Mental Health Program Incorporating Healthy Living Practices Into Everyday Living

1. Mental Health ProgramIncorporating Healthy Living Practices Into Everyday Living September 21st, 2010 Barb Quesnel MSW, RSW bquesnel@vgh.mb.ca

2. Educational Objectives • Define Metabolic Syndrome (MetS) • Understand the importance of early detection of MetS for mental health patients. • Explore reasons for increased incidence of MetS for MH patients

3. Educational Objectives • Familiarize audience with 13 Mind-Body Wellness modules and other health education materials • Lessons learned from facilitating these modules on an adult in-patient Unit

4. VGH Mental Health Program • 20 bed adult inpatient Unit • 360 admissions a year • Average length of stay 18 days • Multidisciplinary team including 4 psychiatrists • Clozapine Clinic • Depot Clinic

5. WHERE IT ALL BEGAN

6. Dr. Marie-Josée Poulin MD, FRCP (C)University of Québec Robert-Giffard Hospital

7. Life Expectancy is Reduced Significantly for Mentally Ill Patients • Patients with major mental disorders like schizophrenia and bipolar are most affected -up to 20 to 25 years of potential life lost • Leading cause is of death is cardiovascular disease • Other lifelong diseases like diabetes frequently co-occurring • It is the MH care teams responsibility to assess for and educate patients about MetS, and to facilitate medical follow up

10. Definition of Metabolic Syndrome • MetS is a cluster of metabolic abnormalities which represent an elevated risk for cardiovascular disease, and type ll diabetes. A person with metabolic syndrome is 2 times as likely to develop heart disease and 3 times more likely to develop type ll diabetes as someone without Mets. (Casey, 2005, p. 175)

11. Metabolic Syndrome is Preventable and Reversible

13. A word about taking waist measurement

14. Who's Responsibility Is It? • Psychiatry can and must play an important role in assessing and monitoring Metabolic Syndrome Remembering that PREVENTION OF WEIGHT GAIN IS THE BEST STRATEGY

15. Separating Psychiatry & Medical Care For the many of us who have tried to maintain a clear separation between psychiatry and medical care, a change in how we perceive our role may be necessary. Dr. Gary Remington Am J Psychiatry 163:7, July 2006 PP. 1132-34

16. Can We Separate Psychiatry & Medical Care? No. The reasons: • Little, or inconsistent medical care for those individuals with prolonged and reoccurring mental illness • MH patients have more contact with mental health professional than “health” professionals

17. Can We Separate Psychiatry & Medical Care? • Given the concern of the weight gain side effect with the newer anti-psychotics – we have a responsibility to monitor changes in health • Increased likelihood of development of co-occurring medical conditions make it necessary to ensure physician follow up

18. Separating Psychiatry & Medical Care No controversy in what knowing what needs to be done – it’s a matter of translating knowledge into practice

19. Separating Psychiatry & Medical Care The silver lining to this cloud is that, as these issues come to the fore, an opportunity for us to take decisive steps toward establishing a comprehensive model of care in which psychiatrists play an integral role in the overall health, physical and mental, of patients with schizophrenia. Gary Remington P. 1133

23. Best Practices for Treatment • Start patient on medication • Assess for MetS: • Baseline medical tests/measurements • Fasting blood glucose • Fasting triglycerides level • Fasting HDL – Cholesterol level • Blood pressure • Waist measurement

24. Best Practices for Treatment • Educate and support healthy life style changes • Continue to monitor MetS clinical values and ability to make life style changes

25. Best Practices for Treatment • At six month mark of starting medication if patient is doing well on medication but risk factors for MetS increasing consider changing medication. • Weigh gain typically tapers off after two years. • However by then unhealthy amount of weight may have been gained

26. Why Is Weight Gain So Important? For individuals that do not have a MI: • Once the weight is gained the odds of losing it and keeping it off are slim • Excess pounds raise the risk of diabetes, heart disease, stroke, many types of cancer, gal bladder disease, and arthritis

27. Why Is Weight Gain So Important? • For individuals with prolonged and reoccurring mental illness (schizophrenia, bipolar illness and psychotic type disorders) excess weight gain is a much greater challenge to control and loose once gained.

28. Metabolic Syndrome isReversible and Preventable

29. Obesity Rates We are growing as a society and the projections are not good

30. Obesity rates, by age group, household population aged 18 or older, Canada excluding territories, 1978/79 and 2004 Obesity rates, by age group, household population aged 18 or older, Canada excluding territories, 1978/79 and 2004

31. Percentage distribution of body mass index (BMI), by sex, household population aged 18 or older, Canada excluding territories, 2004

32. We know all this…… So what’s going on?

33. TOXIC FOOD ENVIRONMENTDr. Kelly BrownellYale UniversityDepartment of Psychology, Epidemiology and Public HealthNutrition Action Health LetterMay, 2010

34. Brownell is co-founder and directs Yale’s Rudd Centre for Food Policy and ObesityWorks to improve the world’s eating habits, prevent obesity and reduce weight stigma

35. Brownell says the Environment is toxic because it is making people sickHe is identifying the environment as the problem – not the individual person

36. Toxic Food Environment Also Brownell equates our toxic food environment with our tobacco-industry experience. • Initially gov’t took a hands off approach • Billions of dollars to be made by private companies and gov’t tax revenue

37. Toxic Food Environment con’t • The individual (who smokes or has the weight problem) is blamed for the medical consequences – not viewed as industry or gov’ts responsibility • Industry critical of gov’t if they get involved calling gov’t “food police” and accusing gov’t of stripping people of civil liberties

38. Historical Action Taken with Tobacco Industry • High tax on product • Not available for purchase if not 16 years of age • Health warnings on packages • No advertising on TV& or in magazines • Out of sight at stores • Educational programs targeting pre-teens/teens and /women who are pregnant • Many drug stores opting out of selling product • Strict regulations on where you can smoke

39. Factors Contributing to Toxic Food Environment • Access to unhealthy food choices is everywhere • Access to healthy food choices limited • Unhealthy (fast food) is cheap • “Super sizing” is even a better deal • Most stores are pushing junk food • Healthier food choices are more expensive and less “convenient”

40. Other Factors Contributing to Toxic Food Environment • Misleading advertising • Bombardment of junk food advertising • Government initially taking a hands off stance RESULTS: • Obesity rates growing in virtually every country in the world • Resulting in healthcare costs skyrocketing • Government is beginning to take action • 2006 Labels on food items

41. Extreme Foods How much of what is a daily requirement? Carbs / Proteins / Fats Guesses?

43. Daily Food Requirements • Carbs – 330 grams • Proteins – 100 grams • Fats – 75 grams

44. How Much Fat? • US National Cholesterol Education Program (NCEP) suggests • Saturated – less than 16 grams • Polyunsaturated – 22 grams or less • Monounsaturated – 44 grams or less • As little trans fat as possible • 82 grams in total- 16 or less Saturated

45. Nutrient Balance Carefully planned nutrition must provide an energy balance and a nutrient balance. The nutrients are: Proteins - essential to growth and repair of muscle and other body tissues Fats - one source of energy and important in relation to fat soluble vitamins Carbohydrates - our main source of energy Minerals - those inorganic elements occurring in the body and which are critical to its normal functions Vitamins - water and fat soluble play important roles in many chemical processes in the body Water - essential to normal body function - as a vehicle for carrying other nutrients and because 60% of the human body is water Roughage - the fibrous indigestible portion of our diet essential to health of the digestive system Retrieved from Internet September 12, 2010: http://www.brianmac.co.uk/nutrit.htm

46. EXTREME FOODS

48. LOS ANGELES — A milkshake containing 2,010 calories - equivalent to eating 68 strips of bacon or 30 chocolate chip cookies — has topped a list of the 20 worst drinks in America compiled by Men's Health Magazine, (May 2010). The Cold Stone PB&C milkshake, made with peanut butter, chocolate ice cream and milk, contains 68 grams of saturated fat and 153 grams of sugar, according to nutritional details on the company's website.