Which three health maintenance and promotion interventions would be most indicated and beneficial for patients with serious mental illness? Select all that apply
a. Walk with the patient during meetings and to nearby appointments.
b. Point out that smoking is dangerous to one's health and discourage it.
c. Screen the patient regularly for hypertension and diabetes mellitus.
d. Encourage the patient to join a health club to promote exercise.
e. Help the patient learn to prepare nutritious, tasty, inexpensive meals.
f. Take the patient to medical appointments, and wait for him outside.
A, C, E
Persons with severe mental illness are at risk for obesity and related disorders due to poor nutrition, medication side effects, and, oftentimes, limited exercise. Therefore, weight control (via nutrition and exercise) and regular screening for such disorders is a priority. Teaching the patient how to cook nutritious, tasty, and inexpensive meals addresses weight control, limited financial resources, and limited cooking skills. Walking with the patient at each opportunity provides increased exercise and helps build the habit of staying physically active. The motivation for smoking is complex and powerful (counteracts medication side effects and symptoms of his illness, nicotine addiction, one of the few sources of pleasure and self-soothing available to many SMI persons), and it is unlikely to respond to simple education and discouragement alone. A health clubs is probably an unrealistic options for promoting exercise. The expense and potential for anxiety related to levels of stimuli and possible stigma from other members are detractors. Taking the patient to medical appointments increases adherence, but SMI persons often communicate poorly with providers, and providers may be biased not to take seriously the somatic concerns of SMI persons. To truly increase the benefit from taking the patient to such appointments, it would help to go into the session with the patient to help compensate for those obstacles to effective care.
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