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Mental health cluster a session two 280411
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Mental health cluster a session two 280411


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  • 1. Mental health cluster APhysical health
    Session two 29/04/11
  • 2. Physical health and mental health
  • 3. 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
  • 4. 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”
  • 5. 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.
  • 6. 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).
  • 7. Why is physical health so poor?
    Mental illness
    Unhealthy lifestyle behaviours
    Segregations of primary health and mental health care sites
    Lack of counselling
    Low socio economic status
  • 8. 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
  • 9. 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
  • 10. Access to services
    Travel issues or maintaining scheduled appointments
    Particularly problematic in rural or remote areas
    Communication barriers
  • 11. 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
  • 12. Lifestyle factors
    High risk behaviours
  • 13. 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
  • 14. 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
  • 15. GP responsibility
  • 16. 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
  • 17. 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
  • 18. 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
    Extrapyamidal side effects (EPSE)
    TardiveDyskinesia (TD)
    Yearly ECG for consumers > 55 years on antipsychotics
    QTc prolongation with some antipsychotics
  • 19. 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
  • 20. 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
  • 21. Let’s think about some activities
    What are some ways you might get your clients more active?
  • 22. 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
  • 23. 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?