Mental health cluster APhysical health

Session two 29/04/11

Physical health and mental health

Why is it an important consideration?

Two pronged approach 1) those with mental illness appear to be

more susceptible to poor physical health 2) physical activity can improve mental

health

The following information has been obtained from Mental Health and Physical Activity Information Pack- “Partnering to enhance recover”. Accessible on Moodle

The evidence

Strongest evidence linked increase physical activity with reduction in depressive symptoms

Cooper Institute “relative increases in maximal cardiorespiratory fitness and habitual physical activity are cross-sectionally associated with lower depressive symptomalogy and great emotional well-being”

The evidence

2002 meta-analysis published in British Medical Journal concluded : when compared with no treatment, exercise reduced symptoms of depression and in studies relating exercise to cognitive therapy, the effect of exercise was similar.

Why is it important?

“psychiatric patients have high rates of physical illness, much of which goes undetected. Such investigations have led to calls for health professionals to be more aware of these findings and for better medical screening and treatment of psychiatric patients” World Federation for Mental Health (2004).

Why is physical health so poor?

Mental illness Unhealthy lifestyle behaviours Medications Segregations of primary health and

mental health care sites Lack of counselling Low socio economic status

Why?

Social factors e.g. poverty and inadequate housing

Lifestyle factors e.g. substance use, sedentary lifestyle

Barriers accessing screening programs and health care

Difficulties in communication or lack of attendance at medical appointments possibly resulting in delayed or missed diagnosis

Stigmatising attitudes of carers, health professionals and the broader community

Socio economic status

People with mental illness are more likely to be low income earners, reliant on a pension or live in poverty

Increased costs in accessing health care due to increased needs

Generally limited to GP’s who bulk bill

Access to services

Travel issues or maintaining scheduled appointments

Particularly problematic in rural or remote areas

Communication barriers

Availability of services

Unaware of how to access care and what options are available

GP’s may not have sufficient training in responding to mental illness or be aware of appropriate services for referral

Many allied health professionals are not covered by Medicare

Lifestyle factors

Transience High risk behaviours

Service silos

Refusal of some specialist services to treat complex co-morbid patients

Lack of continuity Gaps in professionals knowledge re

physical health and vice versa

Overcoming these barriers Actively discussing physical health issues

alongside mental health Adopting a patient, flexible and creative approach

to assessment Assessment of the physical health problem across

a number of interviews, some spent just on the process of engagement

Reinforcing and writing down details of tests or treatments

Taking a more active role in ensuring follow-up Creating effective partnerships between the

consumer, family, carers, PG and mental health clinicians

GP responsibility

NSW Government’s response

Developed guidelines for general practitioners for health checks for individuals presenting with particular mental health issues

Identifies physical health risk factors prominent in patients with specific mental illness

Patients with schizophrenia

Screen for coronary artery disease and its risk factors Check for personal/family history of IHD Take a smoking history Check blood pressure Check weight Check lipids

IHD causes most of the excess mortality in this group

Screen for diabetes Do BSL

Every 6-12 months if on atypical antipsychotics Screen for side effects of medication

Weight gain Metabolic effects - glucose and lipids Hyperprolactinemia Extrapyamidal side effects (EPSE) Tardive Dyskinesia (TD) Yearly ECG for consumers > 55 years on

antipsychotics QTc prolongation with some antipsychotics

Screen for substance use Take an alcohol and drug history Advise/refer if patterns of use are unsafe

Screen for substance use complications Alcohol related disorders eg liver disease, peptic

ulcer disease Hepatitis B/C, HIV/AIDS, infective endocarditis

Screen for cancer Women: mammogram, PAP smear Faecal occult blood - Rectal/colon cancer Skin cancer

These checklists

Provide gps who are not familiar with guidance in relation to specific risk factors

Ensure full health checks are completed with guidelines for reviews

Give a higher level of responsibility to gps

Assist in early diagnosis of physical health issues = prevention

Let’s think about some activities

What are some ways you might get your clients more active?

Increasing healthy living

Joining sporting clubs Setting small tasks such as walking

to the local milk bar Getting them to play a game of

soccer/footy with their kids Keep an activity diary and measure

mood levels in the diary Link with recreational clubs

What would you do?

Mustafa is a 28 year old male who is attending your service due to his cannabis use. He has been diagnosed with Major Depressive Disorder. He lives with his partner and their children (4 & 6 years of age). He is overweight and suffers from asthma. He is currently unemployed.

How would you aim to improve Mustafa’s physical health?