Nurses are pivotal in closing the mental health mortality gap, says RCN

Nurses have key role in achieving physical health equality for people with serious mental health needs

    RCN report puts nurses at the centre of efforts to achieve physical health equality for people with serious mental health needs

    • People with serious mental illness are likely to die 15-20 years younger than the general population
    • This is often due to physical health problems that either go undiagnosed or are managed poorly
    • The RCN aims to raise awareness and knowledge among nurses, while funding and service design are also vital
    MH health check
    Picture: Alamy

    Nurses have a critical role to play in addressing the mortality gap between people with serious mental illnesses and the general population, but need support, says an RCN report.

    Delivering physical health equality for those with serious mental health needs is an urgent issue, given that those with a serious mental illness can die 15-20 years younger than the general population.

    Discrimination, stigma, long-term use of medication with severe side effects, unconscious bias and lack of knowledge and understanding on the part of staff are all contributing factors.

    Funding and service design are also vital.

    Raising awareness

    Donna Kinnair
    Dame Donna Kinnair

    The RCN report, Parity of Esteem – Delivering Physical Health Equality for those with Serious Mental Health Needs, suggests that working in a more integrated way will help address the mortality gap.

    15-20 years

    Mortality gap between people with serious mental health needs and the general population
    World Health Organization

    Chief executive Dame Donna Kinnair says: ‘The best and most effective way to bring about changes in our systems is through collaborative efforts across many organisations. Nursing staff have a critical role to play in closing the current mortality gap.

    ‘We are working across the four countries of the UK to ensure that nurses are equipped with the knowledge, skills and resources to achieve equality across mental and physical health care for those with serious mental health needs.’

    Seamless collaboration

    Angela Willan, physical health facilitator nurse at 2gether NHS Foundation Trust, which provides specialist mental health and learning disability services in Gloucestershire and Herefordshire, says it is ‘simply unacceptable’ that there is still a mortality gap.

    ‘Largely this is due to physical health problems that often are not diagnosed or managed effectively,’ she says.

    ‘There should be seamless collaboration between primary and secondary care to share information, and to provide regular physical health screening for all service users.’

    London development nurse Dan Brown adds that there are many examples of where acute trusts and specialist mental health trusts are not working together effectively.

    He says: ‘There are few shared services, with few mental health lead nurses within acute care.

    ‘There also seem to be real challenges for all wider services, outside a mental health context, taking responsibility for addressing gaps in physical health provision.’

    Too much variation

    1 in 3

    of the 100,000 people who die prematurely each year in England has a mental health problem
    British Medical Association

    While there are many examples across the UK of good practice in mental health and general nursing settings, the RCN report highlights that there is too much variation.

    ‘Nurses tell us... that services are still inconsistent, not always readily available and often don’t work together across a whole pathway to support people in their own communities to make health and lifestyle changes,’ it states.

    ‘There is also a need to emphasise the value of nurses in delivering a wide range of physical interventions, particularly the competencies and skills required, to support those with serious mental health needs.’

    How can nurses make a difference?

    Enquiring about someone’s physical and mental health needs is a simple yet effective intervention to help generate conversations about holistic needs.

    • Ask what your local service is doing to integrate its services for those with serious mental health needs. Research shows joined-up pathways and services shape their experience and outcome
    • Ask what your service is doing to support the physical and mental health needs of its users. Parity of esteem is equally important for anyone in any setting
    • Ask what your service is doing to develop specialist roles, such as that of advanced nurse practitioners, that can support working with people holistically
    • Ask what evidence-based tools, such as the Lester Tool and the Health Improvement Profile, are used to measure and help improve physical health outcomes for people with serious mental health needs
    • Ask the ‘so what?’ question. Knowing someone has had a physical health check is one step. Also consider what interventions may be required, what information they may need and what future community-based service could help them improve their health
    • Ask what your service is doing to develop health promotion roles. Nurses have an important role, through coaching and behaviour change conversations, in helping people make positive lifestyle changes


    What nurses should expect

    Catherine Gamble
    Catherine Gamble. Picture: David Gee

    The RCN says nurses should expect:

    • Workplace activities to increase awareness, knowledge and skills, through post-registration training and good supervision in practice.
    • Good access to services and information that support people with mental health needs in physical health settings.
    • Environments that are well equipped, for example with clinic spaces and equipment, to carry out physical health checks.
    • Reasonable adjustments to be made in wider community settings, such as those that provide primary care, to enable people with serious mental health needs to receive the right checks at the right time.
    • Wider health, social and community resources to help those requiring support make positive lifestyle changes.

    RCN professional lead for mental health Catherine Gamble adds: ‘Harnessing the knowledge, skill and ability of our nurse members to work in new and innovative ways is an important part of addressing this complex issue.’

    Integrating mental and physical healthcare

    King’s Health Partners, an academic health science centre, is completing an ambitious nurse-led programme to integrate mental and physical healthcare systems across South London and Maudsley NHS Foundation Trust (SLAM).

    The three-year project is aimed at establishing sustainable systems and shared pathways to support the integration of mental and physical health.

    It aligns with SLAM’s physical health strategy to tackle premature mortality and is funded through a three-year charitable grant.

    There are three work streams:

    • A physical health improvement and implementation team
    • Volunteer health champions
    • Health Locker, which provides a digital platform to improve consistent provision of information and resources

    SLAM director of nursing Beverley Murphy says nurses are well placed to shape development of the project as well as enable change to be translated into everyday business activity.

    ‘The broader nursing workforce in SLAM will particularly benefit from the education and training provided by the project team to support them to be skilled and confident to support physical health,’ she says.

    ‘It is a truly collaborative approach and is establishing trusting and robust relationships across organisations.’

    She adds: ‘We have in place a range of short-to-long-term outcomes to ensure that there are improved health outcomes and greater physical health equality for those with serious mental health needs.’


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