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Kemi Wright - Move Your Mind

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Presentation by Kemi Wright, Senior Executive Psychologist South Metropolitan Health Service. Move Your Mind: Embedding a clinical exerise physiology within a WA mental health service. Presented at the Western Australian Mental Health Conference 2019.

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Kemi Wright - Move Your Mind

  1. 1. Move Your Mind Embedding clinical exercise physiology within a WA mental health service Kemi Wright– Senior Exercise Physiologist |PhD candidate Dr Bonnie Furzer - Senior Exercise Physiologist |Lecturer WA Mental Health Conference 2019
  2. 2. MI & Physical Health
  3. 3. Structure of FHMHS
  4. 4. How does EP fit in?  1-1 consults  Open gym sessions  Inpatient group classes  Community management
  5. 5. EP Service Pathway ?
  6. 6. Demographics of consumers N=70 M: 29 F: 41 Mean age: 40 years Age range: 19-69 years 2.9% 7.1% 5.7% 7.1% 4.3% 7.1% 10.0% 15.7 21.4 27.1 51.4 0 10 20 30 40 50 60 Feeding and eating Substance related Neurodevelopmental Obsessive compulsive related Other Bipolar and related Trauma and stressor related Anxiety Personality Depressive Schizophrenia Spectrum and Psychotic Diagnosed Psychiatric Disorders 24.3% 20.0% 8.6% 8.6% 0% 0.0 5.0 10.0 15.0 20.0 25.0 30.0 Cardiometabolic Other Musculoskeletal Pulmonary Neurological Physical Comorbidities 14.3% 21.4% 21.4% 22.9% 25.7% 17.1% 35.7% 90.0 12.9 0.0 20.0 40.0 60.0 80.0 100.0 Supplements Antidepressants (SNRI) Anti-anxiety Anticonvulsants Metabolic/CV Other Antidepressants (SSRI) Anti-psychotics Antidepressants (Other) Medications
  7. 7. Service Breakdown 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Open Gym Group Session (Gym) Session Rating of Enjoyment N/A Bad Average Good Great 85% 38% 96% 13% 31% 2% 2% 17% 0 4% GROUP C LA S S E S (GY M) GROUP C LA S S E S (ONW A RD) OP E N GY M S E S S IONS PARTICIPATION RATES (FEB - JULY) Full Partial Presented but did not engage Observed 25% 25% 17% 33% TOTAL SERVICE PROFILE (FEB - JULY) Group Classes (Gym) Group Classes (onward) Individual Open Gym (community)
  8. 8. Service Breakdown 46+ min 46+ min 31-45 min 31-45 min 16-30 min 16-30 min 16-30 min 6-15 min 6-15 min Less than 5 min Less than 5 min 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Group Classes (Gym) Group Classes (onward) Open Gym (community) Minutes of Activity
  9. 9. Case Study- Jess  44 year old female  Referred for weight loss  Goal: ↓ alcohol intake, ↑ improve incidental activity  EPSE: Tremor in hands, leg stiffness  Ongoing auditory and visual hallucinations  SIMPAQ: 14.5 hrs in bed,8 hours sedentary, no structure exercise Outcomes Initial Weight (kgs) 103.8 BMI 34.29 Waist Circumference 124.5 BP 136/86 Sit-to-stand ( 30 secs) 13 Max Push Up (Wall): 10 Plank (knees) 14 secs Wall Squat 30 secs Outpatient Open Gym
  10. 10. Case Study- Jess Outcomes Initial Post Ax Weight (kgs) 103.8 93.4 BMI 34.29 30.5 Waist Circumference 124.5 100 BP 136/86 134/85 Sit-to-stand ( 30 secs) 13 13 Max Push Up (Wall): 10 27 Plank (knees) 14 secs 31 secs Wall Squat 30 secs 30secs Other health related goals: Approx. 5 months with no alcohol intake, is managing to walk around the park 1-2 per week (good weeks) Outpatient Open Gym Current Weight is 90.5 kg, has increased to walking 4-5 times/week with neighbour
  11. 11. Case Study Inpatient- Sam  22 year male  Dx: Schizophrenia/DIP  LOS: 132 days  Hx: DIP, absconding and aggression risk 65.4 73 85.9 88.6 93 101 60 70 80 90 100 110 120 Admission April May June July August Failed discharged Commenced on clozapine Inpatient groups & 1-1 Patient weight status
  12. 12. Challenges and Solutions  Isolation – Identifying key stakeholders and utilising as allies – Reaching out to other allied health professional in similar settings  Clinical guidelines vs. clinical practice – Striving for best practice, but understanding changes to clinical practice can take time  Inpatient vs. outpatient – Limited resources available for patients – Ask for feedback from consumers and other hospital staff  MDT integration – Work with other allied health to see how our team and/or service can be better integrated
  13. 13. Future Directions  Expansion of exercise physiology services at FHMHS  Embedding automatic referral protocol for metabolically active anti-psychotics.  Further integration of lifestyle advice/intervention into standard clinical practice  Quantitative and qualitative analysis of service incl. outcome measures
  14. 14. Questions? E: kemi.wright@health.wa.gov.au P: 9431 3504

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