Mental health nurses need to be confident in providing physical healthcare to their patients, a parliamentary inquiry has been told, with some suggesting Project 2000 was to blame.
The Health and Social Care Committee today held the second evidence session for its inquiry into community mental health services for adults with severe mental health needs.
“It meant there was a generation of nurses who weren’t so confident in looking after physical healthcare”
Lade Smith
Training in physical health skills for mental health nurses was one of the subjects raised during this latest evidence session held by the cross-party group of MPs.
Dr Lade Smith, president of the Royal College of Psychiatrists, cited the impact on current skills of a past set of major higher education reforms for nursing, introduced in the 1990s.
She claimed that the Project 2000 nurse education reform programme had created a “generation of [mental health] nurses not so confident in looking after physical healthcare”.
Seen as a positive turning point in the profession, Project 2000 made nursing a degree-level programme with students able to choose to train as either a mental health, adult or children’s nurse.
Dr Smith noted how, previously, all nurses needed to train as a general nurse first before specialising, for example, in mental health.
“So, psychiatrists, we go to medical school, we become doctors, we train in all the other parts of medicine, then we specialise in psychiatry,” she told the influential committee of MPs.
“And the same was true for nurses – nurses trained as general nurses and then specialised,” she said.
“A decision was [then] made that that didn’t need to happen. So, it meant there was a generation of nurses who weren’t so confident in looking after physical healthcare.
“Psychologists don’t do physical healthcare. Social workers don’t have to do physical healthcare.”
She said it became the case that some mental health nurses did not know how to take a patient’s blood pressure, for example.
However, she said “that’s changing now”, suggesting that there was now greater recognition of the need for mental health staff to be equipped in physical health skills.
Also on the panel alongside Dr Smith was Steve Forsyth, chief nursing officer at Rotherham Doncaster and South Humber NHS Foundation Trust.
Mr Forsyth, whose brother has bipolar disorder, said he was part of the Project 2000 generation – having qualified in the year 2000 as a mental health nurse.
He noted that he did get 18 months of physical health training as part of his mental health course.
“We fatally neglect the physical health of people with significant mental ill health”
Norman Lamb
However, he said he still went back to university to do additional training as an adult nurse “for that very reason”, referring to Dr Smith’s point about mental health nurses lacking general health training.
Meanwhile, Sir Norman Lamb, chair of South London and Maudsley NHS Foundation Trust and a former health minister, also gave evidence later in the session.
“We fatally neglect the physical health of people with significant mental ill health,” he said. “I totally agree with Lade’s point about the training of our nursing workforce.”
The evidence session had begun by hearing from Eve Mair, who was diagnosed with bipolar disorder at the age of 19 and now works at Biploar UK as a senior public policy officer.
Ms Mair told the committee that “the physical implications of mental illness are huge”, citing issues such as the weight gain associated with anti-psychotic medication.
Eve Mair
Despite this, she said people with severe mental illness faced a “lottery” in terms of access to physical health checks and support.
“I think in primary care… it’s luck of the draw,” she told the MPs.
“It’s a lottery as to whether you are going to get somebody who is persistent, whether they have the time and the resources to dedicate to blood tests that are routine, to checking in on making sure that your physical health is as good as it can be in terms of the experiences of other people.”
The committee heard how people with conditions like bipolar and schizophrenia died 15 to 20 years earlier than the general population, with cardiovascular and respiratory disease among the most common causes.
Measures had been put in place to try and improve access to physical healthcare for people with mental health issues.
For example, the primary care payment system – the quality and outcomes framework (QOF) – rewards practices that deliver annual physical health checks for people with serious mental health conditions.
However, variation in access to these health checks across the country persists, the committee was told.
Also giving evidence was Dr Emma Tiffin, a GP and national advisor to NHS England on matters related to community and primary care and adult mental health.
Dr Tiffin said GPs and other physicians sometimes got “slated for not thinking about mental health” but that it was also the case that mental health practitioners “don’t always think [about] physical health”.
“It’s really important that it’s both ways, and there’s that whole cultural approach to physical health,” said Dr Tiffin, who is also associate director of mental health and learning disabilities at Cambridgeshire and Peterborough Integrated Care Board.
Positively, she said she was starting to see a “cultural change” in mental health settings, in which nurses and other professionals were improving their approach to physical health and doing more around blood pressure checks and weight management, for example.
Chief nurse Mr Forsyth noted that his trust had made a commitment that, by 2026, 95% of patients with a severe mental illness would receive an annual physical health check – above the QOF target of 75%.
Read more about the links between mental and physical health
