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Metamorphosis - or how to de-bug care for people with mental health problems in general hospitals

Alex McClimens and colleagues argue for 'cross-fertilisation' between fields of practice to ensure people with mental health problems and learning disabilitlies get appropriate physical healthcare.

Alex McClimens and colleagues argue for 'cross-fertilisation' between fields of practice to ensure people with mental health problems and learning disabilities get appropriate physical healthcare


Picture: iStock

Dear Reader, picture the scene… you wake up one day, in the style of Gregor Samsa in Kafka's novel Metamorphosis, and the realisation gradually dawns as the day progresses and you drop everyday objects, spill drinks and otherwise come across as terminally clumsy, that you have somehow become… horror of horrors... left-handed!

An emergency medical consultation reveals that this is a permanent feature. You stare into the mirror at the miserable creature you have become and begin to appreciate that your life will never be the same again.

During a difficult period of readjustment, you start to notice that the world is designed by right-handers, of right-handers, for right-handers. Undaunted you decide to publicise this blatant discrimination. You write a 'letter to the editor' (after swapping the mouse to the other side of the keyboard, obviously) of a big, shiny academic journal (with a green cover) to highlight the injustice of your situation. If the right-handed people could just be made aware of the left-handed world then perhaps the existing legislation that promotes parity of esteem would be more effectively enforced leading to better outcomes for all.

The rejection email is swift and decisive. Dear Lefty, it begins, we are a right-handed journal. Perhaps you sent this to us by mistake? We suggest you try one of the lesser, niche, smaller circulation, specialist journals that cater for your particular 'disability'.

Discrimination effect

Now that was by way of a parable. What comes next is real. People with mental health problems routinely report discrimination, being on the receiving end of stigmatising behaviour and attitudes, and generally getting sub-optimal care when they seek medical assistance in general hospitals up and down the country. It's happening in an emergency department near you, right now. Three things are happening in parallel and they affect us all. Here's how:

  • Thing one: there is widespread prejudice against people with mental health problems. It becomes very apparent when they present in hospital for perfectly legitimate clinical/medical reasons unconnected with their psychiatric diagnosis. Often (but not always) the clinicians they meet are ignorant and fearful.
  • Thing two: part of the reason for thing one is that nurse education is divided into adult, child, mental health and learning disability fields. That's okay as far as it goes, but when a clinician from one field has to care for a patient from another field, then there is the potential for things to go wrong. If you want to know how wrong they can go (and we're talking dead wrong), read the Six Lives report (Parliamentary and Health Service Ombudsman 2009).
  • Thing three: all practising academics are contractually obliged to publish in order to disseminate new knowledge and keep practice current. But the journals they publish in are often aligned with clinical specialisms or methodological approaches, so getting the message from one silo (let's call it mental health liaison nursing) into another silo (let's call that one adult field nursing) can be tricky.

Now hear this. I confess we wrote an article about mental health liaison nursing and sent it to a big, shiny academic journal (with a green cover). It was, we knew, a right-handed journal and we were sending them a left-handed article. We did this because the mental health nurses we spoke to in the evaluation we were doing were clear that the message needed to go to adult field nurses and that patients with mental health problems were getting a rough deal when they ended up in hospital. The big, shiny academic journal (with the green cover) wouldn't even contemplate the article and suggested we send it somewhere more 'appropriate'.

For the benefit of the patient

But we are optimistic that this situation can be resolved. In the hospital where we did our fieldwork the nurses (and some doctors) who we spoke to and who were not educated and trained in the care of people living with mental health problems were aware of their ignorance and were keen to learn. The presence of a mental health liaison team was beginning to have a positive impact on attitudes to care and treatment.

But don't get too complacent. For every story we heard about clinical staff failing to differentiate between delirium and psychosis, there is a parallel tale where mental health nurses couldn't tell their arsenic poisoning from their elbow.

And the take-home message – clinical and nursing knowledge is for patient benefit. And patients will benefit more when this knowledge is shared. Bridges, not barriers.

The Parliamentary and Health Service Ombudsman (2009) Six lives: the provision of public services to people with learning difficulties 2008 to 2009


About the authors

Alex McClimens is is a senior research fellow at Sheffield Hallam University

Mubarak Ismail is a researcher at Health and Social Care, Sheffield Hallam University

Shona Kelly is professor of interdisciplinary health research at Sheffield Hallam University

Jeff Breckon is a reader at Sheffield Hallam University

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