Physical healthcare for people with mental health problems: Why do we often get it so wrong?
I recently completed some postgraduate study in systemic and family therapy, which I did in order to help me work more effectively with the very vulnerable families that come into contact with child and adolescent mental health services (CAMHS). What I didn’t expect was the way it made me reflect on communication between various agencies, and how bizarre and dysfunctional it can be. There was a prime example of this on Twitter today, courtesy of @debecca. People with mental health problems sometimes have physical health problems. In fact, they’re statistically more likely to have such problems than those who don’t have a mental health problem. There are a number of reasons for this: if you have a mental health problem, you’re more likely to live in poverty, or in substandard housing, to have a poor diet, to be engaging in risky behaviour or drug/alcohol use, to be experiencing the side-effects of psychiatric medications, and so on. And of course, there’s the simple fact that people with mental health problems are people, and people sometimes get sick. It’s this latter reason that seems to have impacted on @debecca, who has both bipolar disorder and breast cancer. She’s currently an inpatient on an acute psychiatric ward. Today she tweeted this.
The District Nurses are refusing to come out to a “ward environment” – you can be physically ill, or mentally ill, but never both. — The Joy of Bex (@debecca) October 18, 2014
I mean, it’s bad luck to have Bipolar Disorder AND cancer but I do, and I should be treated as a whole person. — The Joy of Bex (@debecca) October 18, 2014
Well, that’ll teach them. My drains have backed up and there’s blood all over me and the floor. — The Joy of Bex (@debecca) October 18, 2014
The sad thing is, this sort of clinical incident just isn’t unusual. Time and again people with mental health problems fail to receive the physical healthcare they should be receiving, even when in an inpatient environment. Poor communication between different parts of an NHS service can often be a factor in this, and I wouldn’t be surprised if that communication was affected by the fact that it’s the weekend. Training can be an issue too – psychiatrists often aren’t successful in keeping some of their general medical skills up-to-date. Mental health nurses don’t receive nearly enough training in physical health – some of my medical nurse colleagues can be very surprised when they hear that RMNs usually don’t get training in IV care (though I wouldn’t expect psychiatrists or RMNs to handle a mastectomy drain). Conversely, general nurses often don’t have nearly enough training in mental health. In this case, it appears that good old-fashioned prejudice may have played a role.
Manager of the ward agreed that the District Nurses won’t come to the ward because of the misconception that all mentalists are violent. — The Joy of Bex (@debecca) October 18, 2014
Still no nurse to deal with my mastectomy drains because they won’t come onto a mental health ward. Still bleeding everywhere. — The Joy of Bex (@debecca) October 18, 2014
Fortunately it was eventually resolved, but not before @debecca was put through unnecessary pain and suffering.
Nurses finally came after a lot of nagging. My drain had kinked and twisted and was pulling out my stitches, hence the blood and pain. — The Joy of Bex (@debecca) October 18, 2014
I asked @debecca via Twitter whether her mental health issues had previously been a factor in her receiving poor cancer care. She replied that this has been a factor “time and again”, and she was already suing her NHS trust even before this incident. This is a sorry tale, and it simply shouldn’t have happened. It’s not new to say that physical healthcare needs to be done better for people with mental health problems, but sadly it’s something that people have to keep saying. Courtesy of Phil Dore at The Not So Big Society