Health Promotion?

I’m getting a bit tired of the emphasis on just promoting physical health – what about mental health? Of course, five portions of fruit and vegetables are important, so is not smoking etc – of course mental health nurses have a role in this, but…

 

When I became a mental health nurse, it was because I believed that I could help people in distress. I found that I could easily talk to people and communicate on a variety of levels. I developed the ability to enter into someone’s ‘world’ to see it as they did. Indeed, as time passed I found that I had a particular skill in talking to those who were becoming physically aggressive to de-escalate the situation. I can spot side effects and help people who are experiencing these distressing consequences of the medication that we give. I can help a depressed person out of their hole and assist families to understand.

 

I have got some idea about physical needs, despite a relative lack of training in this area. I am not suggesting that I couldn’t spot the overweight person who smokes 40 a day and drinks alcohol like it is going out of fashion. Rather, what I am saying is my area is essentially concerned with facilitating people to enjoy their life. To give an example – I do not smoke,  yet I will defend the rights of smokers to do so provided that they understand the potential consequences and do not force me to inhale their smoke. We are adults capable of making a decision. Surely my job is to facilitate the making of an informed decision? The Code of Conduct clearly states that we should respect the right of a patient to decline care yet too frequently if a patient declines then ‘no insight’ is recorded in their notes. I firmly believe that the majority of nurses break the Code on this point.

 

What about Mental Health promotion? WHO have identified that depression will be the number 1 illness in Europe by 2020 but rarely do I see any health promotion on this issue. The ubiquitous health promotion posters tell me to lose weight, stop drinking, stop smoking, lower my cholesterol, go jogging etc etc but I have never seen a poster saying

 

‘Hey! Go and chill out!’

 

And I probably never will. Yes I am well aware that many physical promotion has a knock on effect on mental health but surely we should be promoting factors that are primarily aimed at mental health promotion?

 

The candle that burns twice as brightly lasts half as long. Personally, I want to enjoy my life rather than extend a miserable one.

16 thoughts on “Health Promotion?

  1. Health promotion?
    I can see where Tony is going with his rant about physical health promotion as opposed to mental health promotion, however my understanding is that there should be a “middle ground” in this. Yes we should be able to alleviate psychological distress and communication is an essential part of our roles, but we need to think about the connection between what we eat and how it impacts on us. The mental health foundation has some really useful articles on the impact of food on such things as depression and dementia. (www.mentalhealth.org.uk Feeding Minds). It focuses on a more “recovery” based approach and suggests that certain foods CAN greatly affect the recovery from episodes of depression and the Mediterranean diet has been shown to reduce the incidence of Alzheimer’s disease. Surely education plays a part and as Tony states informed choice, if people are informed and given the right information along with support and encouragement, “you can lead a horse to water…….”

  2. I very much agree with the spirit of your blog entry Tony! I am sure I am most happy and calm (mentally well?) when I feel free to make my own mistakes, when I am allowed to be responsible for myself, and when I eat and drink things I enjoy! I think it can be helpful to consciously identify things that make us happy – and do more of them. For me this involves being out of doors, singing, playing music, being in the bath – that sort of thing…

    Encouraging people to actively enjoy life – to choose life – is part of mental health promotion. Plus encouraging people to get enough sleep. Enough fun and enough sleep – and some of Carole’s ideas about food: oily fish, ripe mangos, strawberries and cream, lemon drizzle cake, chips, ice-cream, that first cup of tea in the morning after a night in the tent… Maybe that’s not exactly what Carole was saying…

    It would be good to cultivate a love of life!

  3. I kind of agree with you statement that the promotion of Mental Well Being is not being pushed anywhere near enough a level it should be, in fact I was quite excited a few weeks ago when I saw information about schizophrenia in an advert. But I think there is a major problem, it’s very easy to say stop smoking and reduce cholesterol because these are usually very visual things, such as eating 5 a day, and when ‘visible’, they tend to be taken on board and be more effective. Another problem regarding Mental Health is the fact that we can’t say when people will get depressed or suffer with schizophrenia, why or really how to deal with it. But you can virtually guarantee a long term smoker or someone with high cholesterol will suffer problems, need help and therefore put a burden on the health system etc etc.

    As to your candle comment, I do think it’s quite a naive standpoint. Why not allow everyone to take cocaine every night or drive around at 90 mph, your life might be more exciting but we all as members of society have a social responsibility that we need to live up to.

  4. Hi. Found your blog through Mental Nurse and just wanted to say this is a great post. The last promotion of mental health I had the misfortune to witness, was the “well being in the East of England” series which brought new meaning to the word “Patronising”

    Lola x

  5. Hi Tony,
    My speciality is not mental health, but I have been asked to assist from the military point of view suporting our students – my speciality is actualy occupational health – and I agree there is not enough health promotion relating to mental health. I have however seen campaigns (although military) relating to stress and burn out – recognising symptoms in each other and self. It was also a subject taught on a management course (to all levels of management as part of career promotion) and whilst I’m aware that this is only a drop in the ocean I thought I’d let you know there is a little being done. – I admit I thought there was a national strategy.

    Thanks for the prompt.

  6. Like Carole I too can see where Tony is going with his rant about physical health promotion as opposed to mental health promotion, however my understanding is that there should be a “middle ground”
    But I also recognise there is some evidence that

    ‘Schizophrenic patients are extremely heavy tobacco smokers. However, a lower incidence of lung cancer in schizophrenic patients has been observed in comparison to other heavy smokers.’ 1

    ‘It has been suggested that genetic predisposition towards schizophrenia is associated with reduced vulnerability to lung cancer, and p53 gene is one of the candidate genes. … (and) that the p53 polymorphism specifically found in schizophrenia patients may be associated with reduced vulnerability to lung cancer… the results suggest that the p53 polymorphism specifically found in schizophrenia patients may be associated with reduced vulnerability to lung cancer ’ 2

    And that the old smoking room on psychiatric inpatient ward was a wonderful place to de-escalate sometimes rather tense situations with a fag and a cup of coffee (regardless of whether the Nurse smoked or not) and a more relaxed atmosphere could be found and patients would sometimes talk more freely than they would during 1:1 therapy sessions.

    I would also like to take up the point raised by Donna Price that she has

    ‘Seen campaigns (although military) relating to stress and burn out – recognising symptoms in each other and self’
    Such campaigns have been also none existent within the NHS, at this point I write as an RMN who has been through ‘burnout’, where certain staff perceive you to have gone over to the other side from Staff to Patient and staff who you thought were friends cut you off without a second thought, as if ‘burnout’ was contagious.

    This gives one a very real sense of living ‘Life on Mars’ and appreciating the discrimination suffered by mental health service users as described by Carole in her Blog entry of February 18, 2009 ‘Service losers?’
    It is for this reason I write under a pseudonym, I hope you understand?

    1 Olincy, A., Leonard, S., Young, D.A., Sullivan, B. and Freedman R., Decreased Bombesin Peptide Response to Cigarette Smoking in Schizophrenia Neuropsychopharmacology (1999) 20 52-59.10.1038/sj.npp.1395236, http://www.nature.com/npp/journal/v20/n1/full/1395236a.html

    2Park, J.K., Lee, H.J., Kim, J.W., Park, Y.H., Lee, S.S., Chang, H.I., Song, J.Y., Yoon, D.J., Bahn, G.H.,
    Shin, Y.H., Kim, Y.J., Kim, S.A., Choe, B.K., Kim, C.J., Chung J.H.,
    Differences in p53 gene polymorphisms between Korean schizophrenia and lung cancer patients
    Schizophrenia Research, Volume 67, Issue 1, Pages 71-74, (1 March 2004)
    http://www.schres-journal.com/article/S0920-9964(03)00155-5/abstract

  7. I have to agree with Tony to a degree, although I can understand and do appreciate the role ‘healthy’ physical health has on our lives. However, to be quite pointed, how does eating my 5 portions of fruit and veg per day, help me if I go to work at 7am, I arrive home at 8pm, my brother had a psychotic episode threw himself out of a bedroom window and is now paralysed, my elder brother whom I am vey close to has just died of cancer, I lost my mum when I was 15 yrs old and my stress levels are through the roof. This is an example of a person that I now who actually is incredibly conscientious about their physcial health. But their psychological suffering through particular traumas and the excessive working hours has led to quite poor mental health.
    I suppose the point I am trying to make rather badly is that we need to acknowledge that both phsyical health and mental health play an equal role in keeping us ‘healthy’ and I agree with Tony in that mental health promotion seems to be somewhat neglected.

  8. I am certainly pleased that I have stimulated discussion though I would certainly like to clarify a few points. I am not opposed to physical health promotion. I simply want to see more mental health promotion. I would not advocate the taking of illicit substances and behaving in a socially irresponsible way.

    My overall point is this:- we are so obsessed with anti smoking, stop drinking, start jogging, loose weight etc etc that we have forgot to be happy. I wish to assure everybody that tonight I will be drinking whisky and not jogging. Because it makes me happy.

  9. RE: HEALTH PROMOTION

    I can see where you are coming from Tony, it is important for people to get out and enjoy their selves. And while you recognise that smoking and excessive alcohol may not be good for someone’s physical health, It is that person’s right to do so. I also do both myself in moderation, which is also my choice to do so. I love going to the social club and dancing the night away, this is one way that I enjoy myself!

    Physical health is also linked to mental health and I cannot see how these two things should be separated. Statistics says that people with mental illness have a much shorter life span than the general population. Something that is preventable with the right support and recognition. Where this goes wrong is, in the separation of the mental health services and the physical health services by both being treated separately instead of hand in hand.

    It is not unknown for people with a mental illness who complains to a GP about a physical problem for this to be put down as psychsomatic. No action is taken and that person has ended up dying of cancer or other.

    You said you can recognise when someone is overweight and that you have some idea about physical needs, despite a relative lack of training in this area. I have raised this issue a few times on message boards, about risk of heart disease and metabolic syndrome which go hand in hand with diabetes. And often got the reply this is down to the service users life style.

    Smoking for example is a choice by the person who smokes, excessive smoking as in chain smoking is down to the effects of their mental health. You could say part of this is down to life style and part down to their illness. What is rarely recognised is the effects of medication and the link to people becoming obese.Many anti psychotics give a craving for carbohydrates, such as chocolates, coke in excess. Some medications especially Clozaril raises blood sugars and cholestral on it’s own without the addition to all of the carbohydrates that is craved. This is not down to a chosen life style but down to medication being prescribed for their mental health. The patient is at double the risk if not higher of developing heart disease.

    At the age of 35 my son suffered a heart attack and had to have a stent fitted to his artery to unblock it. I knew of the possibilities but everytime I mentioned it to his nurse or Dr I was told what I was saying was not right. About 6 months after the heart attack I attended a seminar on the topic of Clozaril. Almost the first words the lecturer said was, Clozaril causes heart disease and heart attacks, not to mention strokes. I then posed the question, “why do you not inform patients of this” and his reply was if we did they wouldn’t take it!

    I suspect this information is not widely shared going by the reaction of some of the professionals present. One saying that patients are not given an informed choice. I ask myself the question, why did I know this and they didn’t. The reason being because of past experiences with medication and not being listened too. I go looking for it!

    Which is why it is important that attention is paid to a patients physical health in addition to their mental health needs. My son’s heart attack could have been fatal, fortunately it wasn’t. But it could have been prevented with the right information and the preventative measures that are now in place. Like cholestral lowering tablets and regular health and blood checks.If people like yourself do not look out for a service users physical health, this can quite easily be sidelined, with sometimes fatal consequence.

  10. I find this discussion pointles.

    Far too much money is wasted on so called mental illness – when are these people going to realise its a figment of their respective imaginations. More money should be targeted to proper illnesses – you know those things that have real symptoms.

  11. Hi there,

    I’ve read CARNEY et al’s ‘Occurrence of Cancer Among People With Mental Health Claims in an
    Insured Population’(2004) full text at http://www.psychosomaticmedicine.org/cgi/reprint/66/5/735

    as found by A Mother on February 20, 2009 @ 9:06 pm
    in HIGHER RISK OF CANCER WITH MENTAL ILLNESS
    http://www.schizophrenia.com/sznews/archives/001093.html

    The paper says that ‘Schizophrenia has long been thought to have a protective effect, whereas depression has been thought to predispose to malignancy (22–28). However, the findings regarding both mental conditions are inconsistent.’ And adds little to this believes either for or against. Other than to conclude that a Meta-analysis of the research out their including grey papers is perhaps long overdue.

    Is anyone aware if one has been completed and if so when at and published where?

  12. Tony,

    I remember when you couldn’t go a shift without eating 6 pork pies (to the point you looked like one….) – I never criticised. I smoke 20 a day – you never criticised. However, I wet myself laughing when you tried to save money by shaving your head and ended up looking like a victim of reprisals for consorting with the enemy!

    I do feel that psychiatric care has had too many ‘health promotion strategies’ foisted upon it with the result that the message is watered down so that non-specialised staff can deliver it. these repeatedly appear to come from general health initiatives that are a priority eslewhere, to which the psych priorities have to play second fiddle. Every week I am asked to identify yet another ‘link-person’ to take on responsibility for yet another area of responsibility of which they have no real background knowledge or substantive training. A half hour ‘update’ doesn’t suffice. The latest one being ‘dermatology advisor’!

    PS Has the hair grown in yet?

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