1. Mental health cluster APhysical health Session two 29/04/11

2. Physical health and mental health

3. 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

4. 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”

5. 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.

6. 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).

7. 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

8. 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

9. 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

10. Access to services Travel issues or maintaining scheduled appointments Particularly problematic in rural or remote areas Communication barriers

11. 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

12. Lifestyle factors Transience High risk behaviours

13. 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

14. 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

15. GP responsibility

16. 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

17. 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

18. 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) TardiveDyskinesia (TD) Yearly ECG for consumers > 55 years on antipsychotics QTc prolongation with some antipsychotics

19. 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

20. 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

21. Let’s think about some activities What are some ways you might get your clients more active?

22. 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

23. 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?