Enhancing physical health care for patients with severe mental illness: describing the implementation of a physical health liaison nurse in a mental health outreach team for long-term care

Abstract

Background: Tackling physical health problems in people with severe mental illness is crucial, as they often experience higher rates of chronic diseases and reduced life expectancy compared to the general population. Addressing these physical health disparities could significantly improve overall well-being and quality of life. As the World Health Organization emphasizes the need of additional professionals in bridging the gap between mental health and physical health services, this study evaluates the implementation of a physical health liaison nurse within a Belgian mental health outreach team (MHOT). We aimed to enhance the physical health of patients with severe mental health conditions, ensuring that patients receive comprehensive care. Methods: A mixed-method approach was employed, combining quantitative and qualitative data collection. The Health Improvement Profile was used as a quantitative screening tool to identify physical health needs. Qualitative data were gathered through interviews with patients and mental health professionals, along with field notes from the physical health liaison nurse. The RE-AIM framework guided the implementation and analysis to ensure relevance and stakeholder engagement. Quantitative data from the screening tool were analyzed alongside qualitative insights to provide a holistic view of the implementation. Results: The implementation of a physical health liaison nurse facilitated the identification of physical health needs and the development of personalized health plans. Quantitative data showed high rates in being overweight and smoking, and low rates of blood samples among participants. Except for blood samples, referrals or other action showed no significant improvement on health outcomes. Qualitative data revealed the perceived effectiveness of the service, identified real-world facilitators and barriers to implementation, and assessed feasibility. Conclusions: The integration of a physical health liaison nurse within a MHOT showed promise in addressing physical health needs of patients with severe mental health conditions. In office presence of the nurse facilitated the inclusion of physical health in care plans. Recommendations for future implementations include enhancing stakeholder engagement and addressing identified barriers, such as inadequate funding mechanisms. On a policy level, supporting financial incentives for physical health screening in primary care or promoting capitation based finance models could improve a more holistic approach.