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Mental health cluster a session two 280411
 

Mental health cluster a session two 280411

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    Mental health cluster a session two 280411 Mental health cluster a session two 280411 Presentation Transcript

    • Mental health cluster APhysical health
      Session two 29/04/11
    • Physical health and mental health
    • Why is it an important consideration?
      Two pronged approach
      1) those with mental illness appear to be more susceptible to poor physical health
      2) physical activity can improve mental health
      The following information has been obtained from Mental Health and Physical Activity Information Pack- “Partnering to enhance recover”. Accessible on Moodle
    • The evidence
      Strongest evidence linked increase physical activity with reduction in depressive symptoms
      Cooper Institute “relative increases in maximal cardiorespiratory fitness and habitual physical activity are cross-sectionally associated with lower depressive symptomalogy and great emotional well-being”
    • The evidence
      2002 meta-analysis published in British Medical Journal concluded : when compared with no treatment, exercise reduced symptoms of depression and in studies relating exercise to cognitive therapy, the effect of exercise was similar.
    • Why is it important?
      “psychiatric patients have high rates of physical illness, much of which goes undetected. Such investigations have led to calls for health professionals to be more aware of these findings and for better medical screening and treatment of psychiatric patients” World Federation for Mental Health (2004).
    • Why is physical health so poor?
      Mental illness
      Unhealthy lifestyle behaviours
      Medications
      Segregations of primary health and mental health care sites
      Lack of counselling
      Low socio economic status
    • Why?
      Social factors e.g. poverty and inadequate housing
      Lifestyle factors e.g. substance use, sedentary lifestyle
      Barriers accessing screening programs and health care
      Difficulties in communication or lack of attendance at medical appointments possibly resulting in delayed or missed diagnosis
      Stigmatising attitudes of carers, health professionals and the broader community
    • Socio economic status
      People with mental illness are more likely to be low income earners, reliant on a pension or live in poverty
      Increased costs in accessing health care due to increased needs
      Generally limited to GP’s who bulk bill
    • Access to services
      Travel issues or maintaining scheduled appointments
      Particularly problematic in rural or remote areas
      Communication barriers
    • Availability of services
      Unaware of how to access care and what options are available
      GP’s may not have sufficient training in responding to mental illness or be aware of appropriate services for referral
      Many allied health professionals are not covered by Medicare
    • Lifestyle factors
      Transience
      High risk behaviours
    • Service silos
      Refusal of some specialist services to treat complex co-morbid patients
      Lack of continuity
      Gaps in professionals knowledge re physical health and vice versa
    • Overcoming these barriers
      Actively discussing physical health issues alongside mental health
      Adopting a patient, flexible and creative approach to assessment
      Assessment of the physical health problem across a number of interviews, some spent just on the process of engagement
      Reinforcing and writing down details of tests or treatments
      Taking a more active role in ensuring follow-up
      Creating effective partnerships between the consumer, family, carers, PG and mental
      health clinicians
    • GP responsibility
    • NSW Government’s response
      Developed guidelines for general practitioners for health checks for individuals presenting with particular mental health issues
      Identifies physical health risk factors prominent in patients with specific mental illness
    • Patients with schizophrenia
      Screen for coronary artery disease and its risk factors
      Check for personal/family history of IHD
      Take a smoking history
      Check blood pressure
      Check weight
      Check lipids
      IHD causes most of the excess mortality in this group
    • Screen for diabetes
      Do BSL
      Every 6-12 months if on atypical antipsychotics
      Screen for side effects of medication
      Weight gain
      Metabolic effects - glucose and lipids
      Hyperprolactinemia
      Extrapyamidal side effects (EPSE)
      TardiveDyskinesia (TD)
      Yearly ECG for consumers > 55 years on antipsychotics
      QTc prolongation with some antipsychotics
    • Screen for substance use Take an alcohol and drug history
      Advise/refer if patterns of use are unsafe
      Screen for substance use complications
      Alcohol related disorders eg liver disease, peptic ulcer disease
      Hepatitis B/C, HIV/AIDS, infective endocarditis
      Screen for cancer Women: mammogram, PAP smear
      Faecal occult blood - Rectal/colon cancer
      Skin cancer
    • These checklists
      Provide gps who are not familiar with guidance in relation to specific risk factors
      Ensure full health checks are completed with guidelines for reviews
      Give a higher level of responsibility to gps
      Assist in early diagnosis of physical health issues = prevention
    • Let’s think about some activities
      What are some ways you might get your clients more active?
    • Increasing healthy living
      Joining sporting clubs
      Setting small tasks such as walking to the local milk bar
      Getting them to play a game of soccer/footy with their kids
      Keep an activity diary and measure mood levels in the diary
      Link with recreational clubs
    • What would you do?
      Mustafa is a 28 year old male who is attending your service due to his cannabis use. He has been diagnosed with Major Depressive Disorder. He lives with his partner and their children (4 & 6 years of age). He is overweight and suffers from asthma. He is currently unemployed.
      How would you aim to improve Mustafa’s physical health?