{'fraction_non_alphanumeric': 0.030034655371582595, 'fraction_numerical': 0.012321909896033885, 'mean_word_length': 5.374233128834356, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Terminal psychiatric illness.

I once worked with a psychiatrist colleague who spoke of “terminal psychiatric illness” when describing individuals with such severe and chronic psychiatric conditions that their existence in life, involving psychosocial aspects and physical health, was compromised and could result in early demise. While he was speaking of severely disturbed adolescents and their health trajectory into adulthood, the concept of comorbid physical health and psychiatric issues across the life cycle is not a new one. While acknowledging that psychiatric illness can result from physical health issues, this editorial will focus specifically on the precarious physical health risks of psychiatric illness. The term serious mental illness (SMI) has been used to denote mental disorders that interfere with social functioning (U.S. Department of Health and Human Services [USDHHS], 1999). It has also been defined as a “diagnosable mental, behavioral, or emotional disorder that meets criteria in the DSM-IV and results in functional impairment that substantially interferes with major life activities” (Colton & Manderscheid, 2006, p. 2). The Harvard Mental Health Letter (2003) notes that people with psychiatric illness have higher rates of medical illness and often do not seek medical care. Difficulties accessing care can be related to poverty, unemployment, poor housing, or stigma. Mental health providers tend to focus on mental illness rather than physical health also linked with erratic adherence to screening and treatment, and case management issues (Colton & Manderscheid, 2006). These illnesses include vulnerabilities such as weight gain and metabolic syndrome related to psychiatric medications, non-insulin-dependent diabetes, respiratory disease, and cancer (Robson & Gray, 2007). Health-related behaviors that contribute to these physical ailments include cigarette smoking, obesity, and low rates of exercise (Robson & Gray, 2007). Nurses and other healthcare providers have been identifying and managing these risks for a long time. Smoking cessation (Cole, Trigoboff, Demler, & Opler, 2010), lifestyle intervention in diet and exercise (Chacon, Mora, Gervas-Rios, & Gilaberte, 2011), and manualized psychoeducation around health issues (Vreeland et al., 2010) have all been suggested as intervention strategies. Hardy and Thomas (2012) note that insufficient priority is being given to the physical health needs of people with mental illness. The burden of mental health-related illness has personal, political, and fiscal implications on an international level. A study done on the public health clients in eight states in the United States found that, not surprisingly, these clients had a higher relative risk of death than the general population of their state. There is global concern about the physical health of individuals with severe psychiatric illness. The World Health Organization has recognized the importance of comorbid mental illness as amplifying the “burden” of other noncommunicable diseases such as diabetes and cardiac disease (Kolappa, Henderson, & Kishore, 2013, p. 3). They call for an eradication of the artificial divisions between mental and physical health. Yet, surprisingly, a recent report from The Cochrane Collaboration extensively reviewed the literature around monitoring the physical health of people with SMI (Tosh, Clifton, Mala, & Bachner, 2010). The goal of the report was to assess the effectiveness of physical health monitoring as it pertained to reducing morbidity, mortality, and decreased quality of life for individuals with SMI. There was no evidence from randomized controlled trials for current physical health monitoring guidance given to individuals with SMI. Even though 2,382 references (from 1,558 studies) were identified in the origin search, none met the criteria for the Cochrane review. This has fascinating implications for nursing practice. There is no body of evidence supporting one particular practice of physical health monitoring for individuals with SMI. While there is no question that physical and mental health issues must be managed, the report notes that “it is possible clinicians are expending much effort, time and financial expenditure on monitoring the physical health of people with serious mental illnesses which is unnecessary, intrusive and costly. Clinicians should, therefore, take a much more critical view of current guidance and attempt to initiate or get involved with any studies which could provide an evidencebase for this practice” (Tosh et al., 2010, p. 10). Most physical health monitoring in people with serious psychiatric illness is based on good intentions and expert opinion. But we don’t really know what is most effective with this group of individuals and we won’t know until the question is researched and published. Nurses are in a key role to facilitate this. Our assumptions about health monitoring and interventions need to be put to the research stringency of randomized studies. It is time to take “terminal” out of the equation of SMI through evidence-based practices aimed at managing the physical health issues associated with this population.