keeping the body in mind: a lifestyle intervention …...keeping the body in mind: a lifestyle...

Keeping the Body in Mind: A lifestyle

intervention program for people with

Severe Mental Illness.

Andrew Watkins

On Behalf of Keeping the Body in Mind (KBIM) team

South East Sydney Local Health District

Clinical Nurse Consultant, Clinical Lead KBIM Team

PhD Candidate, University of Technology, Sydney

Equally Well Symposium, March 2019 @iphYs_YMH

Keeping the Body

in Mind YMH

https://www.seslhd.health.nsw.gov.au/keeping-body-mind

iphys.org.au

Research evidence

evidence

implementation

THE

ROLLOUT

EXTENDING THE KBIMPROGRAMME DISTRICT WIDE

4 CENTRES IN SESLHD

KoSiM

PHASED

IMPLEMENTATION OF

KBIM PROGRAMME

Bondi

Sutherland

St George

KBIM TIMELINE

2013

KBIM initial evaluation for

FEP clients

KBIM teams employed

- 9 clinicians- 3 peer

workers

2014

KoSiMWave 1

Phase 1 rollout:

FEP clients

KBIM Maroubra employed

2016

KoSiM Wave 2

Phase 2 rollout:

Clozapineclients

Phase 3 rollout:

LAIclients

20172015

Projects:-y-QUIT;

-headspace Active;-OSA;

-oral health;-peer health

coach

2018

kg

Months 12 240 4836

Established psychosisRCTs

Established PsychosisRCTs

10

5

20

15

12 kg

4 kg

3 kg

Alvarez-Jimenez et al; CNS Drugs, 2008

Antipsychotic-Induced Weight Gain in Chronic and First-Episode Psychotic Disorders: a Systematic Critical Reappraisal

First episode of psychosis RCTs

NEUTRALITY

WAIST (CM) PRE AND POST KBIM

INTERVENTIONN = 67

86

87

88

89

90

91

92

93

Male Female TotalBaseline Follow-up

↓ 1.20cm p=0.41

↓ 1.36cm p=0.10

↓ 1.31cm, p=0.07

KBIM TIMELINE

2013

KBIM initial evaluation for

FEP clients

KBIM teams employed

- 9 clinicians- 3 peer

workers

2014

KoSiMWave 1

Phase 1 rollout:

FEP clients

KBIM Maroubra employed

2016

KoSiM Wave 2

Phase 2 rollout:

Clozapineclients

Phase 3 rollout:

LAIclients

20172015

Projects:-y-QUIT;

-headspace Active;-OSA;

-oral health;-peer health

coach

2018

Overview – What is KoSiM?

A brief staff physical health intervention delivered by a CNC, dietitian and exercise physiologist.

WHY?

Create a shift in organisational culture towards one that is inclusive of physical health

Enable mental health staff to confidently address the physical health needs of consumers

Give staff an understanding of the role of EPs and dietitians in mental health.

(n=212)

Qualitative feedback

Working with consumers

Family

Personal health improvements‘I now know how to have basic conversations about

food with my clients which in the past I got stuck at’‘My doctor called me in after

my blood tests… He said all of my results had improved and

asked me what I was doing differently!’

Workplace culture

Morale

Productivity

‘The environment changed completely, because there’s more people around taking

care of themselves’

‘I really, really value that NSW Health gave us the

opportunity, a perk in the job is just marvellous…It is, hard

to come by’

KBIM TIMELINE

2013

KBIM initial evaluation for

FEP clients

KBIM teams employed

- 9 clinicians- 3 peer

workers

2014

KoSiMWave 1

Phase 1 rollout:

FEP clients

KBIM Maroubra employed

2016

KoSiM Wave 2

Phase 2 rollout:

Clozapineclients

Phase 3 rollout:

LAIclients

20172015

Projects:-y-QUIT;

-headspace Active;-OSA;

-oral health;-peer health

coach

2018

NEEDS ANALYSIS

301 on LAI & 416 on Clozapine

64% 36%

Mean Age ~ 44 years

Primary diagnosis – schizophrenia or schizoaffective disorder

7% ATSI

CARDIOMETABOLICRISK FACTORS

Cardiometabolic Risk Factor LAI Clozapine

Overweight or Obese (BMI) 75% 80%

Waist Circumference at RiskMale (mean, SD)Female (mean, SD)

79%105cm, 17.0102cm, 19.4

85%109cm, 16.6 104cm, 17.7

High Risk of Type 2 Diabetes 65% 68%

Smokers 62% 44%

Metabolic syndrome 43% 58%

• Diet

• PhysicalAssessment

• Behaviour change

• Self management

• Goal setting

Health Coaching

• Practical life skills

• Social connection

• Self esteem

Group

THE PROGRAM• Clozapine and LAI clients

• 12 weeks

SITE PARTICIPATION

Total

First timers 133

Repeats 64

Total 197

0

10

20

30

40

50

60

< 35 35 to 44 45 to 54 55 to 64

Age Category62% 38%

• Waist reduction ↓ 1.9cm

• Sit time ↓ 5.9 hours per week

• Food and drink energy intake ↓ 17%

• Carbon Monoxide score of participating smokers ↓ 16.8ppm (71% reduction)

COMPLETERS RESULTS

would suggest the program to someone else

“Everyone was spot on, thank you for your help.”

“You got me out of the house, thank you KBIM.”

“I liked we had some people in group each week as I got to

know them.”

“I have so much more energy now- I never want to go back to how I was.”

KBIM TIMELINE

2013

KBIM initial evaluation for

FEP clients

KBIM teams employed

- 9 clinicians- 3 peer

workers

2014

KoSiMWave 1

Phase 1 rollout:

FEP clients

KBIM Maroubra employed

2016

KoSiM Wave 2

Phase 2 rollout:

Clozapineclients

Phase 3 rollout:

LAIclients

20172015

Projects:-y-QUIT;

-headspace Active;-OSA;

-oral health;-peer health

coach

2018

QUIT

y-QUIT toolkit

y-QUIT intervention

(12-25 yrs)

evaluation

Interventions

41 young people commenced a harm reduction smoking cessation intervention.

12, 29%

9, 22%

20, 49%

Incomplete Full Completed Full

Completed Brief

0

2

4

6

8

10

12

14

16

18

Cigarettes Exhaled CO

Smoking-related measures

Pre Post

Full Intervention

y-QUIT: Smoking Prevalence, Engagement and Effectiveness of an Individualized...Jackie Curtis,Charry Zhang,Bernadette McGuigan,EstherPavel-Wood,Rachel Morell,Philip B. Ward*,Andrew Watkins,Julia M LappinFront. Psychiatry - Schizophrenia, DOI: 10.3389/fpsyt.2018.00683

Raising Expectations

www.seslhd.health.nsw.gov.au/keeping-body-mind

www.iphys.org.au

https://www.equallywell.org.au/

Andrew WatkinsOn behalf of the Keeping the Body in Mind teamSouth East Sydney Local Health District

Andrew.Watkins@health.nsw.gov.au