Enhancing Physical Health for SMI: A Comprehensive Literature Review

This literature review investigates methods to improve the physical health of individuals with serious mental illness (SMI), addressing the increased mortality and morbidity rates in this population due to chronic physical health issues. The review analyzes literature from CINAHL and Medline databases (2010-2019), identifying six relevant articles that highlight four key themes: the need for physical health training for staff, physical health monitoring, collaboration between healthcare staff, and the role of GPs and case managers in the physical care of people with SMI. The findings emphasize the importance of developing staff skills and providing educational resources related to physical health, as well as fostering collaboration with GPs and case managers to mitigate physical health risks. The review concludes by advocating for the application of these findings to improve healthcare practices for individuals with SMI and suggesting directions for future research to further enhance their well-being. Desklib provides access to this and other solved assignments to aid students in their studies.

Running head: MENTAL HEALTH
Topic: How physical health could be improved for people with serious mental illness?
Name of the student:
Date of submission:
Word count:

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

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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

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details regarding summary of search process using PRISMA flow diagram, data
abstraction and method of data analysis.
Research question:
Framing of a research question is the first step towards identification of answers
to the research problem (Creswell and Creswell 2017). A well-formulated research
question is the backbone of research and it provides the context based on which the
research must be conducted. For this literature review, the background information
related to the topic helped to identify the research question. The focus was to make the
research very, concise and focused so that research process can be effectively
implemented. The success of a research is dependent on how well a research question
has been formulated. A well-formulated research question is one which is extremely
specific, precise and identified specifics research variables and population of interest
(Doody and Bailey 2016). There are many frameworks available to formulate a suitable
research question. The most popular framework includes the PICO (population,
intervention, control and outcomes) framework that facilitates identification of relevant
information. PICO based research question helps to address specific population,
intervention and the relevant effect of that intervention (outcome) (Aslam and
Emmanuel 2010). Hence, if the question is able to identify a specific research problem
and point towards aspects which are missing, then it offers good deal of support in
conducting research.
For this literature review, consideration of risk in people with SMI helped to
complex clinical question. The main population of interest identified was people with
SMI and the key research variables included treatment of physical illness in the target
population group. The research question that was framed after identification of specific
research variables was as follows:
How physical health could be improved for people with serious mental illness?
The review of the above research question shows that unlike PICO based
research question, here the focus is not to evaluate just one intervention. Instead the
research question favours exploration of different types of interventions and finding the

9MENTAL HEALTH
best solution to promote physical health of the people affected by mental disorder. The
research question is suitable for an extended review as it would favour critical analysis
of those papers that suggest relevant intervention to address the burden of physical
illness in people with SMI.
Search strategy:
Formulation of keywords helped in searching for relevant articles in databases.
The important keywords were identified from the research question and the research
topic. The important keywords or phrases included ‘people with SMI’, ‘physical illness’,
‘management of physical illness and ‘treatment of physical illness in SMI’. After the
identification of keywords related to the research topic, other synonyms were used to
generate additional search terms. By the use of this approach other search terms found
for the literature review included ‘physical illness’, ‘chronic illness’, ‘intervention or
solution’, ‘health and well-being. As many database have advanced search filters,
Boolean operators like ‘AND’ and ‘OR’ was used to extract relevant research article.
‘AND’ was used when the purpose was to find both key terms in the research articles
and ‘OR’ was used to search for synonyms or alternatives in the same citation. Search
filters like year of publication and search field were modified to get relevant research
papers as per the inclusion and exclusion criteria. The following table shows how key
terms and concepts were combined to identify relevant articles for the literature review.
Concept 1 Concept 2 Concept 3

10MENTAL HEALTH
AND ANDPhysical health
OR
Physical health
outcome
Improvement
OR
Management
People with mental illness OR
mentally ill people OR people
with schizophrenia OR people
with mental disorder
While conducting search for research literatures, it is necessary to search for
more than one database to obtain all relevant papers that contributes to the research
question. The choice of database in this review was influenced by the research topic
and research question. As the research is related to the issues faced in management of
the field of mental health, those database were taken which published peer-reviewed
journal articles from the field of nursing, biomedical and allied health field. Some of the
important databases that were used for search included PubMed and CINAHL. The
main rational behind selecting CINAHL was that it provided access to full text for
nursing and allied health journals. Hence, searching in this database can help to extract
relevant articles related to the study objective. In addition, PubMed was selected for
article searching as it publishes journal articles and online books from the field of life
science and biomedical, nursing and pharmacy. Google scholar was used to select
relevant articles because it is easily accessible and it does not have any complex
search filters or features.
Inclusion and exclusion criteria:
As the main of the extended literature review is to identify and assess all the
research papers that give detail on interventions to improve physical health in people

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with mental illness, the inclusion strategy was to select only those papers that reports
about interventions or strategies related to preventing physical illness. Any paper
reporting about experience of SMI people with physical illness was excluded from the
review as those papers may not serve the purpose of research. Any research paper
published in foreign language was excluded. However, there was no restriction to
selection of paper based on location and age group of research participants. An
overview of the inclusion and exclusion criteria for selecting relevant research papers
were as follows:
Participants Only those papers were included which had history or current diagnosis of
SMI like schizophrenia, dementia and personality disorders. Others were
excluded.
Intervention The selection of article was not limited to any intervention as the main goal
of the extended literature review was to identify interventions that could
promote mental health of people with mental illness.
Type of study
design
Paper selection was not limited to any specific study design too. All types
of research design such as experimental, cross-sectional and longitudinal
studies were included. Both qualitative and quantitative designs were
taken. However, secondary research designs such as systematic review
was least preferred.
Target outcome Another inclusion criterion for paper selection was that that all research
papers must report about ways to improve physical health and well-being
in people with SMI. Articles reporting about mental health outcomes were
excluded.
Target setting The inclusion of article was not restricted to any locality or specific country
of choice. All types of research setting and research done in any country
were included in the extended literature review.
Language Only those papers were taken which were published in English. Articles
published in foreign language were excluded.
Publication To ensure reliability of the research findings, only those papers were
included which were published between the year 2010 to 2019.
Data extraction: