Mental health nurses 'set bad example to patients'
 

Poor physical health is rife among people with severe mental illness in the UK, a study shows.

The study leader said mental health nurses might be partly to blame for setting a bad example.

High levels of obesity, heart disease and diabetes were found among 782 patients with conditions such as schizophrenia and bipolar disorder.
The University of East Anglia study suggests this is why their life expectancy is much reduced.

Some studies suggest the life expectancy of people with severe mental illness is as much as 25 years shorter than that of the general population.
The latest work, published in BMC Psychiatry, adds to evidence that physical health, not mental health issues, such as suicide, are primarily to blame.

It found that inactivity, poor diet, smoking and excessive alcohol consumption were the norm.

A high number of the participants were being prescribed drugs known as atypical antipsychotic drugs, which are associated with weight gain.
Lead researcher Professor Richard Gray, of UEA's School of Nursing and Midwifery, said: "Mental health nurses do a tough job and are compassionate and highly committed.

"But they do not tend to be skilled at managing the physical health of their patients."

Bad example

Professor Gray said that many mental health nurses often did not follow a healthy lifestyle themselves.

His previous research has showed that mental health workers have a higher rate of smoking than the general population.

He suggested that their bad habits might rub off.

"Since mental health workers tend to have sustained one-to-one relationships with their patients over many years, those who smoke, have a poor diet and fail to take regular exercise are having a negative influence on the lives of already vulnerable people.

"We urgently need to train our mental health workers to lead by example and intervene if their patients' physical health is deteriorating.
"All health professionals have a duty to promote health in the patients they treat.

"Government guidelines must reflect the shared responsibility all health care professionals have to promote health in one of the most marginalized and socially excluded groups in our society."

Dr Peter Carter, Chief Executive and General Secretary of the Royal College of Nursing, said: "Mental health nurses will recognise that too often, patients can suffer twice over because of a combination of poor mental and physical health.

"There are some complex reasons behind this, such as the side effects of prescription drugs, lifestyle limitations and social and economic problems.
"However, we also know that there are some excellent nurse led initiatives which can really make a difference to people.

"It takes a concerted effort not just among different parts of the health service but with other professions to turn this situation around."

http://www.bbc.co.uk/news/health-12732954

Thats the equivalent of saying that primary school teachers shouldnt eat crisps for lunch because its a bad example for pupils.

I dont know what to think of this.

Lol <<< That is my initial reaction.

I'd say the biggest contributing factor for obesity in patients with psychotic illnesses is the prescription of antipsychotic medication by a long shot! I gained a ton of weight on it, even visiting the gym twice a week, going for regular walks, and cutting down on food didn't stop me piling it on.

All this talk about mental health workers not leading by example seems like a cop out to get the drugs companies off the hook to me.

Funnily enough since I dumped the meds, the weight has come straight off and I'm now back to a decent weight whereby clothes actually fit me again.

Yes alot of MHN's Ive come across do smoke.
They do a damn well stressful job, and after someones just been kicking off in their face about how their going to "do them in" it does help to have a cigarette.
It doesnt mean they promote it, it just means they do the same activity that alot of people who are under alot of stress do.
ARGH. Im not awake enough to explain my point properly, but these people who criticise can damn well do my job, and every other MHN's job before they can criticise.

I would think that persons with MH conditions need additional persons on their team. I used to participate in regular exercise as part of the relationship with my support worker. There are also dieticians and trainers that can provide help. Maybe a MH day centre should have walking or cycling clubs for persons with MH issues.

One of the issues may be once you get past the meds, sessions and general maintenance- as in are they bathing, etc. maybe no one is thinking about managing that persons general health...........but it doesn't sound right. Don't nurses have to do general nursing first? I just think they can't be expected to fulfill that role- like your psychiatrist cannot check your feet, or take your temperature.

But someone should be making sure that the care of the MH patient is holistic. Physical conditions due to lifestyle needs to appreciate that carbs, sugars, lack of motivation, are all factos that MH patients struggle with. Once a person gets the new health diagnosis it needs to be included in their care and coordinated.

I think it is the responsibility of the nurses when the patient is in hospital or acute. Once the person is not acute- they need to be trained to take some responsibility for themselves. Other community based support can be brought in too. And yeah- the drugs need to be reviewed- though I don't think enough studies are done about the impact of meds on weight......is it impacting metabolism- what is the reason persons gain weight?

Definitely agree with it being the meds.

Was going to say something similar about it being the stress of the job which makes nurses smoke. Nurses in general hospitals are the same.

My local general hospital is no smoking even in the surrounding grounds and car park. So nurses just stand centimetres from the border, on the pavement by the road smoking and drinking from mugs from their staff room on their breaks. Lol.

You don't have to train as a general nurse before you become a mental health nurse, although the very first year of training is the same academically, the practical part of the course is spent in mental health settings.

On a side note how many of the patients smoked before they had any contact with the mental health services? It would be interesting to look at that and not just blame the nurses for being a bad influence.

^ That's an interesting question actually. I didn't smoke until I came in contact with Adult MHS.

I think this study is based on a long shot. I am much more inclined to believe it is medication and lack of activity that causes obesity and diabetes in patients with illnesses primarily controlled with anti-psychotics and mood stabilizers [bi-polar and schizophrenia].

Nurses are stressed, so they smoke, patients are stressed by their illness, so they smoke.. it doesn't mean one group encourages the other. The best way to measure it seems to be asking the question of when and why a person started smoking.

Actually yes you do. All nurses have to do the Common Foundation Modules, which is general nursing, before they go into branch, and you have placements with every branch.

What a load of crap.
If anything, other patients are more of a bad example than then nurses.
They're not perfect but they're human too and they shouldn't have to completely change just because of the job they do.

But thats what I said. The first year academically is the same, although the placements are different. I took the original point as the poster asking if you have to qualify as a general nurse before specialising in mental health, the same way that you qualify as an adult nurse then chose to specialise in cardiac, respitory or even a wound care nurse.

Not true, I'm doing mental health nursing, although I have to do a year of general nursing, all of my placements will be mental health.

Im also doing mental health nursing, and you have to have placements making sure you can fill all your outcomes. Are you on the course yet or going this year?
Ive done placements in a midwifery ward, health visitor, day nursery and also I will be on a ward at some point, as well as doing a respite care placement. I have MH placements, but you have to hit medical outcomes that alot of MH wards wont be able to help you with.

I think this may be down to the way different uni's operate. I know for my mental health colleagues they are only receiving placements with a mental health focus.

Anyway, back to the original topic...

Well my reason for posting the original statement was more redundant- I think that nurses are trained in the medical care of patients. However, unless there is some sort of plan when the person is obese or has physical health conditions- it is a lot to manage in the follow up visits.

My key worker/ nurse was having a nervous breakdown and their irratic behaviour did affect me. I suppose if nurses smoke because of the stresses of their job it would affect the care they give- but then that seems more an issue with workload and a separate initiative to improve the work environment for community nurses, but not fair to blame the health of mental health patients on nurses or form a correlation.

Playing devil's advocate Archer One- maybe we have stumbled on a point in terms of the placement/ training / experience actually given to mental health nurses from their courses. Do mental health nurses feel qualified to deal with physical health conditions?

Another worthy study to do

to be fair does that then mean anyone in certain jobs (teachers, doctors, nurses god i imagine theres a huge list) have to live in a certain way because of the job they do? should anyone overweight or who smokes or who enjoys drinking be banned from doing such jobs?

I think where you train has a part to play in how confident you are as a mental health nurse in dealing with physical health conditions. But it also works the other way, I really don't feel very confident in treating the mental health problems of patients who come in for physical problems. Also, while I understand that restraint is sometimes necessary it makes me feel very uncomfortable and a little scared to see it happen.

Why? Everyone has work stresses, everyone deals with that stress in different ways. Doesn't mean their care will be any different.

I always found it odd that so many nurses who are supposed to be promoting health living are smokers, overweight, inactive, binge drinkers.

I appreciate they're human, but I always feel like, if you're gonna go into that profession you should at least look after your own body before advising others to look after theirs.

Yeah, Katy, first year you'll have to get a lot of skills signed off that you wouldn't be able to do on MH placements. Obv, it depends on what placements you get though :P

im just going to copy and paste what i wrote else where


Thats rubbish! Many of those things are caused by meds and the low self esteem of the patients you could apply those things to all nurses anyway who are they to judge people due to their life styles? They could be brilliant nurses! Also in ...the state of obesity and physical health problems i dont think shoving a fit full of it person in front of someone who has a crushing self judgement and isnt helped by their physical shape. They'll probably feel worse as they'd think they were being looked down on and judged! I know people who are a healthy example but arent exactly empathetic and proffessional and likewise i knew exactly the oppossite. I knew fantastic nurses who werent obviously healthy and someone who were the ideal image of health and aweful nurses also due to my weight gain on medication and it disabling my ability to do exercise with back pain i felt judged by them and inferior likewise my current community workers are fairly healthy and i feel they are judging everything due to my wieght even though they dont give a damn or see me regularly. I doubt someones appearence and state of lifestyle will make someone live that way its something that happens that cant be really controlled, a nurse should be judged on the suport they give not their lifestyles. A patient in such a state of mind needs help just coping and dealing with life, they know their physical state is bad and it makes them feel worse they dont need a perfect example of what the should be shoved down their throats aswell life is hard enough, they need someone gentle and understanding to support them in getting healthy again. I just think thats an unfair judgement on so many people.

I got asked to leave my course for having anorexia.

A guy on my course with COE was allowed to stay.

Obesity is becoming normal and it's not cool.

I don't know what COE is, but Anorexia is a mental illness, obesity isn't. Being fat doesn't make you irrational or illogical or any of the things that ED's do. Yes, it's not healthy still but the course does not cause a risk to overweight students or to future patients.

^ Compulsive Over Eating.

It is an eating disorder whereby the person compulsively eats food, often leading to obesity. Leads to the same irrationality as anorexia but being overweight is becoming socially acceptable. For the brief time I was on the wards, 100% of the staff nurses where overweight. It doesn't make sense to me that people who are clearly unhealthy can promote health and well being.

Hmm, different ends of the same spectrum, really.

I don't think patients actually give a **** whether their nurses or doctors are overweight or anything.

People aren't going to start making themselves fat because their nurse is, yet vulnerable people may see an anorexic person and get ideas.
If by your view fat people aren't good role models and should not be able to promote health and wellbeing, than neither should anorexic people, or depressed people, or anyone with any sort of ongoing issue. That's pretty much everyone.

Patients are more likely to be analysing and in competition with other patients, not the staff.

I think for people on the ED spectrum thats a fair comment and they need people of healthy example to promote well being. Whilst i was IP the eds found it very stressful and were cynical when having a large person at the supported table or as their key worker in which i could understand and i think they needed the say a healthy person to act as example and promote healthy thinking likewise not having underweight people is good for them either as it would just be telling these vulnerable people to gain weight when the person themselves needs too really its not fair.

But i think for say people not in that area it doesnt make a difference... a person with no weight issue wont look at a overweight or underweight person and think oh they can be that way why cant i? they smoke so can i.. i think its unfair telling someone how to live their lives due to the job they're in. I struggle with healthy people as i have weight problems i used to be underweight and was forcibly made overweight by medication and it mortified me im ashamed of my weight and feel judged by healthy or underweight people but thats me. I wouldnt be impacted on how my nurse lives id only care if they were good at their job. Right now i have a cpn who is healthy for her age and active and yet shes not good at her job nor is she a nice person to be honest.. shes not a good example, shes created distrust in her role and doesnt appear reliable to go to if im having a crisis infact i avoid her like the plague not that she tries to see me to me shes not a good example on a patient, she doesnt listen or even bothers to read background notes therefore isnt aware of my problems or the way i act so im just left to carry on shes the bad image of nursing not say an overweight nurse who smokes with a lovely and empathetic nature who tries their best to everything they can for a patient.

About obesity becoming the norm... i dont know really i dont bat an eyelid about peoples weight apart from my own unless it becomes life risking. I think its the wayu they chose to live and if they're happy that way i have no right to judge.

^ I suppose it's only an issue becasue it makes the advice kinda... I don't know, less likely to be taken? If an over weight person told me I was leading and unhealthy life and should make myself more healthy by eating XYZ I would be like, err, yeah sure. Same with a really thin nurse. Same with a nurse who I later saw smoking who had told me not to. Same with nurses who post pictures of themselves absolutely wasted on non-private FB's. It just doens't correlate - at least smoke out of sight of the hospital/don't put up pictures like that.

Depression/MH isn't something that can necessarily be seen, so I don't see that as the same kind of thing in terms of impact on other patients. To be fit to work, any nurse would have to be at a functional level with their depression?MH so it wouldn't have an impact on their patient advice/care.

Completely agree its true i witnessed it consistantly for months whilst IP as majority of patients were those with anorexia and once one person started or someone made a comment the competition began and would loop continuously hence relapsing recovery. Not everyone is like this and i saw some sufferers really struggle to resist competing with the others once it began and i really saw the pain it caused

^ Do have to point out I do and have compared myself to my therapists :P

yeah precisely you hit the nail on the head there. I would hope that people working within mentalhealth if their depression etc was impacting on their work it would be declared and they can get leave to recover or stabalise. I remember arguing in group therapy once whilst in hosp as one staff member was really rude and just plain horrible and always had been theyd upset me and id had enough and brought it up and the tw*t of a doctor was saying 'we all have lives and our own stresses' and i just replied saying 'yes but you're working with suppossedly vulnerable people and if it impacts on your work and how you treat patients you need to go to occupational health to be assessed'

and i stand by that strongly

I have to admit so have i, both my psychologists have been very slender and pretty people and ive felt constantly judged and wanting to be their weight lets say... i always feel though my strongest comparison was the eds whilst ip before i was made ip i was underweight and the meds made me weight pile on and i felt more judged and compared myself to them more their eyes and judgement burning through me and my head telling me they're beautiful and should be like them.

Sorry that was rather personal

^*hugs*

And I agree with your 1st post, too.

Buttons, like cutting smoking is not an ideal way to deal with stress/ MH issues. It creates its own set of issues.

A lot of people who can't control their own behaviour compensate by working to control behaviour of others.

I am completely aware of that but to be honest it's socially acceptable (more so than cutting etc) it's not doing anyone else any harm if you aren't smoking too near them and if it helps someone be calmer and therefore do a better job then I really don't give a damn. Yes it causes health problems. Yes it's Very.Bad.For.You. But it's a personal choice that shouldn't be restricted by your occupation. I for one would have had second thoughts about going into nursing if it placed that level of restrictions on my free time.

I've seen nurses snapping and getting angry at patients because they're overworked on a 12 and a half hour shift and they haven't had time to have a fag... Smoking well away from the hospital/in your own time is fine as long as patients don't get any of the side effects, be that physical second hand smoke or irritability.

I agree, im very good at helping other people, well maybe not good at it but try to do it as much as posible and yet i never look after myself or take my own advice i have loads of self help techniques i know whats a healthy diet, healthy to have and do what sleep you need, exercise yatta yatta but dont take it upon myself to even try to help myself.

I know my old cpn doesn't smoke though my cousin who's a pysch nurse smokes. Whenever i have been to A&E for SH there's some many nurses out there smoking its unreal sometimes.

Am i just weird that i have no problem with nurses smoking.. i really dont see it as a problem its their life they do what they want i judge them more on their jobs as nurses i think attitude is more detrimental to patients than whether they smoke or not.

No you're not weird, I don't have any problem with nurses smoking either. As long as it doesn't affect the way they do their job, I don't care about what they do at all.