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2. Physical Health Workshop Improving the physical health of people living with mental illness: A workshop for consumers who are living well with mental illnessPart 1: Medical Issues by Vivien Kemp BA (Hons) And Dr Sue Jackson MB BS, FRACGP HealthRight and Hills Community Support Group www.healthright.org.au

3. Overview • Introduction: The physical health of people living with mental illness. • How physical health can effect mental health. • Barriers to good health care. • Getting the most out of GP visits. • Health checks for men and women. • Summary.

4. World Health Organisation “Health is a state of complete physical, mental and social well being not merely the absence of disease or infirmity” 1

5. Facts about the physical health of people living with mental illness The 2001 Duty to Care2 report found that: • People living with a mental illness were 2 ½ times more likely to die of preventable and treatable diseases than people in the general population. • Diseases affecting people living with mental illness are either not diagnosed, not treated properly or diagnosed and treated at a much later stage of the disease process. • The most common cause of death was heart disease. • About 8% of the population have a diagnosed mental illness, and half of these smoke.

6. Small Group Discussion Get into groups of 3 or 4: Why do you think people living with mental illness have such poor physical health?

7. How does physical health affect mental health? • Quite often physical health problems can be mistaken as a symptom of mental illness. • Improvement of physical health will often improve mental health.

8. Example: Under active thyroid • Constipation • Weight gain • Slowing of mental function • Depression

9. Example: Overactive thyroid • Weight loss • Anxiety/agitation • Pressure of speech • Sleep problems

10. Prescribed medications • May lead to raised cholesterol, raised blood sugar, raised blood pressure and unwanted weight gain. • May make diabetes more likely.

11. Barriers to receiving effective healthcare

12. Barriers to receiving effective healthcare • Ability to identify health concerns. • Beliefs of health care provider. • Ability to access health care. • Wanting to keep mental and physical health separate. • Not wanting to know.

13. Brainstorm Think of the last time you went to a GP… What did you like/dislike?

14. GP visits • Choose your GP carefully. • Book a longer consultation. • Plan your visit. • Take someone with you.

15. GP visits • Request a full medical. • Keep a personal health record detailing BP, weight, pap smears, lipid and sugar measurements and when they are next due. • Take this record with you whenever you go to a GP, psychiatrist, chemist etc.

16. Recommended Health Checks for Everyone  A NOTE ON MEDICATIONS: • People who take psychiatric medications maybe at increased risk of physical health problems. • Tell your doctor which psychiatric medications you take and ask him/her if there are any tests you should have, and how often you should have them.

17. Recommended Health Checks for Everyone CANCER: Many types of cancer are now treatable with good outcomes, especially if detected and treated early. Some common cancers are: BOWEL CANCER • If you have a family history of bowel cancer ask your doctor about screening options and how often you should be checked. People over 50 are advised to get checked every 2 years. • Whatever your age, if you experience any symptoms such as bleeding from the anus, change in bowel habit or abdominal pain talk to your doctor about it as soon as you notice the change.

18. Recommended Health Checks for Everyone SKIN CANCER • Everybody is advised to do a skin self-examination every 3 months. • If you have many moles that change in shape or colour or an area of skin that looks unusual, and seems to have changed recently, ask a doctor to examine your skin as soon as you notice it. • If you have had skin cancers before, ask your doctor to examine your skin regularly.

19. Recommended Health Checks for Everyone DENTAL HEALTH • Everyone should have regular dental check- ups. Your dentist will advise you on the timing of dental examinations.

20. Recommended Health Checks for Everyone HEART DISEASE AND STROKE • It is recommended that everyone over the age of 45 is tested every 5 years. • It is a good idea to be tested more regularly if you are at risk due to family history, smoking, obesity, high cholesterol, high blood pressure or inactivity.

21. Recommended Health Checks for Everyone WEIGHT GAIN   • Everyone should be aware of their weight. • People who take some types of psychiatric medication are advised to have their weight checked every year. • Increased waist measurement raises the risk of heart disease and diabetes.

22. Recommended Health Checks for Everyone OPTICAL HEALTH (Eye checks are free under Medicare every 2 years.) GLAUCOMA • People usually have the first eye check for glaucoma at age 40, and then regularly after that. • For people who may be at risk of glaucoma due to family history of glaucoma, diabetes, short sightedness, eye injuries or if you have ever taken cortisone, it is suggested that you have the first eye check at age 35 for glaucoma and then regularly after that.

23. Recommended Health Checks for Everyone EYE CHECKS • Your optometrist can advise you about how often you need an eye check if you already wear glasses. • People who are aged 50 or over are advised to have an eye test every 5 years, or earlier if their vision starts to deteriorate. People over 65 are advised to have an eye test every 12 months.

24. Recommended Health Checks for Everyone TYPE 2 DIABETES • People with impaired glucose tolerance, people over 45 or who have a family history of diabetes are advised to be tested once a year. • People who are overweight, have high blood pressure or have had a heart attack, angina or stroke, should ask their doctor about how often they need to be tested.

25. Extra checks for men… TESTICULAR CANCER • It is a good idea to become familiar with how your testes normally feel. If you notice any unusual lumps, talk to your doctor about it. • Men should do regular checks for lumps or swellings if they have a family history of testicular cancer, or if they have undescended or absent testicles. If you notice any unusual lumps or swelling, talk to your doctor about it.

26. Extra checks for women… BREAST CANCER • All women should be familiar with the normal look and feel of their breasts. See a doctor immediately if you notice any unusual breast changes. • You can have free access to breast screening for a mammogram if you are over 40. Mammograms are recommended every 2 years if you are aged between 50 – 69. • Talk to your doctor about how often you need to be screened if you have a family history of breast cancer.

27. Extra checks for women… CERVICAL CANCER • Pap Smears are recommended every 2 years for any woman who has ever had sex and not had a hysterectomy. Your doctor may recommend that you to have more frequent screening if you are at an increased risk of cervical cancer.

28. Part 1 summary • For a number of reasons living with a mental illness usually means a person has poor physical health. • It is very important to find a GP you are comfortable with and ask for regular physical health checks. • Use the tips we have given you about GP’s and health checks to make sure you get good health care.

29. Break

30. Physical Health Workshop Improving the physical health of people living well with mental illnessPart 2: Lifestyle Issues by Vivien Kemp BA (Hons) And Dr Sue Jackson MB BS FRACGP HealthRight and Hills Community Support Group

31. Overview • Alcohol and other drugs • Alcohol guidelines • Smoking and mental illness • Dietary guidelines • Physical activity guidelines

32. Alcohol

33. Alcohol and other drugs • May have significant effects on both physical and mental health. • Have effects on well being and social functioning.

34. Alcohol and other drugs • May themselves induce psychosis. • May make it harder to separate drug-induced problems from mental health problems.

35. What is a standard drink? • Health authorities use the idea of a STANDARD DRINK to help people keep track of the amount of alcohol they drink. • Different kinds of alcoholic drinks have different amounts of alcohol in them. • A standard drink and a standard glass size are not the same thing. • Look on the bottle, can or cask to see how many standard drinks it contains.

36. What does a standard drink look like?

37. Alcohol guidelines

38. Tips for reducing alcohol intake ● Don’t drink on an empty stomach. ● Space your drinks – make each drink last an hour. ● Alternate with non-alcoholic drinks. ● Choose low alcohol alternatives. ● Make sure you have some alcohol free days every week.

39. Are you comfortable about the amount you drink? If not… • Think about the situations where you are most likely to drink. • What part does alcohol play in your life? • What can you do to reduce possible harm?

40. Smoking

41. Smoking • Smoking cessation has been shown to be the biggest single factor in the improving life expectancy. • Smoking cessation increases the effectivenessof antipsychotic medication. • Smoking cessation significantly improves finances!!

42. Smoking • 20% of the general population smoke. • 46% of people with mental health problems smoke. • Up to 90% of people with schizophrenia smoke.

43. Why smoke ?? • To relieve boredom and provide framework for the day. • Smoking can improve social interaction.

44. Nicotine - • May help relaxation. • May increase alertness. • Antidepressant effect. • Reduce symptoms such as hearing voices.

45. Stopping smoking • Various pharmacological agents available. • Courses and information. • Be aware of specific difficulties individuals with mental health problems may face.

46. Group brainstorm: How can I eat more healthy foods?

48. Good news! Before you feel overwhelmed…… Small changes now can lead to long term benefits down the track.

49. Small changes that over time make a BIG difference For Example: • Buy low fat instead of full cream milk (Hi-Lo, Skim, No Fat etc). • Buy whole grain or wholemeal breads and pastas, • Basmati rice. • Don’t add salt to your cooking. • Look for ‘mono-saturated’ or ‘poly-unsaturated’ butter, margarine and oils.

50. Small changes that over time make a BIG difference Cut down of the amount of sugar in your diet • Reduce the amount of sugar in tea and coffee by 1/4 of a teaspoon a week until you add no sugar at all. • Switch to diet soft drinks and cordials instead of regular soft drinks and cordials. • Drink unsweetened fruit juice. • Buy canned fruits in natural juice not syrup.