Linda Nazarko, Nurse Consultant Physical Health Care at West London NHS Trust

People with mental health problems are more likely to have physical health problems and more likely to experience complications from these conditions. 

When a person’s mental health deteriorates they may struggle to manage their physical health. People admitted to acute mental health wards often arrive with physical health problems that require help. When a person is admitted to a mental health unit in crisis it can be difficult to address physical health problems as specialist input may be required. Referring someone who is unwell with their mental health to accident and emergency departments or to medical colleagues can lead to acute hospital admission. This can be difficult for the individual as treatment of medical problems can impede treatment of mental health.  

At West London, our consultant nurse, Linda Nazarko, has been working with Jade Thorne, a diabetes nurse specialist based at West Middlesex Hospital. They carry out joint ward rounds, see patients who have diabetes, review medication and stabilise patients within the mental health unit. Their work has prevented patients having to go to accident and emergency, and they have found that optimising physical health has a positive effect on mental health too.  

We found that Mrs X, a 45-year-old lady admitted with depression, was no longer responding to her oral medication used to treat her diabetes. In the past this would have required admission to an acute ward to stabilise her diabetes. The nurses worked together to start Mrs X on insulin and stabilise her diabetes on the ward. Ward nursing staff checked blood glucose and insulin was changed daily until Mrs X’s diabetes was stabilised. Reducing her very high blood sugar improved her physical health and well–being and she responded to treatment for depression.  

Mr Y, a 46-year-old gentleman with psychosis, felt unwell. He was thirsty, passing lots of urine and felt hungry and exhausted. Blood tests showed that he had developed type two diabetes, the type of diabetes associated with being overweight. The nurses were able to prescribe medication to treat Mr Y, monitor his blood sugar and adjust medication so that diabetes was well controlled. This improved Mr Y’s general health. They were also able to advise Mr Y and nursing staff on the ward about Mr Johnston’s diet and to encourage him to be more active. 

This partnership has been going on for around a year and helps patients to recover more quickly. It also reduces the stress associated with attending accident and emergency and being admitted to an acute hospital.   

Please note the names have been changed to X & Y to protect their identities