Strengthening Our Communities with Nutrition and Mental Health Training: A Pilot

November 7, 2019 12PM – 1PM EST

Nutrition Connections is a centre for nutrition knowledge and collaboration. We support health professionals, community organizations, educators, researchers, and others working in food and nutrition to build capacity, connect, and share information. • Operating under the Ontario Public Health Association since 1999 • Formerly funded by Ontario’s Ministry of Health and Long-Term Care • Supported in part by the Helderleigh Foundation

Presenter Vincent is a Public Health Nutritionist at the Thunder Bay District Health Unit who is passionate about health equity, mental health and collaborative approaches. His experience volunteering at a local drop in center and completing a placement at Waypoint Center helped him to realize the power of food in promoting mental health. In his current role, he is building capacity of mental health professionals by piloting a training on nutrition and mental health. He is excited to share this work and explore the role of nutrition professionals in mental health promotion.

Vincent Ng, RD, MPH

STRENGTHENING OUR COMMUNITIES WITH NUTRITION AND MENTAL HEALTH TRAINING

Vincent Ng Public Health Nutritionist November 7, 2019

INTRODUCTION

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Thunder Bay

Public Health Nutritionist Thunder Bay District Health Unit

CONTENTS

1. Background

2. Pilot development

3. Results

4. Next Steps

5. Discussion, Q & A

BACKGROUND Mental Health and Nutrition

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MENTAL HEALTH IN CANADA

In any given year, 1 in 5 people in Canada will personally experience a mental health problem or illness. By age 40, about 50% of the population will have or have had a mental illness. Approximately 8% of adults will experience major depression at some time in their lives.

https://cmha.ca/fast-facts-about-mental-illness

MENTAL HEALTH VS MENTAL ILLNESS

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RELATIONSHIPS BETWEEN MENTAL HEALTH AND NUTRITION

The Lancet Psychiatry (2015) “Although the determinants of mental health are complex, the emerging and

compelling evidence for nutrition as a crucial factor in the high prevalence

and incidence of mental disorders suggests that diet is as important to

psychiatry as it is to cardiology, endocrinology, and gastroenterology

(emphasis mine)”

Sarris, J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., ... & Nanri, A. (2015). Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry, 2(3), 271-274.

RELATIONSHIPS BETWEEN MENTAL HEALTH AND NUTRITION

RELATIONSHIPS ARE COMPLEX

Brain composition

Nutrition and Stress

Antioxidants

Medication Interactions

Specific nutrients and clinical conditions

Relationship to food

Social factors (e.g. food insecurity)

And More

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SMILES STUDY (2017)

13

Jacka, F.N., O’Neil, A., Opie, R. et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med 15, 23 (2017) doi:10.1186/s12916-017-0791-y

HELFIMED (2017)

14

HELFIMED (2017)

15

PILOT DEVELOPMENT Purpose and process

PROJECT TIMELINE

Spring 2018 • Requests from

local MH organization

Summer/ Fall 2018 • Draft material

+ input • Determined

pilot sites

Winter 2019 • Pilot

Presentation

Spring 2019 • Evaluation and

dissemination

PILOT DEVELOPMENT – AUDIENCE

Requests from local MH organization Outpatient counseling Pilot Sites chosen Lakehead University Health Services Confederation College Counseling CMHA Clinic *Atikokan

PILOT DEVELOPMENT - PURPOSE

Introductory 1. Relationship between Nutrition and Mental Health 2. Tips for discussing nutrition* Focus on Nutrition and Depression/mood disorders Current research Dietary patterns Prevalence

*Including when to refer to a Registered Dietitian

PILOT DEVELOPMENT - OBJECTIVES

1. Increased knowledge of how nutrition and food are related to mental health Focus on depression and mood

2. Increased confidence to discuss nutrition and food concerns with clients

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PILOT DEVELOPMENT - CONTENT

Based on learning needs

Input from professionals: • Julie Slack, MSc, RD, Public Health Nutritionist, Northwestern Health Unit

• Dr. Laura Lachance, Psychiatrist and Lecturer, Centre for Addiction and Mental Health - University of Toronto

• Julie Besse, RD, Mental Health Outpatient and Chronic Pain Management Programs, St. Joseph's Care Group

• Rachel Hicks, RD, MPH, Toronto Public Health

• Karen DeGagne M.S.W., R.S.W, Regional Outreach Eating Disorder Program, St Joseph's Care Group

• Colleagues and other professionals

PILOT DEVELOPMENT - CONSIDERATIONS

•Scope of practice

•Diet mentality

•Evidence

•Food insecurity

•Purpose of training

PILOT DEVELOPMENT

Final result: • 90-minute presentation • Handout

Topics Include: Background Dietary patterns Tips for discussing nutrition Weight stigma Non-diet approaches RD referrals

PILOT DEVELOPMENT - EVALUATION

•Pre-post survey

•Follow up at 1 month

•Likert scales + Open ended questions Knowledge Confidence Importance Usefulness Adult learning principles Feedback

RESULTS So what did we find?

RESULTS - PARTICIPANTS

•40 participants

•25 completed both pre and post training surveys

•9 participants completed the one-month follow-up survey

WHAT WE WANTED TO KNOW

OBJECTIVES

1. Increased knowledge of how nutrition and food are related to mental health Focus on depression and mood

2. Increased confidence to discuss nutrition and food concerns with clients

WHAT WE WANTED TO KNOW

Did we increase knowledge and confidence?

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RESULTS

0%

20%

40%

60%

80%

100%

Rate

of

Resp

onse

s

Very/Somewhat Knowledgeable Responses

Level of Knowledge in General Nutrition

Pre-Training Survey Post-Training Survey

RESULTS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Rate

of

Resp

onse

s

Very/Somewhat Confident Responses

Level of Confidence Discussing Nutrition Information with Clients

Pre-Training Survey Post-Training Survey

RESULTS - KNOWLEDGE

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Very/Somewhat knowledgeable

Rate

of

Resp

onse

Relationship between nutrition and depression and/or mood disorders

Pre-Training Post-Training

RESULTS

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

What nutrients influence mental health - POST

What nutrients influence mental health - PRE

How nutrients influence mental health - POST

How nutrients influence mental health - PRE

What foods reduce risk of depressive disorders - POST

What foods reduce risk of depressive disorder - PRE

Medication impacts on hunger and metabolism - POST

Medication impacts on hunger and metabolism - PRE

NUTRITION KNOWLEDGE

Very/Somewhat Knowledgeable A Little/ Not at All Knowledgeable

RESULTS - KNOWLEDGE

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

When to refer to a Registered Dietitian - POSTWhen to refer to a Registered Dietitian - PRE

SMART goals - POSTSMART goals - PRE

Tools for discussing nutrition goals with clients -…Tools for discussing nutrition goals with clients -…

Important social considerations when discussing…Important social considerations when discussing…

Intuitive Eating or Non-dieting approaches to…Intuitive Eating or Non-dieting approaches to…

Weight bias - POSTWeight bias - PRE

When to refer to a eating disorders program…When to refer to a eating disorders program…

NUTRITION COUNSELING CONSIDERATIONS

Very/Somewhat Knowledgeable A Little/ Not at All Knowledgeable

RESULTS

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Referring to an RD - POST

Referring to an RD - PRE

SMART goals for food related goals - POST

SMART goals for food related goals - PRE

Nutrition information with clients - POST

Nutrition information with clients - PRE

Medication interactions and nutrition - POST

Medication interactions and nutrition - PRE

CONFIDENCE DISCUSSING NUTRITION

Very and Somewhat A little and not at all

RESULTS

>80%

RESULTS

88%

96%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Importance of nutrition in MH - PRE

Importance of nutrition in MH - POST

RESP

ON

SE R

ATE

EXTREMELY/VERY IMPORTANT

Importance of Nutrition as a Mental Health Intervention

LIMITATIONS

•Basic material

•Pilot sites self-selected

•Self-assessment

•Social desirability bias

•Outcomes to clients unknown

•Indigenous Input Lacking

LEARNING LESSONS

•Needs Assessment and Pre-Training Survey

•Narrowing content

•Pilot sites

•Follow up evaluation

•Indigenous people

POINTS OF REFLECTION

RD led material

Unintentional consequences?

Systems change

NEXT STEPS Where to go from here?

IN THUNDER BAY

•Second round

•Part 2 Training - workshop

AND BEYOND?

•Designed to be shared

•Expand audience

•RD led?

FEEL FREE TO REACH OUT Vincent Ng Public Health Nutritionist Thunder Bay District Health Unit Vincent.ng@tbdhu.com 807-625-5968

Questions

Annual Forum

www.nc-forum.com

Thursday, November 14th, 2019

Thank you Vincent Ng, RD, MPH E-mail: vincent.ng@tbdhu.com Phone: 1-(807) 625-5968