PROMOTING PHYSICAL HEALTH IN MENTAL HEALTH PATIENTS

Promoting Physical Health in Mental Health Patients
Mental health patients are often affected with medical conditions that can impact their
quality of life. Patient education and awareness is one way in which medical complications can
be prevented or delayed. In this paper we will discuss common medical problems in the mental
health population, and promoting patient education to help with awareness and encourage
patients to be an active part of managing their health. We will also review the Institute for
Healthcare Improvement (IHI) model for improving care and apply it to a plan for promoting
awareness using the Plan Do Study Act (PDSA) process.
Common Medical Problems in the Mental Health Population
It is reported that one in four adults living in the United States have a mental illness and
many of these patients are described as having poor physical health (Martin, 2016). Many suffer
from obesity, diabetes, cardiac disease, and other health conditions. Weight gain which can lead
to obesity and other health complications is a side effect of many psychotropic drugs. Correll,
(2015), reports that upward to 72% of patient taking antipsychotics can have a weight gain
greater than 7% of their normal weight. The risk for diabetes doubles in patients with mental
health and the onset of diabetes can be seen10-20 years earlier than in those that do not have a
mental illness or taking psychotropic medications; antipsychotic in particular can have a direct
effect by causing insulin resistance or an indirect affect by causing weight gain (Correll, 2015).
Cardiovascular disorders such as torsades de pointes, ventricular tachycardia, and QTc
prolongation are reported and the chances of sudden cardiac death becomes two to four times as
much than those without mental illness or those not taking psychotropic medications (Correll,
2015). Liver and kidney disease, pneumonia, and risk for seizure are other disorders that are
more prevalent in the mental illness population than in other populations (Correll, 2015).
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Promoting Patient Education
Mental health affects physical health and vice versa. Barriers exist in integrating the
treatment of physical and psychosocial healthcare. In some cases, the mental illness can promote
early physical illness either as a result of the medication(s), poor insight into health, or the
inability to recognize and understand the important actions needed to prevent or decrease
exacerbation of physical illness. It is also reported that physical health is being neglected by
mental health professionals (Martin, 2016). Many providers are focused on overwhelming
psychiatric symptoms and unintentionally overlook physical symptoms (Martin 2016).
Another barrier is the lack of patient education. Stenberg (2016), reports changing the
rate of morbidity and mortality in the mental health population should start with patient
empowerment through education and actively involving the patient in their care. It is also
important to link patients to other health professionals that can serve their current needs.
Health Promotion Program
The health promotion program being tested for the purpose of this paper will utilized
educational handouts that will be provided to the patient at the arrival of their clinic visit, unlike
the usual process of handing out educational materials at the end of the visit. To have effective
patient education, there needs to be the opportunity to ask questions, communicate with the
patient about his needs, and clarify expectations (Stenberg, 2016). Utilizing the Model for
Improvement, the Plan Do Study Act (PDSA) test plan will be applied. The PDSA provides an
organized study approach that ask: what are you trying to accomplish, how will you know that a
change is an improvement, and how can you modify the plan to result in an improvement (IHI,
2020).
PROMOTING PHYSICAL HEALTH IN MENTAL HEALTH PATIENTS
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The study here is that physical examinations must become part of usual mental healthcare
to help identify threats to physical wellbeing and improve health outcomes for mental health
patients. Martin (2016), recommends performing a physical assessment during the mental health
exam after which patients should be referred to their primary care providers and follow-up care.
Conclusion
Patient education and health promotion by mental health providers and referrals to
primary care providers can help reduce physical illness in mental health patients. A proactive
approach by making the patient aware of potential complications and providing them with the
knowledge to prevent or delay complications will be more effective that a reactive approach.
Trying to manage these complications after they have already acquired illnesses such as diabetes,
obesity, cardiac disease, kidney disease, liver disease, or other illnesses is what we want to avoid
if possible.
Summary of the PDSA is that patients, through education and collaboration with the
mental health provider will identify how often patients should see their primary provider. Patient
will also discuss preventative measure that can be taken such as yearly EKGs, blood pressure
monitoring, lab work yearly or more often if needed, learning about BMI, discussing healthy
eating habits, participating in an appropriate exercise technique, managing diabetes, and
discussing with their providers concerns the patient may have that will help them live a healthier
lifestyle.
PROMOTING PHYSICAL HEALTH IN MENTAL HEALTH PATIENTS
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Plan:
Question:
 Does providing educational handouts help
patients to be more informed and help
prevent medical complications common in
mental health patients.?
Prediction: Patients will gain
knowledge on actions they can take to
prevent medical complications such as
DM, obesity, or cardiac complications
 Develop a plan to test the change. (Who?
What? When? Where?)
The handouts will be given out
starting on April 1 -14, 2020 and will
be given to all patients that come into
the clinic.
 Identify what data you will need to
collect.
o # of Patients that found the
handout to be helpful
o # of Patients that now have PCP
appts.
o # of Patients that have or plan to
have and EKG
o # of Patients requesting additional
info on BMI, exercising or eating
healthy?
List your action steps along with person(s)
responsible and time line:
 Provider will take 1 week to create
handouts with information on how often
patients should see their PCP, get labs
drawn, have an EKG, participate in
exercise, and eating healthy
 Front desk clerk will provide handouts to
all patients up check-in and ask them to
read through it while waiting to be seen
by provider & to save questions for the
provider.
 Provider will briefly discuss information
contained in handout during visit with
each patient.
 Provider will document in note the
patient’s response to handout topics on
last PCP visit, EKG and lab work
performed, eating, and exercise habits.
 Provider will create an Outcome
Worksheet to manually track the
following info:
o Which patient found handout
helpful
o Which patient have or plan to
make and appt. with PCP
o Which patient have an exercise
routine or want info on exercise
o Which patient want info or a
referral to a nutritionist
o Last EKG performed
PROMOTING PHYSICAL HEALTH IN MENTAL HEALTH PATIENTS
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Do:
 For a 2 wk. period, all patients will be
given an educational handout at check-in.
 They will be asked to read the handout
and think about how they could help us to
help them improve their physical health.
 The provider will review the handout with
the patient at this visit and answer
questions or make referral as necessary.
 Provider will ask if handout was helpful
 Provider will track the patient’s response
using the Outcome worksheet
Describe what actually happened when you
ran the test:
We would like the handout and info session
with the provider to educate mental health
patients on some of the health complications
common in this population and prompt them
to want to be more health conscientious.
We would like the handout and info session
with the provider to encourage patients ask
question about diet, exercise, and to make
appointments to see their PCP, get EKG and
lab testing done if needed.
Study & Analyze data:
 Data will be analyzed to see what
percentage of patients thought educational
handout was helpful
 What number of patients will see PCP and
get suggested EKG, BP checks and labs
done regularly
 What number of patients will inquire
about diet and exercise.
 How much time did this new process add
onto the appt.
Summary:
Prediction: This new process will increase the
amount of time needed during the appt. to
review the handout, answer questions and
make referrals if needed.
Prediction: Some patient may still have no
interest in participating in the initiative
Describe the measured results and how
they compared to the predictions:
 Outcome to start is that no less than 25%
of the patient in the first 2wk. period
report the handout being helpful
 Outcome is that 25% of the patients in this
test make a PCP appt and get an EKG if
needed
 Outcome is that all patient in test know
that BMI before leaving the appt.
 Outcome is that 25% show and interest in
learning about diet and exercise
Act:
 Allow extra time for those needing help
reading the educational handout.
 Expand the trial to 4 wks. to get a better
idea analysis of the impact on patient’s
health and time provider will need to
complete
Describe what modifications to the plan
will be made for the next cycle from what
you learned:
 Development of an electronic Outcome
Worksheet to more efficiently track data
collected from the study. seen,
 Modifications will have to be made for
those that may need help reading.
 Increase appt times by 10-15 minutes.
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References
Correll, C. U., Detraux, J., De Lepeleire, J., & De Hert, M. (2015). Effects of antipsychotics,
antidepressants and mood stabilizers on risk for physical diseases in people with
schizophrenia, depression and bipolar disorder. World Psychiatry, 14(2), 119-136.
doi:10.1002/wps.20204
Institute for Healthcare Improvement (2020). Science of improvement. Retrieved from:
http://www.ihi.org/about/Pages/ScienceofImprovement.aspx
Martin, C. T. (2016). The value of physical examination in mental health nursing. Nurse
Education in Practice, 17, 91-96. doi:10.1016/j.nepr.2015.11.001
Stenberg, U., Haaland-Overby, M., Fredriksen, K., Westermann, K. F., & Kvisvik, T. (2016). A
scoping review of the literature on benefits and challenges of participating in patient
education programs aimed at promoting self-management for people living with chronic
illness. Patient Education and Counseling, 99(11), 1759-1771.
doi:10.1016/j.pec.2016.07.027

HPP Example 1