Target Population

1. Making the Case for integrating physical activity programming into mental health services settings

2. Target Population

3. High-level Value of Physical Activity for People with Serious Mental Illness

4. Why Now? • Solid empirical findings that people living with serious mental illness are usually less active and more sedentary than the general population • Recent research has concluded that strategies to change physical activity behaviour which have proven successful in healthier populations can be adopted for SMI population • Growing scientific evidence that physical activity/ exercise has a multitude of physical, mental and social benefits for persons with serious mental illness

5. Why Now? • Increasing knowledge and lessons learned are surfacing from community mental health service providers – locally and globally - who have pioneered the integration of physical activity programming for consumers. These will be shared shortly… • Body-mind connection is better understood and supported by primary health care practitioners and mental health clinicians • Ontario government is committed to implementing a holistic and integrated approach to health which includes funding community partnerships that address health promotion initiatives such as physical activity and mental health promotion

6. Why Mental Health Services? • Physical activity can support recovery  fits with mandate of community mental health services • Established professional relationships & ongoing contact with SMI population • Specialized training and sensitivity to address barriers facing SMI population with respect to participation in physical activity programming • Well-positioned to partner with local health promoting agencies • Opportunity to reduce service coordination issues within and outside of mental health care sector thereby that enhancing access to lifestyle intervention supports for SMI population

7. Presenting the Evidence: Data Collection Methods • Evidence-based studies from literature review • CMHA Ontario environmental scan (2008/09) • Eight in-depth interviews with mental health service providers running a physical activity program • 6 out of 8 interviewees provided a successful running and/or walking group (as part of their program) • Other programming activities included basketball, tennis, racquetball, swimming, ping-pong, weights, yoga and dance • 144 responses to an online questionnaire by mental health service providers • 41% (n = 59) were running a physical activity program • 59% (n = 85) were not running a physical activity program

8. Reported Physical Health Benefits of PA* Program • Improves cardiovascular functioning and strength • Mitigates epic problem of weight gain and metabolic disorders (e.g., diabetes) • Improves muscle toning • Improves posture • Helps to normalize sleep patterns • Helps to wean off medications for metabolic issues and high blood pressure PA = Physical Activity

9. Reported Mental Health Benefits of PA* Program PA = Physical Activity

10. Reported Social Benefits of PA* Program • Serves as a bridge to engaging with other agency groups and activities • Natural stage for rehearsing social skills without feeling in the spotlight • Social interaction, social support and motivation provided • Companionship;“physical needs bring clients to PA program, but social benefits keep them there.” • Opportunity to “step out of shell” despite having arrived in a withdrawn state • Sense of belonging to a group Community integration e.g., through involvement in community races, public presentations regarding the group, etc. &

11. Additional Benefits of PA* Programs for the Seriously Mentally Ill • Physical activity is associated with minimal adverse side-effects – in contrast to pharmacological interventions • Physical activity can be sustained indefinitely by the individual, unlike psychotherapeutic treatments which often have a specified end point • Many other non-drug treatments (e.g., cognitive behavioral therapy) are expensive and often in short supply • Physical activity is a normalizing health-focused experience, unlike drug treatments and other clinical interventions that are a constant reminder of one’s illness

12. Current Landscape: PA* Programming in Mental Health Services Settings • There is always a lag between evidence-based research findings and program implementation • Despite the recognized physical, mental and social benefits of regular physical activity/ exercise, the systematic prescription of therapeutic exercise is not common in mental health settings • Some mental health service settings have incorporated physical activity programming into service delivery, however this is still not viewed as an essential element of recovery • Programs that do offer physical activity programs tend to be ad-hoc initiatives of a staff person(s) with interest, passion and dedication

13. Systemic Barriers to Implementation of PA* Programs in SMI Population • Views and attitudes of Western medicine: The mind-body disconnect in terms of treating physical and mental health conditions • Mental health clinics lack knowledge about the therapeutic benefits of regular physical activity/ exercise coupled with unclear “prescription” guidelines as to how much exercise is beneficial • The perceived simplicity of PA programs contrasted against the reality that many practitioners are daunted by how to motivate clients with low self-esteem, significant weight gain and low energy (whether a side-effect of medication or the illness itself) • Lack of communication and knowledge exchange within the community mental health system

14. Organizational Barriers to Implementation of PA* Programs in SMI Population • Access to adequate facilities/ physical space • Availability of funds to support staffing and other program expenses • Lack of staff motivation and knowledge about physical activity programming benefits • Challenges to motivate participants and provide individualized support • Staff time management with competing priorities • Program evaluation challenges: difficult to establish a meaningful baseline and post-exercise measures given continuous intake process

15. Participant Barriers to Implementation of PA* Programs in SMI Population • Health and mental health-related concerns (e.g., medication sedation, weight gain and body image, distracting thoughts and ability to focus, and fear of unsafe conditions and of being injured) • Social anxiety • Transportation costs to attend the program and other costs associated with participation

16. And Now for the Good News!How to Overcome these Obstacles and Build Capacity PA = Physical Activity

17. Community Partnership Building and Inter-agency Collaboration

18. Community Partnership Building and Inter-agency Collaboration • Community-specific partnerships are developed through the establishment of professional relationships between two or more groups that share a mutual goal • Opportunity to raise community awareness about mental health issues and de-bunk myths/ stigma associated with mental illness

19. TYPES of Partnerships (from CMHA Environmental Scan) • FACILITIES: free or subsidized use of community centre, church space, community swimming pool, local gym facility • EXPERTISE: working with a community food advisory program; working within a large interdisciplinary mental health facility where recreation staff consult with dieticians and doctors to understand interaction between medication, diet and exercise; access to a team of health professionals on a consultancy basis • RESOURCES AND STAFFING: sharing of resources between mental health agencies in the same area • FINANCIAL DONATIONS: tapping into a charitable community program that collects and distributes lightly used running shoes and fitness apparel; partnership with community running race that donates part of charitable proceeds to PA program

20. Tapping into Existing Resources • The ideal staffing complement to run a physical activity group includes those with an adequate knowledge of physical activity – not necessarily a qualified fitness leader – coupled with a genuine passion and empathy for helping those living with mental illness • Adequate knowledge of physical activity was described as valid whether it was achieved through prior self-learning, on-the-job training or through partnering with fitness experts in the field

21. Tapping into Existing Resources • Staff training and program start-up costs can be kept to a minimum in large part due to the availability of several free online physical activity resources, including: • Canada’s Physical Activity Guide • Ontario’s Active 2010 • Heart Health Resource Centre • Recent research findings advocate for adapting mainstream physical activity programs for use with SMI populations, rather than creating entirely new programs from the ground up • Mental health providers who partner with community fitness leaders can tailor an existing PA program so that its structure and pace meets the needs of SMI participants in that group

22. Tapping into Your Volunteer Base • Community colleges and universities are optimal places to seek out volunteers who may already bring some knowledge and experience in the physical and social sciences; student work placements can provide invaluable real-life exposure to the field of community mental health for individuals considering this career choice • Volunteers can assist with running a PA group, training staff and peer leaders, participant follow-up and attendance reminders as well as raising funds and awareness about the importance of physical activity to mental health

23. Peer Mentors and Leaders: A Win-Win Approach • Peer leaders can derive many personal benefits from their role • Improved physical and mental health, and athletic skills • Enhanced leadership and communication skills • Ongoing social connections • Increased self-confidence and satisfaction of helping others

24. Peer Mentors and Leaders: A Win-Win Approach • Peer leaders can serve as a powerful motivator for encouraging fellow peers to reach their fitness goals • Real-life experiential observation of success in someone else who shares similar barriers and health conditions can be very inspirational • Peer support can make one’s personal goals feel more attainable as these individuals are living proof of the benefits of physical activity

25. Peer Mentors and Leaders: A Win-Win Approach • Peer leaders can provide staff with additional support to help reduce the pressures of competing service demands and diminishing resources • Helpful support functions expressed by respondents included: peer workers picking up new clients at their home who had a hard time getting to the PA group; peer workers providing friendly phone call reminders the night before a PA group • These types of support were identified as especially useful when trying to engage secluded and hard-to-reach individuals who are without access to transportation

26. Concluding Remarks • Everyone can benefit from regular physical activity – regardless of age or fitness level • Successful strategies to change physical activity behaviour in healthier populations can be adopted for those with serious mental illness, and can be implemented in mental health service settings or in partnership with other community agencies • Physical activity has the potential to simultaneously improve physical health and mental well-being, and treat mental illness • It’s a logical fit to integrate PA programs into community mental health services given their frequency and duration of contact with the SMI population and their specialized training and expertise in understanding the needs and sensitivities of this group

27. Concluding Remarks • The risks of PA program implementation are extremely low • Starting up a PA program need not be complicated nor expensive • PA programs can start very small – such as organizing a running or walking group – and slowly expand to include other physical activities • The evidence-based benefits of investing in these initiatives far outweigh the costs of failing to do so from and individual and public health care perspective

28. Concluding Remarks As noted by one respondent: “ Exercise is a wonderful metaphor for understanding the struggles associated with recovery from serious mental illness and life itself. Exercise – like recovery – is an ongoing effort that must be taken one step at a time.”