Ebook Preventing diet-related chronic disease in people with severe mental illness: Embedding integrated care pathways into a local community mental health service
Studies over the past sixty years have consistently shown that consumers of mental health services have higher mortality and morbidity rates than the general population. Death often occurs at a younger age, with life expectancy shortened by up to 25 years in people with chronic severe mental illness (SMI).
Despite a focus on the higher risk of suicide, accidental and violent death in this group, evidence shows that the excess mortality and morbidity seen in this group is primarily a consequence of diet-related chronic disease; 12-14% of people living with chronic mental illness have diabetes (compared to 4-7% in the general population), the rate of obesity is double, metabolic syndrome prevalence is up to 4 times higher and cardiovascular-related deaths are more than twice as common than in the general population.
The aetiology of diet-related chronic disease and risk in people living with SMI is extremely complex and very poorly understood. However, it is clear that risk factors such as obesity, hypertension and dyslipidaemia, which directly contribute to diet-related chronic disease, form part of the aetiology. The high level of diet-related chronic disease and disease risk in people with SMI likely stems from multifactorial issues (‘the causes of the causes’) at three key levels: the health-care system, the health practitioner and people living with SMI. Each of these levels are fundamentally impacted and influenced by social determinants of health.
Research indicates that any activity that can reduce diet-related chronic disease risk in people with SMI will have a significant positive impact in a number of areas, including a reduction in mortality rates, less stigma and discrimination, increased medication compliance, better psychosocial outcomes, decreased medical costs, decreased severity of SMI symptoms, increased quality of life and better rehabilitation and recovery rates.
However, one of the most consistent problems seen in the health arena is the difficulty translating best practice evidence (as determined by research) into clinical practice. In the past 5 years, a number of national and international guidelines have been developed to promote cardio-metabolic health in people with SMI in the U.S., U.K., Europe, Canada and Australia. Yet despite the introduction of many of these types of guidelines across the world, there is very little evidence that monitoring or screening rates have increased. Management and treatment rates (even when diet-related chronic disease or risks are detected in people with SMI) are also incredibly low compared to the general population. It is likely that the problem continues for reasons that include barriers related to worker and consumer knowledge, attitudes and skills; inter-sectoral communication and collaboration issues; a lack of clear role delineation resulting in ‘turf wars’; poor workforce capacity; time constraints; and financial impediments.
In late 2007, funding support was secured by the project leader through the Southern Adelaide Health Service (SAHS) Service Enhancement Initiative (part of the Australian Better Health Initiative) to help address the issues at a local level. Southern Mental Health is part of SAHS, covers the region from Parkside through to Sellicks Beach and includes mobile emergency teams, inpatient units, residential rehabilitation, emergency department services and community mental health teams. Two sites, Adaire Clinic (a community mental health centre) and Trevor Parry Centre (a community recovery centre), were the focus of activities. The project leader established a project to improve the identification of diet-related chronic disease risk, and to develop locally relevant integrated care pathways to help consumers prevent diseases such as obesity, cardiovascular disease and diabetes. The project also aimed to address particular service gaps – specifically a need to focus on identifying and implementing health promotion, prevention and early intervention services and resources to help support consumers to take up healthier eating and become more physically active.
Contents
Executive Summary
Background Literature Review
Mental health, mental illness and severe mental illness
Diet-related chronic diseases
- Chronic disease
Links with diet and activity levels
Diet-related chronic disease and severe mental illness
Prevalence of diet-related chronic disease risk in severe mental illness
- Prevalence of metabolic syndrome
Prevalence of obesity, hypertension and dyslipidaemia
Aetiology of diet-related chronic disease and risk in severe mental illness
The impact of diet-related chronic disease and risk in severe mental illness
- Diet-related chronic disease and mortality rates
Stigma and discrimination
Medication “non-compliance” due to weight gain
Psychosocial impacts of antipsychotic induced weight gain
Increased medical costs
Effects on psychopathology
Decreased quality of life
Impact on rehabilitation & recovery
Detection, prevention and management of diet-related chronic disease and disease risk in severe mental illness
- Detection of the problem: “Monitoring Guidelines”
Prevention
Management
Introduction
Southern Mental Health – Adaire Clinic and Trevor Parry Centre
Project Rationale
Methods and Results
Clinical Practice Improvement Methodology
- Step 1: The project phase
Step 2: The diagnostic phase
Step 3: The interventions phase
Step 4: The impact and implementation phase
Step 5: The sustaining improvement phase
Discussion and Outcomes
Project Goal
Project Objectives
Local Gaps and Barriers
Recommendations
The South Australian Context
Proposed recommendations for Southern Adelaide Health Service and Southern Mental Health: Next Steps
- System Level Recommendations
Practice Level Recommendations
Individual Level Recommendations
Conclusion
References
Appendices
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