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Dr Susanne Stanley PhD and Lucia Ferguson

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Presentation by Dr Susanne Stanley PhD and Lucia Ferguson - The Wellness Clinic: A model of integrated care for people with complex mental illness.
Presented at the Western Australian Mental Health Conference 2019.

Published in: Healthcare
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Dr Susanne Stanley PhD and Lucia Ferguson

  1. 1. The Wellness Clinic A model of integrated care for people with complex mental illness Dr Susanne Stanley (PhD) Ms Lucia Ferguson
  2. 2. Overview  Poor Physical Health in Mental Health  Wellness Clinic: – Cross-sectional – Cohort – Longitudinal  Discussion  Where to from here?
  3. 3. Poor Physical Health 0 50 100 150 200 250 Suicide Accidental death Respiratory system diseases Other circulatory disease Stroke Other heart disease Heart attack Cancer Death Rate Mental Illness WA Population Figure 1. Death rates in people with mental Illness compared to the WA population (taken from Coghlan et. al., 2001, p. 18). 15-25yr lifespan difference
  4. 4. 0 5 10 15 20 25 30 % Health Conditions With mental and behavioural condition Without mental and behavioural condition Figure 2. People with selected long-term physical health conditions by mental and behavioural condition status, 2014-15 (taken from ABS, 2015).
  5. 5. Wellness Clinic  Introduced in August 2014 as an adjunct to Curtin University project  Aim - to attend to the physical health of people with complex mental illness  Integrates primary care into mental health  WAPHA (phn) – Mental health into primary care  Staff - NP (0.5 FTE), CN (0.5 FTE), GP (0.2 FTE)  Clinic - 4.5 years - 412 referred (22.6% did not attend)
  6. 6. Fremantle HMHS Wellness Clinic Model of Care Community Mental Health Team Early Intervention for PsychosisNo engagement with GPDepot Clozapine Complete History Medical History Social History Bloods Waist/Girth Lipids BSL Blood Pressure Medication Diagnosis Allergies Height Weight BMI ECG Spirometry STIs Alerts Carers Dental Eyes Feet NURSING STAGE 1 Referral STAGE 2 Assessment STAGE 3 Discharge / Ongoing Monitoring Discharged from CMHT Nurse Practitioner General Practitioner + Nurse Practitioner Discharged to Community GP General Practitioner + Clinical Nurse Simple Typical Complex Chest X-Ray (if smoker) Full Pulmonary Lung Function Cervical Screening Lifestyle Modification Exercise Aboriginal & Torres Strait Islander People Ongoing Monitoring Link with Community GP CMHT Monitoring Nurse Practitioner + Clinical Nurse Figure 4. The Fremantle Hospital Mental Health Service Wellness Clinic Model of Physical Health Care.
  7. 7. Cross-sectional Data  Demographics – 2:1 male to female ratio – F20-F29 primary diagnosis (psychoses) - (87%M, 72%F)  Clinic Services – Engaged with GP - 22% – Clinic appointments average -10M, 8F – Referrals – dental, diet, cardio, respiratory, physio, gastro, hepatology – Scans/tests – initial FBC + STI, ECG, spirometry • Chest X-ray, stomach/abdominal ultrasound, echo, urinalysis, PAP smear  Medication
  8. 8. Cross-sectional Data (cont.) Smoking – 70.2%M, 58.3%F Blood Pressure – Males sign. higher than Females but averages both within normative range Heart Rate – 88/87bpm – variance of 14bpm (range 74-102bpm) Cholesterol / Younger age groups good; HbA1c% / fBGL males & females abn 36yrs+ Weight / Girth / Male mean increased initially at 26-35yrs, BMI then held stable for later age groups; female mean increased with each age group
  9. 9. Cohort Data 1.5 1.7 1.9 2.1 2.3 2.5 2.7 2.9 3.1 3.3 3.5 Baseline 12 Months 24 Months 36 Months Male Psych Male Other Female Psych Female Other Males Age Females Age Baseline 222 42 (11.4)* 97 42 (13.3) 12 Months 137 43 (11.0) 43 44 (13.0) 24 Months 80 45 (09.9) 24 45 (13.0) 36 Months 46 44 (10.2) 11 48 (12.0) Figure 6. Mean number of psychiatric and other health medications for males and females in each cohort. Table 1. Number and average age of people in each time cohort * Standard Deviations in parenthesis Age Medications
  10. 10. Baseline 12 Months 24 Months 36 Months M F M F M F M F Number of People 208 90 133 41 78 21 46 10 Abnormal 62 23 33 7 24 5 21 2 % 30 26 25 17 31 24 46 20 Cohort Data (cont.) 0 20 40 60 80 Baseline 12 Months 24 Months 36 Months Percentage % Time Periods Male Female Figure 7. Percentage of people who smoke in each cohort. Table 2. Abnormal Blood Pressure readings (outside of 140/80) and total percentage of abnormal results for each cohort. Smoking Abnormal BP
  11. 11.  Demographics  46 males, 11 females  91% had a primary diagnosis of F20-F29 – psychoses  22% males had English as a second language, 0% females  Females consistently prescribed more psychiatric and ‘other’ health medications than males Longitudinal Data Male Female Antipsychotics 1.42 1.83 Mood Stabilisers/Anxiolytics 0.27 0.44 Antidepressants 0.32 0.45 Table 2. The mean number of psychotropic medications prescribed to males and females.
  12. 12.  No sig. changes for most Metabolic Syndrome factors:  BP  Triglycerides  fBGL  Girth Longitudinal Data (cont.) Baseline 12 Mths 24 Mths 36 Mths fBGL M 5.8 6 5.8 6 fBGL F 5.4 5.6 5.5 5.6 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 6 6.1 mmol/L Time Periods Figure 19. Mean fasting Blood Glucose Levels over time for males and females.
  13. 13. Longitudinal Data (cont.)  HDL-C (‘good’ cholesterol) improved significantly over time Baseline 12 Mths 24 Mths 36 Mths HDL-C M 1.1 1.1 1.1 1.2 HDL-C F 1 1 1.1 1.2 0.9 0.95 1 1.05 1.1 1.15 1.2 1.25 mmol/L Time Periods Figure 9. Mean HDL-C levels over time for males and females
  14. 14.  People with mental illness:  Reduced life-expectancy (15-25 years)  Difficult to engage with their GP  Need situation appropriate support  The Wellness Clinic  Collaborative, holistic, aligns with SHR Strategies  Keeps physical health stable over time  Improve physical health - Prevention/Intervention 1. Solidify the existence of the Wellness Clinic 2. Develop an Intervention for 26yrs+ Discussion
  15. 15. Exercise physiologist/physiotherapist Nutritionist/Dietician Community Mental Health Team Psychiatrist/Pharmacist/GP/Nurse Practitioner

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