Reflective accounts

Reducing health inequalities

A CPD article improved Christine Mason’s understanding of the importance of reducing health inequalities for people with serious mental illness.

A CPD article improved Christine Mason’s understanding of the importance of reducing health inequalities for people with serious mental illness


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What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?

The CPD article outlined the health inequalities that people with serious mental illness (SMI) may experience. It acknowledged the barriers they often encounter in accessing healthcare services, and discussed how lifestyle behaviours, symptoms of mental illness and the side effects of medication can contribute to reduced life expectancy.

What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?

People with SMI may experience several barriers in relation to physical healthcare, including difficulty identifying physical health concerns, accessing healthcare services and receiving treatment.

I learned that these difficulties may be compounded by cognitive impairment associated with their mental illness, social isolation and suspicion of healthcare services. In addition, side effects of psychiatric medication, such as sedation, may make the process of accessing healthcare challenging.

The article outlined four areas of physical health that commonly affect people with SMI: metabolic syndrome, smoking, oral health and sexual health.  

I am now aware that cigarette smoking can cause some medications to be metabolised and excreted more quickly in smokers, meaning that they may require higher doses.

Suboptimal oral health can result in dental complications and may be exacerbated by symptoms of mental illness; for example, vomiting and malnutrition associated with some eating disorders. An individual’s sexual health and libido may be affected by the side effects of some psychiatric medications, often resulting in sexual dysfunction.

How did you change or improve your practice?

The article was relevant to my role as a mental health nurse in an inpatient unit for older people with SMI, and it has increased my confidence in identifying, assessing and planning treatment for physical health issues experienced by these individuals.

Nurses in all healthcare settings have an obligation to address health inequalities by providing interventions to people with SMI that support their physical health.

In my practice, I will ensure physical health screenings and regular reviews are undertaken for people with SMI. I have found it beneficial to use the ‘4 As’ (ask, advise, assist and arrange) to identify a person’s smoking habits and provide appropriate support, as discussed in the article.

I will also be proactive in advocating for dentist referrals for people with SMI, where necessary, and develop harm minimisation strategies for those with suboptimal oral health.

The article outlined the Ex-PLISSIT model, which has improved my ability to ask people with SMI about sexual health issues, enabling me to support them in maintaining intimate relationships.

How is this relevant to the Code? Select one or more themes: Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust

One of the themes of The Code is prioritising people, which involves ensuring that their physical, social and psychological needs are assessed and responded to, as well as promoting well-being and preventing ill health. This is relevant to the article, which emphasised the importance of using evidence-based strategies that enhance the experiences of people with SMI, challenge stigma and address health inequalities.

Christine Mason is a staff nurse at Elizabeth Court, Stevenage


This reflective account is based on NS894 Hallett N, Rees H (2017) Reducing health inequalities for people with serious mental illness. Nursing Standard. 31, 38, 60-70

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