Addressing the health and lifestyle issues of people with a mental illness: the Healthy Living Programme

Factors related to malnutrition in community-dwelling patients with schizophrenia

PURPOSE

This study aims to identify demographic, clinical, and nutritional factors related to malnutrition in community-dwelling patients with schizophrenia.

DESIGN AND METHODS

We used a descriptive cross-sectional design. Between June and July 2016, 188 community-dwelling patients with schizophrenia were included in this study.

FINDINGS

Of the 188 participants, 4.3% were classified as malnourished, and 40.4% were at risk of malnutrition. Living status, body weight, and appetite were significant factors related to malnutrition in community-dwelling patients with schizophrenia.

PRACTICE IMPLICATION

Assessment of nutritional status should be considered along with demographic and nutritional factors in community-dwelling patients with schizophrenia.

Scoping review of research in Australia on the co-occurrence of physical and serious mental illness and integrated care

The physical health of people with serious mental illness (SMI) has become a focal area of research. The aim of the present study was to ascertain the attention and distribution of research from within Australia on physical illness and SMI co-occurrence, and to identify gaps. A scoping review of peer-reviewed research literature from Australia, published between January 2000 and March 2014, was undertaken through an electronic literature search and coding of papers to chart trends. Four trends are highlighted: (i) an almost threefold increase in publications per year from 2000-2006 to 2007-2013; (ii) a steady release of literature reviews, especially from 2010; (iii) health-related behaviours, smoking, integrated-care programmes, and antipsychotic side-effects as the most common topics presented; and (iv) paucity of randomized, controlled trials on integrated-care models. Despite a marked increase in research attention to poorer physical health, there remains a large gap between research and the scale of the problem previously identified. More papers were descriptive or reviews, rather than evaluations of interventions. To foster more research, 12 research gaps are outlined. Addressing these gaps will facilitate the reduction of inequalities in physical health for people with SMI. Mental health nurses are well placed to lead multidisciplinary, consumer-informed research in this area.

Applying the World Health Organization Mental Health Action Plan to evaluate policy on addressing co-occurrence of physical and mental illnesses in Australia

Objectives The aim of the present study was to document Australian policies on the physical health of people with mental illness and evaluate the capacity of policy to support health needs. Methods A search of state and federal policies on mental and physical illness was conducted, as well as detailed analysis of policy content and the relationships between policies, by applying the World Health Organization Mental Health Action Plan 2013–2020 as an evaluative framework. Results National policy attention to the physical health of people with mental illness has grown, but there is little interconnection at the national and state levels. State policies across the country are inconsistent, and there is little evidence of consistent policy implementation. Conclusions A coherent national health policy framework on addressing co-occurring physical and mental illnesses that includes healthcare system reforms and ensuring the interconnectedness of other relevant services should be prioritised. What is known about the topic? People with mental illness have a lower life expectancy and poorer physical health than people who do not have a mental illness. Government policy is critical to reducing inequalities in physical health and increasing longevity. What does this paper add? Evaluating policy developments against the World Health Organization’s Mental Health Action Plan 2013–2020, this review identified a lack of cohesive national-level policy on how to improve the physical health of people with mental illness. Although there are some state-based policies regarding strategies for better prevention and management of the physical health of people with mental illness, evidence of policy implementation is either scarce or inconsistent. The capacity of current policy to translate into reforms that increase the physical and overall health of people suffering mental health difficulties seems very limited. What are the implications for practitioners? This paper outlines major policy gaps and an overall need for a national-level policy. National-level leadership on integrated health care is required, with monitoring to ensure health care reforms are genuinely informed by consumer and clinician views and are effective.

Physical health inequities in people with severe mental illness: identifying initiatives for practice change

People with severe mental illness have a higher prevalence of co-morbid physical diseases and a significantly reduced life expectancy when compared with people in the general population. This article explores the literature published between 2002 and 2012 in order to identify causes of poor physical health in those with severe mental illness and discusses interventions that may be implemented to enhance health outcomes for this group. The causes of poor physical health in those with severe mental illness are difficult to address. However, existing literature does identify some interventions that can potentially provide the basis for practice change.

Educating for wellness: a wellness education group intervention for adults with chronic severe mental illness living in the community

Chronic severe mental illness (CSMI) is a common disorder in the United States associated with numerous adverse health effects. Health promotion educational interventions can be beneficial. The purpose of this project was to implement and evaluate a community-based educational program for adults with CSMI. Analyses of quantitative and qualitative data showed overall satisfaction with the program and achievement of some specific consumer health modifications. Three primary areas of interest and benefit included socialization and support, education and information, and motivation to change. The Wellness Education Group Intervention (WEGI) can serve as a model for wellness education with adults in similar communities.

Behavioural interventions to reduce the risk of physical illness in persons living with mental illness

PURPOSE OF REVIEW

It is beyond dispute that people living with mental illness suffer a disproportionate disease burden when compared with people in the general population. This review considers the efficacy and effectiveness of lifestyle behavioural interventions at service delivery level as a strategy to reduce the risk factors that contribute to somatic disease comorbidity. As many factors contribute to the very poor physical health of people living with mental illness and as there are no 'quick fix' remedies, strategies to improve physical health need to be sustainable on a system-wide basis.

RECENT FINDINGS

Most studies of behavioural interventions at best report modest success during the period of the intervention. However, even limited success can significantly reduce the likelihood of physical comorbidities developing. Unfortunately, the evidence suggests that any gains during the intervention are mostly lost over time. The implication is that interventions need to be sustainable over the long-term.

SUMMARY

When planning behavioural interventions, consideration ought to be given to extending them over a period of years not weeks or months. Approaches that include additional on-going support beyond the intervention period itself promote a greater likelihood of maintaining the improved physical health of the target population.

Improving the general health of persons with psychosis

OBJECTIVE

A project designed to improve the quality of health care received by persons with psychosis is described.

METHODS

A nurse was appointed to provide liaison between the mental health service and general practitioners, and to facilitate general health care of patients. ACT Health offered service agreements to general practices, with quarterly per capita payments.

RESULTS

About half of the local general practices participated. The number of patients without a general practitioner was reduced and quality of health care improved compared with the previous year. Recurrent funding has been provided.

CONCLUSIONS

Improving the general health of persons with psychosis is an important issue for psychiatry. Having a similar project in all mental health services could be valuable.