mental health cluster a session two 280411
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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?