Chapter 33: Meeting the physical health needs of mental health service users
Case Study: Primary care
Charlotte is a late middle-aged woman with a long history of mental health problems and multiple hospitalisations but more recently has been living at home for many years without hospital admission. She has always smoked heavily and admits to drinking ‘too much’ alcohol to help her sleep and get through social gatherings. Charlotte has quite a few physical health problems, including high blood pressure and diabetes. The most exercise she gets is a little walking, but on the whole she spends large periods at home without going out. She would like to eat more healthy foods, but thinks this would be too expensive and, in any event, she finds it is easier to microwave ready meals than spend time cooking, especially as it is only for herself. Her CPN is aware that she could be helping more to encourage a healthier lifestyle, but is struggling to make any progress. Charlotte’s GP appears very pressed for time and she feels that he is more or less only interested in her mental health problems and deflects her from talking about her physical ailments. The practice nurse asks her to make appointments to review her diabetes and blood pressure, but Charlotte often fails to attend or ignore letters asking her to come in.
If you were the CPN, what else might you try to engage Charlotte in some constructive work to improve her health and well-being?
› Possible answer
Perhaps key to better outcomes here is improving the relationship with Charlotte’s GP and capitalising upon support within primary care. If the locality has adopted the HIP approach, this would be a good place to start. This could also include a review of her medication. The Making Every Contact Count approach has clearly not reached Charlotte’s practice yet, but discussions with the primary care team may be a way of enlisting the interest of the GP in taking this up. The practice nurse may be a good ally in this regard, as she has been making efforts to engage Charlotte. At Charlotte’s age she ought to have been invited for a number of standard screening appointments, so it would be worth checking if she has indeed been screened.
The fact that Charlotte does bring up her physical health with the GP and is frustrated to be deflected from this is regrettable, but a good opening for more constructive discussions you might initiate. She has also given some thought to healthier eating, but may need some support and advice on how best to take action. With regard to a cycle of change model, Charlotte can be seen to be at a contemplative stage, which is an opportune point to offer encouragement and affirmation, or attempt some simple interventions such as motivational interviewing. In a practical sense, you may be able to help Charlotte act on her wishes to eat healthier meals, starting with how she can shop for cheaper, wholesome ingredients and think about simple menus. Help to join a local walking group might help Charlotte widen her circle of friends and take some gentle exercise.
