A holistic approach to practice is widely considered a defining and distinguishing characteristic of the nursing profession. We need only to look at the statistics reporting physical health of people diagnosed with mental illness to see that indeed we have a very long way to go before we can claim to deserve this descriptor. Compared to the general population, people with psychosis are two to three times more likely to develop physical health conditions and likely to die 10–25 years sooner. Preventable physical illness accounts for approximately 80% of premature deaths. These alarming statistics require immediate attention.
People accessing mental health services are entitled to receive the same standard of health care as anyone accessing any component of the health system. Whether services are accessed for childbirth, surgery, injury or chronic disease, nurses play a crucial role in ensuring the standard and quality of healthcare. Nurses almost universally comprise the largest component of the professional health care workforce, and in most settings provide the majority of frontline care. We are therefore well positioned to contribute to solutions. With this in mind, I welcome you to this special issue on physical health and mental health care.
It was great pride and enthusiasm I accepted the opportunity to guest edit this special issue. Physical health care and treatment within mental health services is a great driving passion of mine as a researcher, mental health nurse and community member strongly believing in human rights. When I learned the appalling statistics about the physical health of people diagnosed with a mental illness, I was shocked and horrified. I also discovered these statistics, until recently, were not well known among many health professionals, and understandably even less so with in the general population.
By far the largest causes of death for people diagnosed with mental illness are attributable to preventable physical illnesses. Failing to prevent the deterioration in physical health associated with a diagnosis of mental illness is something we can no longer ignore or tolerate. We can no longer label it as someone else’s problem and confine our role to the mental health domain. While our profession rightly specialises in mental health care, as nurses our priority must be health, genuine person-centred, holistic health care. My own research has clearly demonstrated that for people diagnosed with mental illness, the division between the physical and mental components of their health is quite artificial. They are concerned about their health, with every aspect of their illness being equally important and preferably in balance. This perspective fits perfectly with nursing’s philosophical approach to person-centred and holistic health care. The time to move this from rhetoric to reality is well overdue.
Increased knowledge of these physical health statistics has created discomfort and ethical dilemmas for nurses in mental health settings. They are clearly aware that some treatments, while aimed at improving mental health, will have a deleterious effect on physical health. At present our health systems do not work well together to ensure mental and physical health care are given equal preference. Our health systems tend to be fragmented and lack clear coordination. The highly specialised nature of services tends to focus on the admitting diagnosis with much less attention devoted to other aspects of health and well-being that form the essence of being human. There are no easy solutions to such complex problems and yet solutions must be found as a matter of urgency. This special issue is presented as one small step in that direction.
The papers included in this special issue shed light on the complexity and diversity of the underlying problem and potential solutions. Topics addressed in this issue are broad ranging and include: attitudes of nurses towards providing physical health care; prevalence of physical health co-morbidities in people diagnosed with depression and anxiety (particularly important given the general focus on psychotic disorders in relation to physical health research); identifying the problem and evaluating interventions for specific physical health concerns including smoking, physical activity and diet; and identifying and addressing barriers to physical health screening by co-locating phlebotomy facilities within mental health services. Broader perspectives of key stakeholders are included through a qualitative study of parents of young people accessing mental health services. The capacity of mental health nurses to positively impact physical health care is demonstrated through specific interventions and specialist roles. It is so pleasing to capture a strong geographical spread with manuscripts from Australia, Germany, Ireland, Portugal, Turkey, Sweden and the United States. This emphasises the universality of the problems we share and enables us to learn from experiences throughout the world.
I hope to see these papers widely read and widely cited and most of all I present them as a call to action. To the reader I say whether you are an academic, clinician, manager, policy officer or any other role within the mental health workforce, there is something you can do to address this problem. Whether it be at the individual level or implementing change in policy and practice, whether it be chipping away at the entrenched culture that sees healthcare separated into component parts, we can all do something.
I hope you enjoy reading this issue as much as Sandra and I enjoyed compiling it. My thanks to Sandra Thomas for this wonderful opportunity. Our sincere gratitude to the authors who contributed their work and responded so positively to feedback and suggestions. Please read, cite widely and share these articles with your colleagues.