1
|
Carney R, Imran S, Law H, Carmichael-Murphy P, Charlton L, Parker S. "If you're struggling, you don't really care" - what affects the physical health of young people on child and adolescent mental health inpatient units? A qualitative study with service users and staff. BMC Psychiatry 2024; 24:498. [PMID: 38982436 PMCID: PMC11234625 DOI: 10.1186/s12888-024-05858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 05/21/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Physical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15-20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care. METHODS We conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14-42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted. . RESULTS Thematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle. CONCLUSIONS Promoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment.
Collapse
Affiliation(s)
- Rebekah Carney
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK.
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK.
| | - Shermin Imran
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, M13 3BL, UK
| | - Heather Law
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Parise Carmichael-Murphy
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
| | - Leah Charlton
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
| | - Sophie Parker
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
| |
Collapse
|
2
|
Hui TT, Garvey L, Olasoji M. Perspectives of mental health clinicians on physical health of young people with early psychosis. Int J Ment Health Nurs 2024; 33:649-659. [PMID: 38012093 DOI: 10.1111/inm.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
The aim of this study is to explore the views and understanding of youth mental health clinicians with regard to the physical health of young people with early psychosis and their perspectives on lifestyle interventions improving the health and well-being of young people with early psychosis. Physical health disparities leading to premature mortality among people with mental illness are well evident in the literature. Mental health and physical health are directly correlated. The risk of poor physical health often begins before the onset of mental ill health. Young people with early psychosis are highly susceptible to poor physical health. A co-designed integrated approach focusing on early prevention and intervention in overall well-being and health is imminent for this targeted population to prevent poor physical health trajectory across the lifespan. Ten clinicians were recruited and participated in this study through semi-structured interviews. Five themes were identified: (i) Impact of early psychosis, (ii) Focus of care, (iii) Conversations around physical health, (iv) Co-location of specialist roles and (v) Health literacy. The findings of this study confirm the dimensional impact of early psychosis on the well-being and health of young people through the vicious cycle of early psychosis. Promotion of health literacy along with social connectedness and elements of self-determination, as well as having a prime focus on the individuals' experience in the journey of health promotion through participation in lifestyle interventions, has been identified as critically prominent.
Collapse
Affiliation(s)
- Ting Ting Hui
- Federation University Australia, Berwick, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Loretta Garvey
- Federation University Australia, Berwick, Victoria, Australia
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology Australia, Hawthorn, Victoria, Australia
| | - Michael Olasoji
- Federation University Australia, Berwick, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Leung KCY, Bakr B, Chung C, Parmar M, Elhindi J, Brakoulias V. A streamlined multidisciplinary metabolic clinic in psychiatric recovery service: a pilot study. Front Psychiatry 2024; 15:1344453. [PMID: 38445084 PMCID: PMC10913053 DOI: 10.3389/fpsyt.2024.1344453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
Background The metabolic syndrome (MetS) is a collection of risk factors for cardiovascular disease and type-2 diabetes, that includes central obesity, hypertension, hyperglycaemia and dyslipidaemia. An audit indicated inadequate MetS screening in an Australian psychiatric recovery service. Objectives We aimed to improve MetS screening, identification and intervention by offering streamlined lifestyle education, clinical reviews and discharge planning. This pilot program prioritized holistic, culturally-sensitive, patient-centric, and trauma-informed approaches to enhance metabolic health outcomes. Methods A Metabolic Clinic was piloted in two psychiatric rehabilitation cottages (n=35), which involved disciplines of dietetics, exercise physiology, diversional therapy, occupational therapy, peer workforce, social work, clinical psychology, pharmacy, nursing and medical. Another cottage (n=15) was assigned as the comparison and received standard care. A 12-week, 3-times-per-week lifestyle and behavioral program, called MetFit, was devised and offered to those identified at screening for the treatment cottages. Outcome measures were feasibility measures, the five metabolic parameters (waist circumference, blood pressure, fasting serum triglycerides, high-density lipoprotein, and glucose), functional measures, and a meal questionnaire. Results The treatment cottages had qualitative advantages in screening and identifying MetS. Of four enrolled consumers in MetFit, an improvement of triglycerides (p=0.08), squats (p=0.02), and push-ups (p=0.07) was observed. Major challenges of enrolment included an overall lack of acknowledgment of its importance, poor motivation of consumers and resources limitation. Conclusions The one-stop provision of groups, peer support and inpatient pathway with multidisciplinary team-integration was generally accepted by consumers and the MDT and has iteratively demonstrated the urgent need for consumer-centered physical care and a cultural shift to foster collaboration within a psychiatric service.
Collapse
Affiliation(s)
- Kelvin CY. Leung
- Recovery Service, Cumberland Hospital, WSLHD, Sydney, NSW, Australia
- Research and Education Network, WSLHD, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Bianca Bakr
- Recovery Service, Cumberland Hospital, WSLHD, Sydney, NSW, Australia
| | - Cindy Chung
- Recovery Service, Cumberland Hospital, WSLHD, Sydney, NSW, Australia
| | - Mayuri Parmar
- Recovery Service, Cumberland Hospital, WSLHD, Sydney, NSW, Australia
| | - James Elhindi
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vlasios Brakoulias
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| |
Collapse
|
4
|
Peisser AM, Cornet S, Moerkl S, Müller-Stierlin A. ["But without Therapeutic Support, I wouldn't Succeed" - Exploration of Subjective Experiences of People with Mental Illness Regarding Support with Diet-Related Problems]. PSYCHIATRISCHE PRAXIS 2024; 51:16-23. [PMID: 37429315 DOI: 10.1055/a-2106-7234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE In this study we explored the subjective experiences and needs of people with severe mental illness regarding dietary and weight-related support within routine care. METHODS For this purpose, a total of 16 interviews with adults living with mental illness were conducted in Ulm (Germany) and Graz (Austria) using a semi-structured topic guide and were analysed in a qualitative approach. RESULTS Several participants criticized the limited support by professionals regarding diet- and weight-related problems and wished for greater awareness of these issues in mental health care. CONCLUSION The implementation of health-promoting services in mental health care is important to ensure needs-oriented care from the patients' point of view. Interdisciplinary care concepts could be used to share responsibilities among several professional groups.
Collapse
Affiliation(s)
- Anna Maria Peisser
- Universitätsklinik für Psychiatrie, Psychosomatik und Psychotherapie, Klinische Abteilung für Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Österreich
| | - Sebastian Cornet
- Klinik für Psychiatrie und Psychotherapie II, Ulm University Medical Faculty, Günzburg, Deutschland
| | - Sabrina Moerkl
- Klinische Abteilung für medizinische Psychologie, Psychosomatik und Psychotherapie, Medizinische Universität Graz, Österreich
| | - Annabel Müller-Stierlin
- Klinik für Psychiatrie und Psychotherapie II, Ulm University Medical Faculty, Günzburg, Deutschland
- Institut für Allgemeinmedizin, Universitätsklinikum Ulm, Deutschland
| |
Collapse
|
5
|
Jordan G, Ng F, Thomas R. How clinicians can support posttraumatic growth following psychosis: a perspective piece. Ir J Psychol Med 2023:1-6. [PMID: 36799213 DOI: 10.1017/ipm.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Psychosis is often a traumatic experience that can lead to significant suffering. However, people may also experience posttraumatic growth following psychosis. Posttraumatic growth refers to the positive changes that people experience following a struggle with an adversarial event and has been shown to occur in at least five domains, including a greater appreciation for life; improved relationships with others; greater personal strengths; new life possibilities and spiritual/existential growth. Studies have shown that mental health services can play a key role in facilitating posttraumatic growth. However, there are no recommendations that clinicians can follow to best support posttraumatic growth following psychosis specifically. Without guidance, clinicians risk invalidating people's experiences of, or providing improper support for, posttraumatic growth. To address this knowledge gap, we reflect on current research and clinical guidelines to recommend ways that clinicians can support posttraumatic growth following psychosis.
Collapse
Affiliation(s)
- Gerald Jordan
- University of Birmingham, College of Life and Environmental Science, School of Psychology, Institute for Mental Health, Centre for Urban Wellbeing, Birmingham, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Robyn Thomas
- School of Social and Political Science, University of Edinburgh, 15a George Square, Edinburgh, UK
| |
Collapse
|
6
|
Czosnek L, Rosenbaum S, Rankin NM, Zopf EM, Cormie P, Herbert B, Richards J. Implementation of physical activity interventions in a community-based youth mental healthcare service: A case study of context, strategies, and outcomes. Early Interv Psychiatry 2023; 17:212-222. [PMID: 35766548 PMCID: PMC10947482 DOI: 10.1111/eip.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/30/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022]
Abstract
AIMS Physical activity interventions are recommended for community-based youth mental health services to prevent physical health disparities. Implementation is challenging, and studies focusing on the methods to achieve change are needed. This study aims to identify the context, implementation strategies, and implementation outcomes that illustrate how physical activity interventions were implemented within an early intervention service in Australia. METHODS A theoretically informed case study was undertaken. Data from a community-based youth mental health service that delivers an early psychosis programme were collected between July and November 2020. Three data sources were accessed (1) interviews with service managers, mental health clinicians and exercise physiologists; (2) document review of organizational policies and procedures; and (3) survey using the Program Sustainability Assessment Tool. The implementation outcomes investigated were acceptability, fidelity, penetration, and sustainability. Framework analysis was used, and a logic model developed guided by an established template, to interpret findings. RESULTS Forty-three contextual factors and 43 implementation strategies were identified. The data suggests that creating a new clinical team and auditing and feedback are critical for implementation. High levels of acceptability and sustainability were described, while fidelity of implementation was difficult to establish, and penetration was low. CONCLUSIONS The relationship between constructs suggests several mechanisms underpinned implementation. These include changing professional beliefs, establishing new organizational norms, augmenting existing work processes, and aligning physical activity with priorities of the mental healthcare system and existing work tasks. This case study provides direction for future health service planning of physical activity interventions in community-based youth mental health service.
Collapse
Affiliation(s)
- Louise Czosnek
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental HealthUniversity of New South WalesSydneyAustralia
- School of Health SciencesUniversity of New South WalesSydneyAustralia
| | - Nicole M. Rankin
- Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneAustralia
| | - Eva M. Zopf
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Cabrini Cancer InstituteThe Szalmuk Family Department of Medical Oncology, Cabrini HealthMelbourneAustralia
| | - Prue Cormie
- Peter MacCallum Cancer CentreMelbourneAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneAustralia
| | | | - Justin Richards
- Faculty of HealthVictoria University of WellingtonWellingtonNew Zealand
| |
Collapse
|
7
|
Mueller-Stierlin AS, Peisser A, Cornet S, Jaeckle S, Lehle J, Moerkl S, Teasdale SB. Exploration of Perceived Determinants of Disordered Eating Behaviors in People with Mental Illness-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:442. [PMID: 36612764 PMCID: PMC9819820 DOI: 10.3390/ijerph20010442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Disordered eating behaviors are common in people with a serious mental illness (SMI) such as schizophrenia, bipolar disorder and major depressive disorder. This study employed qualitative exploration to understand the perceived determinants of eating behaviors, in particular those connected to disordered eating patterns, in people with SMI. In total, 28 semi-structured interviews were conducted in a consecutive sample of people with SMI under treatment in local mental health services in Australia (n = 12), Germany (n = 8) and Austria (n = 8) (mean age: 43.3 years, proportion of female participants: 61%, proportion of participants with ICD-10 F2 diagnosis: 57%, proportion of participants with ICD-10 F3 diagnosis: 64%). A thematic analysis approach, the framework method, was applied using MAXQDA 2020. Three main themes of determinants were derived: (i) impacts to daily functioning, (ii) disrupted physical hunger cues and (iii) emotional hunger. For impacts to daily functioning, the following themes emerged: lack of daily structure, time and drive, and difficulty planning ahead. For physical hunger, themes emerged for disrupted hunger and satiety cues, and mindless eating. All motives listed in the Palatable Eating Motives Scale (PEMS), i.e., coping, reward, social and conformity, have been reported by participants to be drivers for their emotional eating behavior. Subsequent reported behaviors were eating too much or too little, binge eating, night eating and food cravings. We conclude that interprofessional approaches should target daily functioning, disrupted physical hunger cues and emotional eating to reduce disordered eating behaviors in people with SMI.
Collapse
Affiliation(s)
- Annabel S. Mueller-Stierlin
- Department of General Practice and Primary Care, Ulm University Hospital, 89070 Ulm, Germany
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany
| | - Anna Peisser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Sebastian Cornet
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany
| | - Selina Jaeckle
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany
| | - Jutta Lehle
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany
| | - Sabrina Moerkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Scott B. Teasdale
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW 2052, Australia
- Mindgardens Neuroscience Network, Sydney, NSW 2052, Australia
| |
Collapse
|
8
|
Brooke LE, Gucciardi DF, Ntoumanis N, Chapman MT, Lines RLJ, Perry Y, Gilbey D, Formby T, Phillips T, Lin A. Enhancing functional recovery for young people recovering from first episode psychosis via sport-based life skills training: outcomes of a feasibility and pilot study. Health Psychol Behav Med 2022; 10:1136-1158. [PMID: 36437870 PMCID: PMC9683043 DOI: 10.1080/21642850.2022.2147073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
Early intervention within First Episode Psychosis (FEP) recovery efforts support functional recovery in several ways, including increasing levels of (1) physical activity (2) life skills, and (3) social connectivity. Sport has been proposed as an ideal platform to target these three goals simultaneously. The primary aims were to assess the feasibility of utilising sport-based life skills within FEP recovery efforts and test intervention components. The secondary aim was to evaluate the potential recovery benefits. Seven young people (aged 15-25 years) with FEP participated in a six-week sport programme alongside their support workers (community and peer workers) from the service, including peer workers with a lived experience of psychosis. The programme consisted of various sporting activities, which were designed to promote physical activity, maximise social connectivity, and teach life-skills (e.g. motivation, emotional regulation, and goal-setting) that are relevant and transferrable to other contexts (e.g. school, employment, independent living). The support participants engaged with the programme at the same level as the young people, with the role of providing support and normalising/modelling engagement. The young and support participants provided feedback during and after the programme via questionnaires and interviews. Young participants self-reported physical activity levels, psychological needs, recovery dimensions, and life skills pre- and post- intervention using established psychometric tools. We used thematic analysis to analyse the qualitative data and compared this information with other data collected (e.g. attendance, feedback, quantitative measurements). The study culminated with a process evaluation. The results indicated that, despite challenges with engagement for young people with FEP, sport-based life skills programming may be a feasible and useful recovery outlet. In addition, the results highlighted specific intervention components that were useful to promote engagement and recovery benefits. This study serves as a critical foundation for future sport-based work within FEP recovery.
Collapse
Affiliation(s)
- Lauren E. Brooke
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Daniel F. Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Nikos Ntoumanis
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | | | - Robin L. J. Lines
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Yael Perry
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Dylan Gilbey
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | | | | | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
9
|
Tabvuma TS, Stanton R, Browne G, Happell B. Mental health consumers' perspectives of physical health interventions: An integrative review. Int J Ment Health Nurs 2022; 31:1046-1089. [PMID: 35388954 PMCID: PMC9542531 DOI: 10.1111/inm.13000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 12/12/2022]
Abstract
Consumers of mental health services experience poor physical health compared to the general population, leading to long-term physical illness and premature death. Current research and policy activity prioritizes the physical health of consumers yet few of these recommendations have translated to practice. This implementation gap may be influenced by the paucity of literature exploring consumer perceptions and experiences with physical healthcare and treatment. As a result, little is understood about the views and attitudes of consumers towards interventions designed to improve their physical health. This integrative review aims to explore the literature regarding consumer perspectives of physical healthcare and, interventions to improve their physical health. A systematic search was undertaken using (i) CINAHL, (ii) MEDLINE, (iii) PsycINFO, (iv) Scopus, and (v) Google Scholar between September and December 2021. Sixty-one papers comprising 3828 consumer participants met the inclusion criteria. This review found that consumers provide invaluable insights into the barriers and enablers of physical healthcare and interventions. When consumers are authentically involved in physical healthcare evaluation, constructive and relevant recommendations to improve physical healthcare services, policy, and future research directions are produced. Consumer evaluation is the cornerstone required to successfully implement tailored physical health services.
Collapse
Affiliation(s)
- Tracy Samkele Tabvuma
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Graeme Browne
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
10
|
Gossip K, John J, Comben C, Page I, Erskine HE, Scott JG, Diminic S. Key service components for age-appropriate mental health service planning for young adults. Early Interv Psychiatry 2022; 16:1085-1093. [PMID: 34821037 DOI: 10.1111/eip.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/29/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022]
Abstract
AIM To identify and describe key service components that should be incorporated into age-appropriate integrated mental health care for young adults aged 18-24 years. METHODS Key service components were identified through a mixed-methods approach including targeted examinations of the literature and structured discussions with experts in youth mental health. RESULTS Seven key components were identified as important for providing age-appropriate mental health care to young adults. Two were classified as clinical service components (structured psychological therapies; care coordination and liaison), three were classified as non-clinical service components (vocational support; youth development; peer support) and two as integrated non-clinical and clinical service components (lifestyle interventions and family and network support). Example service models for each of these key service components were identified and described. CONCLUSIONS This is the first study to identify and describe key service components for age-appropriate mental health care for young adults. The findings provide mental health service planners with a framework of services that should be considered when planning and resourcing services for this age range.
Collapse
Affiliation(s)
- Kate Gossip
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
| | - Julie John
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
| | - Charlotte Comben
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
| | - Imogen Page
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
| | - Holly E Erskine
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - James G Scott
- Mental Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Metro North Mental Health Service, Herston, Queensland, Australia
| | - Sandra Diminic
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
| |
Collapse
|
11
|
Mueller-Stierlin AS, Cornet S, Peisser A, Jaeckle S, Lehle J, Moerkl S, Teasdale SB. Implications of Dietary Intake and Eating Behaviors for People with Serious Mental Illness: A Qualitative Study. Nutrients 2022; 14:nu14132616. [PMID: 35807799 PMCID: PMC9268504 DOI: 10.3390/nu14132616] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
The impact of poor diet quality and nutritional inadequacies on mental health and mental illness has recently gained considerable attention in science. As the opinions and experiences of people living with serious mental illness on dietary issues are unknown, we aimed to understand the role of nutrition in a biopsychosocial approach. In total, 28 semi-structured interviews were conducted with people living with serious mental illness (SMI) in Australia, Germany and Austria, and a generic thematic analysis approach was applied. Four positive (positive effects on the body and mind, therapeutic effects in treating somatic illnesses, pleasure and opportunity for self-efficacy) and three negative (impairment related to mental illness and its treatment, perceived stigma and negative effects on the body and mind) implications of diet were identified. A key issue for most of the participants was the mental burden arising from their body weight. This might indicate that negative implications, such as guilt and stigma, were of primary importance for people with SMI when talking about their dietary behavior. In conclusion, diet-related support is urgently needed for people with SMI. However, especially participants from Germany and Austria reported that this is not yet widely available in mental health settings, leading to hopelessness and resignation.
Collapse
Affiliation(s)
- Annabel S. Mueller-Stierlin
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany; (A.S.M.-S.); (S.C.); (S.J.); (J.L.)
| | - Sebastian Cornet
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany; (A.S.M.-S.); (S.C.); (S.J.); (J.L.)
| | - Anna Peisser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Selina Jaeckle
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany; (A.S.M.-S.); (S.C.); (S.J.); (J.L.)
| | - Jutta Lehle
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany; (A.S.M.-S.); (S.C.); (S.J.); (J.L.)
| | - Sabrina Moerkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria;
- Correspondence:
| | - Scott B. Teasdale
- Discipline of Psychiatry and Mental Health, University of New South Wales (UNSW) Sydney, Sydney, NSW 2052, Australia;
- Mindgardens Neuroscience Network, Sydney, NSW 2052, Australia
| |
Collapse
|
12
|
Cvejic RC, Srasuebkul P, Walker AR, Reppermund S, Lappin JM, Curtis J, Samaras K, Dean K, Ward P, Trollor JN. The health service contact patterns of people with psychotic and non-psychotic forms of severe mental illness in New South Wales, Australia: A record-linkage study. Aust N Z J Psychiatry 2022; 56:675-685. [PMID: 34256621 DOI: 10.1177/00048674211031483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe and compare the health profiles and health service use of people hospitalised with severe mental illness, with and without psychotic symptoms. METHODS We conducted a historical cohort study using linked administrative datasets, including data on public hospital admissions, emergency department presentations and ambulatory mental health service contacts in New South Wales, Australia. The study cohort comprised 169,306 individuals aged 12 years and over who were hospitalised at least once with a mental health diagnosis between 1 July 2002 and 31 December 2014. Of these, 63,110 had a recorded psychotic illness and 106,196 did not. Outcome measures were rates of hospital, emergency department and mental health ambulatory service utilisation, analysed using Poisson regression. RESULTS People with psychotic illnesses had higher rates of hospital admission (adjusted incidence rate ratio (IRR) 1.26; 95% confidence interval [1.23, 1.30]), emergency department presentation (adjusted IRR 1.17; 95% confidence interval [1.13, 1.20]) and ambulatory mental health treatment days (adjusted IRR 2.90; 95% confidence interval [2.82, 2.98]) than people without psychotic illnesses. The higher rate of hospitalisation among people with psychotic illnesses was driven by mental health admissions; while people with psychosis had over twice the rate of mental health admissions, people with other severe mental illnesses without psychosis (e.g. mood/affective, anxiety and personality disorders) had higher rates of physical health admissions, including for circulatory, musculoskeletal, genitourinary and respiratory disorders. Factors that predicted greater health service utilisation included psychosis, intellectual disability, greater medical comorbidity and previous hospitalisation. CONCLUSION Findings from this study support the need for (a) the development of processes to support the physical health of people with severe mental illness, including those without psychosis; (b) a focus in mental health policy and service provision on people with complex support needs, and (c) improved implementation and testing of integrated models of care to improve health outcomes for all people experiencing severe mental illness.
Collapse
Affiliation(s)
- Rachael C Cvejic
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Adrian R Walker
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Simone Reppermund
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Julia M Lappin
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Jackie Curtis
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Katherine Samaras
- Adipose Biology, Obesity and Clinical Nutrition Laboratory, Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Department of Endocrinology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Kimberlie Dean
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Philip Ward
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
13
|
Matthews E, Cowman M, Denieffe S. Exploring the Experiences of Physical Activity among Key Stakeholders in Rehabilitation and Recovery Mental Health Services. Issues Ment Health Nurs 2021; 42:128-137. [PMID: 32749911 DOI: 10.1080/01612840.2020.1789782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Physical activity has therapeutic benefits for mental health service users. To date, there is limited evidence that has brought together the experiences of physical activity for service users and key multi-disciplinary service providers that support activity in outpatient settings, particularly in contexts where activity is not well integrated into policy and care structures. Previous research has relied on homogenous samples of either service users or service providers of a specific discipline, and key stakeholders like peer-support workers are under-represented. This research explored and thematically analysed multi-stakeholder (service users, n = 6; and service providers, n = 8) experiences of physical activity in outpatient mental health service in Ireland using phenomenologically influenced qualitative interviews. Two salient themes were identified; 'The challenges of being physically active in recovery' and 'Physical activity is a tool for recovery'. This research presents an account of the experiences of some of these poorly represented stakeholders such as carers, peer-support workers, doctors and nurse management, in addition to other well represented stakeholders.
Collapse
Affiliation(s)
- Evan Matthews
- Department of Nursing and Health Care, Waterford Institute of Technology, Waterford, Ireland.,Nursing and Midwifery Planning and Development Unit, South East, The Health Service Executive, Ireland
| | - Mary Cowman
- Department of Sport and Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - Suzanne Denieffe
- School of Humanities, Waterford Institute of Technology, Waterford, Ireland
| |
Collapse
|
14
|
Chee GL, Wynaden D, Heslop K. Exploring the Health Status of People with First-Episode Psychosis Enrolled in the Early Intervention in Psychosis Program. Issues Ment Health Nurs 2021; 42:57-64. [PMID: 32787709 DOI: 10.1080/01612840.2020.1797251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
People diagnosed with mental disorders are at risk of developing physical health co-morbidities. An exploratory "within-subject" and "between-group" design examined the health outcomes of a group diagnosed with first-episode psychosis enrolled in an early intervention in psychosis program over 12 months. The findings were compared with a group diagnosed with psychosis for more than two years. Participants with first-episode psychosis recorded a significant increase in weight over 12 months when assessed against the comparison group. The findings show that the potential for developing physical health co-morbidities begins from the time of diagnosis and commencement of antipsychotic medications.
Collapse
Affiliation(s)
- Gin-Liang Chee
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia
| |
Collapse
|
15
|
Smith J, Griffiths LA, Band M, Hird-Smith R, Williams B, Bold J, Bradley E, Dilworth R, Horne D. Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care. Front Endocrinol (Lausanne) 2020; 11:577691. [PMID: 33193094 PMCID: PMC7649318 DOI: 10.3389/fendo.2020.577691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
AIM Young people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK. METHODS Participants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months. RESULTS Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence. CONCLUSIONS The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a "real world EIP setting" and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.
Collapse
Affiliation(s)
- Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
- *Correspondence: Jo Smith,
| | - Lisa A. Griffiths
- Department of Nutrition, Food and Exercise Science, Florida State University, Tallahassee, FL, United States
| | - Marie Band
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Rachael Hird-Smith
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Briony Williams
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Justine Bold
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
- Centre for Medical Education, Medical School, Cardiff University, Cardiff, United Kingdom
| | - Eleanor Bradley
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Richard Dilworth
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Dominic Horne
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| |
Collapse
|