The Physical Care of People with Mental Health Problems: A Guide For Best Practice


Edited by: Eve Collins, Mandy Drake & Maureen Deacon

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  • Copyright

    About the Editors and Contributors


    Eve Collins is the Deputy Head of the Department of Postgraduate Medical, Dental and Interprofessional Education at the University of Chester. As an adult nurse she spent the early part of her career working in critical care before moving into higher education in 2000. Her research and writing interests are best described as eclectic and she developed a special interest in the physical health of individuals with mental health problems following her involvement in delivering educational curricular in this area. The inequitable health and wellbeing of this group inspired Eve's passion to work with her colleagues in mental health to use every opportunity to empower practitioners engaged in the challenging field of mental health practice to support the physical wellbeing of their clients.

    Mandy Drake is a Senior Lecturer in Mental Health at the University of Chester. She entered academia 3 years ago following an 18-year career as a mental health nurse and psychological therapist in the community. Prior to joining the university, Mandy worked in primary care and it was here that she started to become interested in the relationship between physical and mental health. Her work in the university has allowed her to develop this interest and, as well as editing this much needed text, Mandy is involved in both teaching and research in this area.

    Maureen Deacon is the Head of the Mental Health and Learning Disability Department and Professor of Continuing Professional Development in Health Care at the University of Chester. Maureen's professional background is in mental health nursing, though her first nursing qualification was as a State Registered Nurse and her first job was as a staff nurse in a specialist cancer hospital. Maureen spent the first 20 years of her career in the National Health Service as a practitioner in both inpatient and community settings, as a clinical leader and manager. During this time she was privileged to be supported in doing her first part-time degree in Health Studies at the Manchester Metropolitan University. Much to her surprise (having left school with an A' level in Needlework!) Maureen found higher education to be an incredibly engaging challenge and this experience opened a new career door for her. Pivotal to her student experience was the generous support and critical encouragement of some amazing academics and she hopes that she has done their excellent role modelling some small justice in her own academic career.

    Maureen has worked in higher education since 1995 and gained her PhD in 2004: an ethnographic study of acute inpatient mental health nursing. She joined the University of Chester in 2009. Her research interests largely concern real-life health care practice in context. Maureen is interested in how organisational life both shapes and is shaped by nursing work. Her teaching has returned time and again to the relationships between mental and physical health and she was delighted to be invited to share in editing and writing this important book.


    Jo Bates has lived and worked in Australia, Canada and the UK. Her specialist area is women's health and sexual health. She has worked as a midwife, Clinical Nurse Specialist in Women's Health and also as a GUM/HIV nurse. Jo is currently working as a Senior Lecturer at the University of Chester in the Department of Midwifery and Reproductive Health.

    Phil Cooper is a nurse consultant who has worked in both substance misuse and mental health fields for nearly 20 years. He has developed training programmes regarding mental health substance use and has been instrumental in developing proactive measures to manage substance misuse in acute care mental health settings in the North West of England. Phil has been active in supporting the development of a drop-in group for people with mental health substance use issues and developing a format to assess intoxication levels when people present to mental health services.

    Sue Curtis works as a Specialist Diabetes Dietician at Manchester Diabetes Centre, Manchester Royal Infirmary and St Mary's Maternity Hospital. She also develops training courses for staff and patients on diabetes, insulin dose adjustment and weight management. Sue's team has set up a type 2 diabetes education patient steering group to keep patients at the heart of Diabetes Centre plans.

    Sarah Curtis is a Trainee Anaesthetist at Leighton Hospital in Crewe. Sarah is enjoying the opportunity to learn the skills required in anaesthetics and is currently particularly interested in orthopaedic anaesthetics

    Professor Ben Green is a Consultant Psychiatrist who has published on the psychopharmacology of antipsychotics and antidepressants. He edited the book Focus on Antipsychotics in 2004 and has published recently on the psychopharmacology of PTSD. He is Professor of Postgraduate Medical Education and Psychiatry at the University of Chester.

    Julie Hughes has worked in infection prevention and control for over 20 years in a wide variety of settings, including general and paediatrics and more recently in mental health and learning disabilities. Her main interests are in educating health care workers around infection prevention and control in this field and what affects their practice and compliance. Julie has recently undertaken a doctorate in this area and is also passionate about service user involvement in infection prevention and control.

    Jane Neve is a Nurse Consultant with 5 Boroughs Partnership NHS Foundation Trust, where her focus is the care of individuals with serious mental illness. Jane has worked with this client group in a variety of settings since qualifying as an RMN 23 years ago; her particular interest being psychosocial interventions and the physical health needs of those with SMI. Jane also has an interest in medico-legal issues, particularly negligence, and has completed the academic stages of legal training.

    Louise Shorney is a Head of Department in the Faculty of Health and Social Care at the University of Chester where she has worked for the past 6 years. Louise is registered nurse with over 20 years experience. Her areas of interest are tissue viability, orthopaedics and long term conditions. Louise teaches tissue viability to a variety of level of health care workers. Louise has published in numerous peer reviewed journals and has is currently writing a book chapter on wound care for people with mental health conditions. This is a joint collaboration with Richard. She is also registered for a PhD investigating the interpretation and implementation of the role of the community matron.

    Richard Shorney is Managing Director of Real Healthcare Solutions. He has over 16 years' experience in clinical and commercial health care settings. Richard has a diverse skill set that has been developed in both clinical practice and through having worked in the health care industry for a blue-chip company. The company Real Healthcare Solutions has been established to utilise Richard's skill set for the benefit of health care organisations, industry, the clinician and ultimately promote and improved cost-effective outcomes for the patient.

    Clare Street is a Senior Lecturer in the Department of Nursing at Manchester Metropolitan University, UK. She is Programme Leader for the part-time, BSc (Hons) Contemporary Health Practice degree. Her main interests and teaching responsibilities are around public health, change management and ethics.

    Siobhan Tranter is a Lecturer at Bangor University in Wales. She is part of the teaching team on the BSc Nursing and MSc programmes within the university. Siobhan is an active researcher within the department and her interests include the effects of language and culture on health care and the physical health of people with serious mental illness.


    The publishers and authors would like to thank Sandra Casey for the use of the following illustrations:

    Figure 4.1 Heart

    Figure 4.2 PQRST

    Figure 5.1 Lungs

    Figure 5.2 Alveoli

  • Glossary

    Acute dystonia

    sustained, often painful muscular spasms, producing twisting abnormal postures.

    Acute Lymphoblastic Leukaemia (ALL)

    a cancer of blood-forming cells in the bone marrow.

    Adipose tissue

    connective tissue consisting mainly of fat cells.

    Adrenocorticotropin (ACTH)

    a hormone produced by the pituitary gland, its key function is to stimulate the production and release of cortisol from the cortex of the adrenal gland.


    the study of causation, or origination.


    an acute condition involving a severe and dangerous lowered white blood cell count.


    a syndrome characterised by unpleasant sensations of inner restlessness that manifests itself with an inability to sit still or remain motionless.


    the absence of a menstrual period in a woman of reproductive age.


    a broad spectrum antiarrhythmic medication used to treat cardiac arrhythmias.


    a type of sexual dysfunction in which a person cannot achieve orgasm.

    Anticholinergic drugs

    principally used for the treatment of drug-induced Parkinsonism, akathisia and acute dystonia; Parkinson disease; and Idiopathic or secondary dystonia. Examples include: procyclidine, oxybutinin and tolterodine.

    Anticonvulsant medication

    a diverse group of pharmaceuticals used in the treatment of epileptic seizures, increasingly being used as mood stabilisers in the treatment of bipolar disorder, examples include sodium valproate.

    Antidepressant medication

    drugs that relieve the symptoms of depression including amitriptyline, paroxetine, mirtazapine, lithium and venlafaxine.

    Antipsychotic drugs

    medication primarily used to manage psychosis (including delusions or hallucinations, as well as disordered thought), particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s. Examples include: chlorpromazine, pimozide, mesoridazine, haloperidol, thioridazine and zuclopenthixol whilst second generation atypical antipsychotics, have been developed more recently, examples include: olanzapine, clozapine, aripiprazole, ziprasidone, quetiapine and risperidone.


    fatty deposits in the walls of arteries.


    a hardening of the arteries caused by a build-up of fat, cholesterol, and other substances which collect in the walls of the arteries and form hard structures called plaques.


    having few or no blood vessels.


    a class of drugs with hypnotic, anxiolytic, anticonvulsive, amnestic and muscle relaxant properties. Often used to treat anxiety, sleeping problems and other disorders. Examples include: diazepam, lorazepam (trade name Ativan®), chlordiazepoxide, temazepam, nitrazepam, loprazolam and valium.


    the study of controversial ethics brought about by advances in biology and medicine.

    Blood dyscrasia

    a diseased state of the blood, usually one in which the blood contains permanent abnormal cellular elements.


    drugs which widen the air passages of the lungs and ease breathing by relaxing bronchial smooth muscle.

    Candida albicans (thrush)

    a colony of bacteria that grows in the intestinal tract of most adults. This can become a yeast infection if the healthy bacteria in the gastrointestinal tract become depleted.

    Cardiac arrhythmia

    a problem with the rate or rhythm of the heartbeat.


    a weakening of the heart muscle or a change in the heart muscle.


    cells that respond to chemical stimuli.


    a waxy substance found in the body that is needed to produce hormones, vitamin D and bile.

    Chronic bronchitis

    a chronic inflammation of the bronchi (medium-size airways) in the lungs.

    Chronic obstructive pulmonary disease (COPD)

    the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.

    Clostridium difficile

    a type of bacteria found in the gut which does not usually cause problems in healthy people. However, when the healthy bacteria in the gut become depleted it can cause diarrhoea, nausea, and abdominal pain and can be life-threatening.


    a fibrous protein found in tissues such as tendon, ligament and skin.


    establish control over.


    a common infection of the conjunctiva which is the membrane covering the front of the eye.


    a condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body.


    a group of steroid hormones with a wide range of physiological functions which are produced in the adrenal cortex or made synthetically.


    a hormone released by the cortex of the adrenal gland and used to manage stress.

    Creatine phosphokinase

    an enzyme found mainly in the heart brain and skeletal muscle.


    the abnormal blue discoloration of the skin and mucous membranes, caused by a lack of oxygen in the blood.

    Cytotoxic drugs

    medication which is used to treat malignancies by directly killing tumour cells.


    any activity that reduces the microbial load to prevent inadvertent contamination or infection.


    a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that consists of connective tissue, supports the epidermis and cushions the body from stress and strain.

    Diagnostic overshadowing

    when a person's presenting symptoms are put down to their existing condition, rather than seeking another potentially treatable cause.


    the time when the heart is in a period of relaxation, diastolic pressure is represented by the lower number in a blood pressure reading.

    Disability adjusted life years (DALYs)

    a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.


    an abnormal amount of lipids (e.g. cholesterol and/or fat) in the blood.

    Electrocardiogram (ECG)

    a test that measures the electrical activity of the heart.


    a long-term, progressive disease of the lungs in which the alveoli are damaged causing shortness of breath.


    inflammation of the small intestine. Symptoms may include abdominal pain, diarrhoea, loss of appetite and vomiting.


    the study of the distribution and patterns of health-events, health-characteristics and their causes or influences in well-defined populations.

    Escherichia coli (E Coli)

    a bacterium commonly found in the lower intestine of warm-blooded organisms (endotherms). Most E. coli strains are harmless, but some types can cause serious food poisoning in humans.

    Extrapyramidal symptoms (EPSES)

    a group of side effects such as parkinsonism, akathisia, dystonia, and tardive dyskinesia, commonly associated with antipsychotic medications.


    any fluid that filters from the circulatory system into lesions or areas of inflammation.


    a process that that occurs inside the body to break down blood clots.


    a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies (necrosis).


    a medical device for determining the approximate concentration of glucose in the blood.


    a polysaccharide that is the principal storage form of glucose (Glc) in animal and human cells.


    the excretion of glucose into the urine.

    Granulation tissue

    the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds.


    the abnormal development of large mammary glands in males resulting in breast enlargement.

    Haemophilus influenza (flu)

    a bacterial infection which can cause serious disease especially in young children.


    is a process which causes bleeding to stop.

    Health care associated infections (HCAI)

    infections that are acquired as a result of healthcare interventions.


    weakness on one side of the body.


    the brand name of a medicine called trastuzumab. It can stop the growth of breast cancer and sometimes reduce the size of the tumour.


    a condition with excess growth of hair in a male pattern caused by elevated levels of male sex hormones.


    a substance present in cells of the body which forms part of the immune response and is released when tissue is damaged and during an allergic reaction.


    the control of internal conditions, be it temperature, specific blood conditions or other variables within living organisms. Hypercholesterolemia high blood cholesterol levels.


    a condition that occurs when your blood sugar (glucose) is too high.


    the presence of abnormally-high levels of prolactin in the blood.


    a condition that occurs when your blood sugar (glucose) is too low.

    Hypotonic solution

    a solution with a lower salt concentration than in the normal cells of the body and the blood.


    reduction of oxygen supply to a tissue below physiological levels despite adequate perfusion of the tissue by blood.


    an unusual feature of a person or object. The term is often used to express peculiarity.


    susceptible to bacterial, fungal, and viral infections that healthy immune systems usually conquer.

    Incretin injections

    a type of medication which works by increasing the levels of hormones called ‘incretins’. These hormones help the body produce more insulin when needed and reduce the amount of glucose being produced by the liver.

    Inherited mutations

    a genetic mutation that gets passed through the genes.


    a restriction in blood supply to tissues causing a shortage of oxygen and lucose needed for cellular metabolism.

    Isotonic solution

    a solution that has the same salt concentration as the normal cells of the body and the blood.


    a cancerous condition of the melanocytic system of the skin and other organs.

    Methicillin Resistant Staphylococcus Aureus (MRSA)

    strains of the bacteria, Staphylococcus aureus, that are resistant to a number of antibiotics, including methicillin.

    Microbial load

    the number and type of micro-organisms contaminating an object.


    very tiny one-celled organisms, viruses, fungi, and bacteria.


    muscle pain or aching.

    Myocardial infarction

    commonly referred to as a heart attack, is the death of heart uscle from the sudden blockage of a coronary artery by a blood clot.


    an inflammation of the heart muscle.


    a device used to administer medication in the form of a mist inhaled into the lungs.


    the most common type of white blood cell.

    Oculogyric crisis

    the name of a dystonic reaction to certain drugs or medical conditions.


    a build-up of fluid in the tissues.

    Oesophageal varices

    dilatated oesophageal veins often secondary to hypertension in the hepatic (liver) vessels.


    the primary female sex hormones.


    an inversely arching, hyperextension of the spine caused by spasm of the axial muscles along the spinal column.

    Orthostatic hypotension

    also called postural hypertension this is a form of hypotension in which a person's blood pressure suddenly falls when the person stands up or stretches.


    a condition that affects the bones, causing them to become thin and weak.


    to treat it partially and insofar as possible, but not cure it completely.


    an agent of disease.

    Peak Expiratory Flow (PEF)

    a person's maximum speed of expiration, as measured with a peak flow meter.

    Pelvic inflammatory disease

    an infection of the womb and/or fallopian tubes.

    Platelet aggregation

    the clumping together of platelets in the blood.


    the use of multiple medications.


    inflammation of the anus and rectum.


    a group of female steroidal hormones including progesterone which is secreted by the ovaries as part of the menstrual cycle.


    the hormone of lactation which is secreted by the pituitary gland.


    a preventive measure.


    containing, discharging, or causing the production of pus.


    fever of unknown origin in adults this is commonly defined as a temperature above 38.3 degrees celcius.

    Reactive arthritis

    also known as Reiter's syndrome, is a condition characterised by painful, swollen joints and is triggered by bacterial infection somewhere else in the body.


    the restoration of a polarised state across a membrane, as in a muscle fibre following contraction.


    specific uptake inhibitors.

    Serous fluid

    any of various body fluids resembling serum which is typically pale yellow, transparent, and of a benign nature.


    the pressure exerted on the arterial walls by the blood when the ventricles of the heart contract, represented by the higher value in a blood pressure reading.

    Tardive dystonia

    abnormal tonicity of muscle, characterised by prolonged, repetitive muscle contractions that may cause twisting or jerking movements of the body or a body part.


    an abnormal drop in the number of blood cells involved in forming blood clots.


    the formation or presence of a blood clot in a blood vessel.

    Tuberculosis (TB)

    a potentially fatal contagious disease caused by the bacterial micro-organism, tubercle bacillus or Mycobacterium tuberculosis that can affect almost any part of the body but is mainly an infection of the lungs.


    narrowing of the blood vessels resulting from contraction of the wall of the vessels.


    widening of blood vessels resulting from relaxation of the muscular wall of the vessels.


    the quantity that describes a fluid's resistance to flow.


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