Tweet 20 commandments 14: Thou shalt help your client to get good dental and physical care and support them on doctor and dentist visits if needed

And

20 commandments 15: Thou shalt help your client to exercise on a regular basis (walk, run, cycle etc.) to increase their health

The problems people with mental health problems have with accessing physical health care are well known and thoroughly documented. What was once seen as an inevitable ‘symptom’ of mental disorder (an unwillingness to use healthcare services) is now understood more accurately as the result of a neglectful and discriminatory culture.

When service-users complain of physical ailments it isn’t necessarily because they’re imagining or ‘somaticising’ their distress. When they complain of chronic anxiety it’s reasonable for us to monitor for signs of gastric or cardiac problems. When they become unexpectedly disorientated we really ought to consider infection or other physical processes alongside the symptoms of ‘psychosis’ we might be familiar with. And it’s reasonable to ensure prompt medical attention just as we would for anyone else.

We also need to remember that basic physical exercise is as important for our service-users as it is for anyone else. In fact in many cases (such as with people who are depressed and lethargic) it’s a vital aspect of recovery.

Some time ago the following post from Peter Brown caught my attention:

http://peterhbrown.wordpress.com/2010/05/09/down-by-the-river-5-minutes-of-green-exercise-boosts-your-mood/

The research that Peter Brown refers to illustrates the effect of exercise on mood but in particular exercise that involves the ‘great outdoors’ which appears to be far more helpful than any other. Exercise in a gym or jogging around urban streets seems to be rather less beneficial.

According to the International Study of Schizophrenia (ISOS) conducted by the world Health Organisation many of the best outcomes for people with mental disorders are found in rural, subsistence societies. It seems reasonable to assume that everyday life in such societies involves a fair amount of physical activity outside the home. Contrast this with the everyday routine of many people in the industrialised West who are diagnosed with ‘serious and enduring mental illness’ (SEMI). Many such people live relatively isolated lives, often remaining indoors for long periods of time.

My own, admittedly anecdotal experience of mental health nursing in a semi-rural area is that more people with ‘enduring’ disorders come from the towns than from the more rural villages. Of course that may well just be a function of the differences in population size and other demographics (wealth for example) between lake-district villages and the larger Cumbrian towns but it may also reflect something more.

Either way there is undoubtedly more to effective mental health care than medication alone.

You can view a PDF account of the research via Peter Brown’s blog here:

http://peterhbrown.files.wordpress.com/2010/05/green.pdf