level health equally well key findings from a literature review informing collaborative efforts to...
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Level Health
Equally WellKey findings from a literature review informing collaborative efforts to improve the physical health outcomes of people with mental illness and/or addiction
Candace BagnallSenior Policy AnalystTe Pou o Te Whakaaro Nui
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Overview
• Introduction to Equally Well• Results of literature review• Suggested areas for action
based on the review• What’s next?
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About Equally Well
• We are a group of individuals and organisations who are taking action on a longstanding, ‘wicked’ problem – the relatively poor physical health of people with serious mental illness and/or addiction
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About Equally Well
• Initiated by members of Platform and Te Pou
• Helen Lockett has been leading the project on a part-time basis, funded through Te Pou’s contract with the Ministry of Health, and with their agreement
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Progress to date
• Brought together research-based information and good practice examples from around the country
• Developed a shared position statement based on the evidence review
• This is supported by a growing number of organisations and representative bodies
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Scope of literature review
• Life expectancy and the prevalence of physical health conditions amongst people with serious mental illness and/or addiction
• Explanations for poor physical health relative to the NZ population as a whole
• Promising interventions for improving health outcomes for this group
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Mortality and morbidity
• International reviews indicate life expectancy up to 25 years shorter than the general population
• NZ research indicates mental health services users have more than twice the mortality rate of other New Zealanders
• Significantly higher rates of CVD, diabetes, metabolic syndrome, and higher death rates from cancer
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Causes of premature death in New Zealanders using mental health services
Women
Men
cancercardiovascother natural causes suicideother external causes
Cunningham et al. NZMJ 2014 127:1394
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Explanations for relatively poor health
• Greater exposure to known risk factors – low SES, smoking, reduced physical activity, poor nutrition
• Psychotropic medication effects – contribution to obesity, metabolic syndrome, CVD and type 2 diabetes
• Reduced access to and quality of healthcare – due to financial barriers, stigma and discrimination, lack of clarity about responsibilities for physical health across primary and secondary care
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Psychotropic medication (Pharmac)
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Solutions - systems level
• Formal acknowledgement in national policy as a priority health group
• Better co-ordination of treatment for physical health problems across primary and secondary care
• Guidelines outlining roles and responsibilities for physical health problems across primary and secondary care
• Workforce development to address stigma amongst health practitioners
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Solutions – service level
• Provide effective physical health monitoring and screening processes for people using mental health services, especially those on psychotropic medication
• Invest in early intervention in psychosis services
• Reduce impact of low SES by supporting access to employment and housing
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Solutions – service level
• Combine smoking cessation, physical activity and healthy nutrition promotion with cognitive behavioural support where possible
• Service user-directed, involving staff • Focus on achieving long-term sustainable
lifestyle changes • Improve access to dental health services for
mental health and addiction service users
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What works for service users
• Build on therapeutic alliance• Combine cognitive and behavioural strategies• Realistic goals• Flexibility to accommodate individual needs• Provide ongoing support• Include a social component• Acknowledge barriers faced by people with
SMI in participating in wellbeing programmes
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Research and evaluation
• Trial alternative and complementary treatment options for psychosis to minimise the effects of medication
• Options include the use of psychological therapies and comprehensive wellness programmes using evaluation to develop best practice in different settings
• Qualitative research to better understand needs of service users
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What’s next for Equally Well
• Summit in Wellington to generate action on 10 November
• Use of online software (Loomio) to generate discussion prior to the Summit
• Encouraging organisations to sign up to the consensus paper
• A programme of collaborative action
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A programme of collaborative action
Heart disease and mental health
Increasing visibility - policyClarity of roles - clinical guidelines
Early intervention in psychosis wellbeing interventions
Cancer and mental health
Improving pathways of care for physical health issues
Research – informing solutionsIncreasing access to
oral health
Addressing stigma and discrimination
Equally Well
champions
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champions
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champions
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Equally Well champions
Equally Well
champions
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Thank you
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