Research exploring the user perspective revealed that professionals often fail to view clients holistically despite the link between mental and physical health. Users viewed losing weight as the single most important motivator for attending lifestyle interventions identified by users, and identified the importance of peer and staff support, and building relationships, and they valued the environment, context and the role and characteristics of the healthcare professional delivering key lifestyle interventions.
From a provider perspective, incentives have been identified as increased knowledge and skills, facilitated through the provision of post-registration training, improvements in the quality of patient care, and increased morale and job satisfaction for nurses. In the context of wider society any decrease in the mortality of those diagnosed with severe mental illness lies in the reduction of inequalities and disparities in service provision, and the enhancement of the human rights of this section of the population.
System related barriers identified included the separation of physical and mental health services leading to fragmentation of services. Organisation level barriers include a continued emphasis on the biomedical model which focuses on ill-health rather than health promotion, diagnostic overshadowing, and continued stigma associated with mental illness.
Individual level barriers include professional attitudes, client behaviour and lifestyle choices, and user non-compliance with advice on medication. Diagnostic overshadowing is identified as significant, with the factors contributing to it include poor communication, client behaviour, overcrowding and noise in the emergency department, and the stigmatising attitudes of staff. Another barrier is the lack of consensus regarding the frequency and type of monitoring required, and although guidelines and policies exist, these are not always implemented.
Proposed solutions have been identified on a continuum of system, organisation and individual levels. At the system level these include the re-integration of physical and mental health services. Organisation level solutions include the provision of post-registration training and education and the introduction of specialist nurses into mental health settings. At the organisation and individual level, proposed solutions include the use of checklists and tools, the implementation of guidelines and policies, and a greater emphasis on health promotion intervention
The integration of physical and mental health services could be facilitated through better co-ordination and active engagement with the physical health of patients with mental illness through the development of GP-led clinics with health community teams attached to them. This would facilitate greater involvement of psychiatrists and the development of shared care to establish full integration between physical and mental health services.
Another solution is the provision of specialist nurses in mental health settings to support MNHs to assess and monitor the physical healthcare needs of their client population, where MHNs work more closely with their colleagues in general health settings. In addition, nurses identified a need for a more robust inclusive system, where clear guidance, information and policies are easily accessible. Other solutions have been identified as checklists and tools, including the Health Improvement Profile (HIP).