Improving the physical health of people with serious mental illness in a low secure forensic unit: an uncontrolled evaluation study of staff training and physical health care plans.

The physical health of people with severe mental illnesses such as schizophrenia and bipolar disorder is a topic of clear importance. All-cause mortality is approximately doubled among people with these illnesses, and life expectancy is substantially reduced. Monitoring and screening for physical health problems is a key part of addressing this health inequality, and in-patient admission presents a window of opportunity for this health care activity.

This study was conducted on a five-ward low secure forensic mental health unit providing care for 75 patients. A personal physical health plan with purpose-designed patient documentation and folders, incorporating clearly presented and easily understood values and targets for health status in different domains, was developed and provided for patients and staff to use. Alongside this, a brief physical education session was delivered to nurses and health care assistants (n=63). Printed learning materials and resources to assist physical health promotion (pedometers and paper tape measures) were also provided.

A single group pre-test post-test design was used to evaluate the impact of the training and associated resources on staff knowledge and attitudes to physical health monitoring and care. The feasibility and acceptability of personal health plans and associated resources was examined using qualitative feedback provided by free text questionnaire responses and follow-up discussion.

63 staff from five wards were involved in the training. 57 participants provided measures of attitudes and knowledge before training and the implementation of the physical health plans; post intervention measures were completed by 49 staff.

Matched pairs analysis indicated a modest but statistically significant improvement in both staff knowledge scores and attitudes to involvement in physical health care. Qualitative feedback indicated limited uptake of the care plans and perceived need for additional support for better adoption of this initiative.

In-patient admission is a key setting for assessing the physical health of this vulnerable client group and promoting improved management of health problems. Staff training and purpose-designed personalised care plans hold potential to improve practice and outcomes in this area, but further resource and support for such innovations appears necessary for their uptake in in-patient mental health settings.