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Debbie van Tonder, Caroline Jagoe, Martina Coen & Paul Geoghegan St Patrick’s Mental Health Services, Dublin

A Missed Population : Design and implementation of a physical health promotion programme for service users with severe and enduring mental illness. Debbie van Tonder, Caroline Jagoe, Martina Coen & Paul Geoghegan St Patrick’s Mental Health Services, Dublin. Background.

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Debbie van Tonder, Caroline Jagoe, Martina Coen & Paul Geoghegan St Patrick’s Mental Health Services, Dublin

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  1. A Missed Population: Design and implementation of a physical health promotion programme for service users with severe and enduring mental illness Debbie van Tonder, Caroline Jagoe, Martina Coen & Paul Geoghegan St Patrick’s Mental Health Services, Dublin

  2. Background • People with serious Mental Health Disorders (MHDs) have a lower life expectancy than the general population: recognised for over 2 decades (Russ et al, 2012; Newman & Bland, 1991). • The higher risk of mortality and morbidity are related to: • Metabolic syndrome: (Keelan & Feely, 2003). Obesity (waist circumference) + high BP + abnormal cholesterol profile + high blood glucose. • Coronary Heart disease (e.g. Garcia-Portilla, 2009; Sowdon & Huffman, 2009), • Type II Diabetes (Citrome et al., 2007; De Hert et al., 2006), • Stroke (Lin et al, 2007; Lin et al, 2008), • Higher rates of smoking (de Leon & Diaz, 2005), • Documented high risk and rates of dysphagia (McManus, 2001; Regan, Sowman & Wlash, 2006). Keck & McIlroy, 2003; Wirshing, 2004).

  3. An issue of equity? “This combination of high rates of physical illness and low rates of effective treatment leads to the fatal consequences of discrimination and neglect: People with all types of mental disorders have an increased risk of premature death” (Thornicroft, Rose & Kassm, 2007, p.118)

  4. Challenges • Attitudinal barriers • Health professionals; service users • Stigma • Informational barriers • format, accessibility • Structural barriers • two pronged system: access • Environmental barriers • Transport, access to leisure services • Intrinsic barriers (nature of the severe and enduring mental illness) • Motivation; revisiting hospital setting; anxiety around stigma causing avoidance; fear of being exposed

  5. Higgins, 2008 (A Recovery Approach within the Irish Mental Health Services) & Higgins & McBennet, 2007 Rootman et al., 2001

  6. The SPMHS Model • Services users can ‘enter’ at any of the three components • Service users can move through the components in any direction • 6 monthly physical monitoring with the vision to have this in place for all service users

  7. SPMHS Model

  8. WHO Principles of Health Promotion

  9. Key considerations Key concepts which have emerged related to Advocating for Equality of Health opportunities: • Embedded physical health promotion programmes within mental health services that can address physical needs alongside mental health needs • Multidisciplinary team • Group context & peer support • Multipronged strategy (intensive opportunity, maintenance, monitoring)

  10. References • Citrome L. Vreeland B. Schizophrenia, obesity, and antipsychotic medications: what can we do? Postgrad Med 2008;120:18-33. • De Hert MA, van Winkel R, Van Eyck D et al. Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophr Res 2006;83:87-93. • Garcia-Portilla MP, Saiz PA, Benabarre A et al. The prevalence of metabolic syndrome in patients with bipolar disorder. J Affect Disord2008;106:197-201. • Higgins, 2008 (A Recovery Approach within the Irish Mental Health Services) & Higgins & McBennet, 2007 • Keck PE, McElroy SL. Bipolar disorder, obesity, and pharmacotherapy- associated weight gain. J Clin Psychiatry 2003;64:1426-35

  11. References continue • Lin HC, Hsiao FH, Pfeiffer S et al. An increased risk of stroke among young schizophrenia patients. Schizophr Res 2008;101: 234-41. • Lin HC, Tsai SY, Lee HC. Increased risk of developing stroke among patients with bipolar disorder after an acute mood episode: a six-year follow-up study. J Affect Disord 2007;100:49-54. • McManus, M. Dysphagia in Psychiatric Patients, Journal of Psychosocial Nursing Mental Health Services, 39, 24 – 30. • Nilsson FM, Kessing LV. Increased risk of developing stroke for patients with major affective disorder – a registry study. Eur Arch Psychiatry ClinNeurosci 2004;254:387-91

  12. References continue • Regan, J., Sawman, R., Walsh, I. Prevalence of Dysphagia in acute and community mental health settings, Dysphagia, 2006; 21, 95 – 101. • SowdenGL, Huffman JC. The impact of mental illness on cardiac outcomes: a review for the cardiologist. Int J Cardiol 2009; 132:30-37. • Tranter S, Irvine F, Collins E. Innovations aimed at improving the physical health of the seriously mentally ill: an integrative review, Journal of Clinical Nursing, 2012, 21, 1199 – 1214. • WirshingDA. Schizophrenia and obesity: impact of antipsychotic medications. J Clin Psychiatry 2004;65:13-26.

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