Improving Physical Health for People with Serious Mental Illness

Running head: MENTAL HEALTH
Topic: How physical health could be improved for people with serious mental illness?
Name of the student:
Date of submission:
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1MENTAL HEALTH
Acknowledgment
I wish to acknowledge that conducting this particular research has been most
enriching experiences of my academic life as it increased my knowledge base and
analytical skills considerably. It provided me the opportunity to experience the new
challenges in research writing. All this, would be impossible without the dedicated
support that I have received from my professors, seniors and friends. I would like to take
this opportunity to thank my supervisor for his constant guidance and support and
encouragement. The constant support received from him has been extremely inspiring.
It has enlightened me with the thought process of the research.
Warmest wishes,
Yours Sincerely,

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Table of Contents
Abstract:........................................................................................................................... 2
Introduction:..................................................................................................................... 3
Background:..................................................................................................................... 3
Methodology:....................................................................................................................5
Findings:.........................................................................................................................12
Discussion: ....................................................................................................................12
Strength and limitation:.................................................................................................. 12
Conclusion: ................................................................................................................... 12
References:....................................................................................................................13

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Abstract:
Aim: The aim of the research is to conduct a literature review to investigate about ways
to improve physical health of people with mental illness.
Background: The topic is considered important because of increase in mortality and
morbidity of patients with SMI because of chronic physical health issues. Poor physical
health for this group has been found because of many reasons and investigating
patient’s and staff’s perception regarding possible solution to minimize physical health
burden is considered important.
Methods: The extended literature review was done by conducting search for literature in
CINAHL and Medline database. Papers published between the year 2010 and 2019
was analyzed and the papers were selected based on screening and eligibility process.
The inclusion and exclusion criteria and review of full text helped to identify articles
eligible for the literature review.
Findings: Six articles were found relevant to the research question and it gave rise to
four themes. The four themes included need for physical health training of staffs,
physical health monitoring, collaboration between health care staffs and role of GP and
case managers in physical care of people with SMI.
Conclusion: The study gives the implication to develop skills of staffs and give them
educational packaged related to physical health. It suggests the need to collaborate with
GPs and case managers to reduce physical health risk for people with SMI.

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Abbreviation table:
SMI Serious Mental Illness
NHS National Health Service
DSM-IV Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition
PICO population, intervention, control and
outcomes
CASP Critical Appraisals Skills Programme
AGREE Appraisal of Guidelines for Research &
Evaluation Instrument
JBI Joanna Briggs Institute
PRISMA Preferred Reporting Items for Systematic
Reviews and Meta-Analyses

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Introduction:
Mental disorders like dementia, schizophrenia and others are regarded as one of
the leading cause of ill-health and disability worldwide. The magnitude of the burden is
understood from the increased risk of physical illness and high mortality rate in such
individuals (World Health Organization 2018). People with serious mental illness (SMI)
have been found to have higher rate of chronic disease compared to the general
population. The increased morbidity and mortality rates associated with SMI creates
additional burden for health care and nursing staffs (Walker, McGee and Druss 2015).
The common reasons cited for poor physical health includes service related factors like
inappropriate assessment, illness related factors stigma, poverty and cognitive deficits,
health behaviours such as smoking, poor diet and lack of exercise and obesity (Robson
and Gray 2007). This shows that paying attention to physical health of people with SMI
is critical and evaluating interventions to improve physical health is vital. The evidence
suggests the need to conduct in-depth exploration of research literature and find out
best possible ways to promote mental health of the target population review. Literature
review method can help to identify health promotion interventions that can be initiated at
the onset of the disorder. The extended literature review paper gives an insight into
background information on the research topic, rationale for conducting research in this
area and methods used to identify and extract information from relevant databases. The
research paper gives details regarding the key findings from thematic review and
implications and recommendations for practice improvement, education and
management. The most vital aspect that is covered through this literature review is that
it gives a conclusion regarding application of the findings to target population or target
setting and recommending future research needs.
Background:
Schizophrenia, bipolar disorder and major depressive disorder are types of
severe or serious mental illness (SMI) that contributes to long term care burden and
physical health issues for affected people (Lee, Rothbard and Choi 2016). Improving
health care provision for people with SMI need to be prioritized as this group has two-

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three times high mortality rate compared to the general population (De Hert et al. 2011).
Research evidence mentions that physical illness is the major contributor of excess
mortality rate as physical illness contributes to 60% of the death in people with SMI (De
Hert et al. 2011). Bartels and DiMilia (2017) indicates that people with SMI are
exposed to high rate of chronic physical health issues like diabetes, respiratory
disorders, cardiovascular disease and obesity, tuberculosis and HIV. Scott et al. (2016)
investigated about the association between DSM-IV mental disorders and 10 chronic
physical illnesses in 17 countries and statistically significant association was found. The
study confirmed that mental disorders of all types are associated with increased onset
of chronic physical illness. These data implies that these groups possess many unique
risk factors that make them susceptible to physical illness and current interventions for
the group are narrowly focused. As this would contribute to additional burden for mental
health nurses and people with SMI, researching on the reasons for such disparities and
finding the way forward to minimize physical illness in the group is important.
The evidence on physical illness in patients with SMI brings the question about
what might be the reason behind such health disparities in the population. De Hert et al.
(2011) justified that higher prevalence of modifiable risk factors itself is not the cause of
poor physical health of people with SMI. Instead such disparities are seen because of
disparities in health care access and utilization and health care provisions. Individual
lifestyle choices, psychotropic medications and psychiatric symptoms are the reason
behind disparities in health care. Another argument given by Vancampfort et al. (2015)
regarding the reason behind the high rate of mortality gap between patients with SMI
and the general population is that several risk factors combine to affect health of the
group such as physical inactivity and smoking. The use of anti-psychotic medication is
regarded as a burden of long term physical health conditions in the group. This is
supported by Thomson, Hall and Shah (2016) too which explains that antipsychotics
contribute to many physical health side effects. Other barriers to health in people with
mental disorders include cognitive problems, fragmented service, poor health literacy
and social isolation. Hence, this suggests that poor physical health associated with
mental illness is mainly due to inappropriate use of health care service and inadequate
quality of care. Physical health issues in people with SMI is considered an important

7MENTAL HEALTH
research problem and conducting research in this area would help to identify useful
interventions to reduce the mortality gap and health status of the target population.
As there are many strong evidences regarding the prevalence of physical health
issues in patients with SMI and its impact on mortality rate, the rationale behind
focusing on this topic is understood. The research question that guides this research
process includes ‘How physical health could be improved for people with serious mental
illness?’. To find solutions to the research problem, it is necessary to evaluate whether
current treatment are accurate for the recovery of people with SMI or additional health
promotion tactics are needed to resolve the problem. The main aim of the research is
to evaluate interventions or strategies that could help to prevent physical illness in
people affected by serious mental disorder. Based on the research aim and objective,
literature review is considered the best method to evaluate interventions in mental
health practice. Extended literature review method can be the best option to investigate
about the topic as it can help in comprehensive assessment of interventions
implemented to improve physical health of people with SMI. It can help to explore new
ideas that may require further investigation and identify innovative ways to resolve the
research problem (Hart 2018). Literature review is necessary to embrace evidence
based practice and move one step ahead towards advancing quality and safety in the
specialty area of mental health. Smith and Noble (2016) revealed the significance of
literature review by reporting that it helps in summarize and interpreting large body of
research literature thus promoting evidence-based practice. Therefore, literature review
is likely to uncover answers to the research question and inform mental health care
professionals about the best available interventions to promote health and well-being for
people with SMI.
Methodology:
Introduction:
This section provides details regarding the methods used to search literatures
and find relevant articles for the review. The process of developing search question and
the search strategy used for retrieving articles has been discussed. The section gives