People who are physically ill are at higher risk of developing mental illness, and vice versa. As part of a holistic approach to care, The Royal has added two new nurse practitioners to support inpatients’ physical health alongside their mental health.
“It’s about raising the standard of care for inpatients at The Royal, and ensuring that we’re supporting their overall health,” says Guillaume Tremblay, a nurse practitioner specialized in primary care who works at The Royal’s Forensic Treatment Unit at the Brockville Mental Health Centre. Another nurse practitioner will soon be joining the Royal Ottawa Mental Health Centre in a similar role.
Numerous studies have shown that the lifespan of people with severe mental illness is 13-30 years shorter than that of the general population, and the largest factor in this discrepancy — representing 60 per cent of excess mortality — is physical illness.
Rates of metabolic, cardiovascular, viral, respiratory tract, and musculoskeletal diseases are all significantly higher among people with severe mental illness than in the general population.
There are several reasons for this, including lifestyle factors, side effects of treatment, and the fact that people living with severe mental illnesses are less likely to receive adequate care for many physical conditions.
Patients in the Forensic Treatment Unit are often inpatients for long periods of time, so it’s especially important to ensure they have access to primary health care. A physician has been providing this at the Brockville Mental Health Centre, and now works collaboratively with Tremblay.
"It’s about raising the standard of care for inpatients at The Royal, and ensuring that we’re supporting their overall health."As a nurse practitioner, Tremblay has many roles which overlap with those of a physician – he can prescribe medication, diagnose, order tests, and make referrals to specialists, for example. He complements the physician’s role by approaching care through the nursing model – looking at people holistically, in their social and emotional context, to nurse them back to health.
Tremblay is able to tend to acute medical needs, such as infections, but a large part of his role is primary and preventative care. For example, he’s currently ensuring that patients’ screenings for cancer, diabetes, cholesterol, and more are up to date.
Part of Tremblay’s role going forward will be promoting healthy lifestyles, including exercise, smoking cessation, meditation, other stress management tools, and various ways to improve inpatients’ quality of life.
Coming from a position in Chapleau, Ont., Tremblay says he’s worn many hats.
“When you’re in a small northern town, you use the resources at hand. You really have the opportunity to become a jack of all trades,” he says. He worked in a busy primary care practice where he gained much experience in mental health, including providing mental health counselling and managing psychiatric medications.
“I’m excited to jump in here and do what I can, and see how we as an interprofessional team can find that edge that helps patients move forward and live good, functional lives with meaning and contentment.”
Donations at work:
Metabolic syndrome is a cluster of medical conditions including abdominal obesity, high blood pressure, high blood sugar, and abnormal levels of cholesterol and triglycerides. It’s linked to increased risk of cardiovascular disease and type 2 diabetes.
People with schizophrenia, schizoaffective disorder, or bipolar disorder may have a predisposition to metabolic syndrome that is worsened by lifestyle factors, side effects of antipsychotic medication, and sometimes limited access to care.
People with mental illness are less likely than most to have a family doctor; those involved in forensic psychiatry are even less likely. Donations to The Royal have allowed the Forensic Outpatient Program to create a new Metabolic Clinic to help detect metabolic syndrome early and help people sooner.
Patients in the Forensic Outpatient Program are mandated by the courts to attend regular appointments. Now, this time can also be used to help support key elements of physical health for people who otherwise might not get this care.