to deliver smoking cessation, alcohol-related advice, weight management, and sexual healthcare, then, over time, we confidently predict improvement in the current statistics of poor physical health of people with mental health problems. Ultimately, along with other advances in care, we would expect to see people with long-term mental health problems living progressively longer and healthier lives.