Improving the physical health of psychiatric inpatients at a mental health facility.

Case Study Submitted by: Amy Wallace
Country: Australia


Clinical Nurse Specialists are working to improve the physical health of people living with mental illness.

Case study

The context:

Statistics show that persons with a mental illness die up to 25 years younger than the general population due to preventable physical health conditions. Diagnostic overshadowing is proven to directly affect the physical health care mental health consumers receive and symptoms of physical illness are often disregarded as signs of their mental state. Preventable physical health conditions such as Metabolic Syndrome, type 2 diabetes, cardio-vascular disease, COPD are contributing to this widening life expectancy gap. The research is there, the knowledge is there, but the gap is widening.

The physical health of patients at menta heath dedicated facilities are often not the priority of care. Clinicians were aware of the poor physical health but were often unable to address this or lacked the knowledge of how to do this. Time constraints and short admission times also impacted on what care could be given.

The program:

The Wellness clinic is an essential service to help reduce the life expectancy gap experienced by mental health patients’ at Graylands Hospital, Western Australia’s largest mental health hospital. Assessing and managing preventable physical health conditions and having targeted approaches to physical health care goes a long way to reducing this gap at Graylands Hospital.

The Graylands Wellness Clinic was established in 2016 to meet both the physical and mental health needs of patients. The Wellness team has developed partnerships with other health services to ensure that people receive optimal care.

Nursing impact:

The CNS drives the service and all the associated projects. Nursing staff are proactive in adopting the initiatives and volunteering to assist and be representatives on associated committees.

In the 12 months prior to the launch of the Wellness Clinic 25 referrals to the General Practitioner were received. During the 12 months of the QI related to this project 101 referrals to the General Practitioner were received and a further 70 to the CNS totalling 180. The impact of this meant that now majority of consumers in the hospital had the opportunity to access physical health specific care at the hospital. Examples include:

  • 100% of patients screening for Metabolic Syndrome
  • Implementation of a sports therapy program as an alternative to standard treatment therapies. The group was widely successful with 118 participants over the 24 week trial. Subjectively mood and improved. Rates of seclusion and PRN use dropped for 6hrs post participation in the group.
  • Implementation of an ECHO cardiogram service for people taking anti=psychotic medication Clozapine. The clinic will run quarterly to ensure patients safety around Clozapine use.

Patient story

A 55yr old female presented with mania with psychotic features and appeared to be in relapse of her bi-polar disorder. It was discovered that she had in fact been taking large doses of corticosteroids for a prolonged period due to relapse of Rheumatoid Arthritis and Fibromyalgia and that her psychosis was steroid induced. While the team treated her mental illness symptoms, the patient identified her RA as the major concern in her life. Unable to have a walking stick on the ward, unable to have steroids which were reducing her inflammation and pain and unable to see her normal general specialists the patients’ wellbeing was significantly affected. The CNS PHC was able to facilitate an urgent physiotherapy review and a wheeled frame was provided to assist the patient to walk. The GP contacted her RA consultant and discussed alternative anti-inflammatory options besides steroids and liaised with the patient to help her decide what was best for her. Pain relief was charted and education around the safe use of this was given to the patient. The patient had her own regime of essential oils which were arranged to have in her cupboard to use as she desired. The above measures helped dissipate her anxiety, pain and inflammation and addressed her major concerns of the admission. The CNS PHC also used therapeutic use of self and disclosed their diagnosis of RA. The patient was so appreciative of having someone to speak with who understood her struggles and to give reassurance.

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