Susanne H. Stanley

Clinical Guidelines for the Physical Care of Mental Health Consumers: A Comprehensive Assessment and Monitoring Package for Mental Health and Primary Care Clinicians:

Objectives: People with a mental illness are more likely to experience poor physical health as compared to the general population. Currently, Australian mental health patients experience a relatively low level of physical health appraisal, prompting the development of the Clinical guidelines for the physical care of mental health consumers assessment and monitoring package. Method: The Clinical guidelines package takes an holistic approach, with a focus on the key dimensions of medication effects, lifestyle, existing or developing physical disorders, alcohol and illicit drug use, and psychosocial factors. Results: The package consists of a metabolic syndrome algorithm wall chart, a Clinician handbook, a Psychosocial assessment booklet, and a set of three screening forms. Conclusions: By taking a user-friendly, flexible, evidence-based approach, the resource can be used by all clinicians involved in the healthcare of people with a mental illness.

Obesity, cardiovascular disease and type 2 diabetes in people with a mental illness: A need for primary health care

People with a mental illness show a growing incidence of obesity, and higher rates of metabolic syndrome when compared with the general population. This paper reviews research on obesity, cardiovascular disease and type 2 diabetes, with the aim of directing clinical attention towards the improvement of patient physical health. A systematic search of cross-discipline databases and journals provided peer-reviewed research for analysis, and national statistics allowed for the investigation of differences in rates of occurrence between people experiencing a mental illness and the general population. Treatment effects via psychotropic medications and lifestyle factors such as poor diet and low levels of exercise suggest that ongoing monitoring is necessary to prevent major physical disorders in people experiencing a mental illness. To aid clinicians, a comprehensive set of clinical guidelines have been developed for the physical assessment and ongoing monitoring of mental health patients.

The impact of lifestyle factors on the physical health of people with a mental illness: a brief review.

BackgroundPeople with a mental illness are much more likely to experience poor physical health when compared to the general population, showing a higher propensity to develop the metabolic syndrome. Past focus has predominantly been upon individuals treated with antipsychotics, yet poor physical health is occurring across diagnoses.PurposeThe purpose of this paper is to draw attention to the major factors within the domain of lifestyle in order to support the need for more detailed and rigorous physical health assessment and ongoing monitoring for people with a mental illness.MethodThis paper reviews existing evidence relating to lifestyle factors such as low exercise levels, poor diet and nutrition, high cholesterol levels, tobacco smoking and poor dental care, contributing to poor physical health such as a higher incidence of cardiovascular disease and type 2 diabetes. An integrative review was conducted from a multi-disciplinary search of online databases and journals, focusing upon mental illness and lifestyle issues predominant in the literature.ResultsThe findings reviewed here suggest that greater attention should be paid to the physical health assessment and ongoing monitoring of all people with mental health disorders so that preventable illness does not result in higher levels of morbidity and mortality for this disadvantaged population.ConclusionEarly identification aids preventive interventions and assists clinicians and mental health staff to more effectively treat emergent physical health problems.

Physical health algorithms for mental health care

It has been known for some time that many people with severe mental illness experience comorbid physical health problems (Lawrence et al., 2001). Indeed, the gap in life expectancy has widened between people with a mental illness and the general population for preventable illness, with most excess deaths (around 80%) associated with physical health conditions such as cardiovascular disease, cancer, and respiratory disease (Lawrence et al., 2013). Mortality rates coupled with high prevalence rates for other health conditions such as obesity and type 2 diabetes mellitus highlight the need for a pre-treatment baseline physical health assessment and ongoing monitoring (Bradshaw and Mairs, 2014; Stanley and Laugharne, 2011, 2014; Stanley et al., 2013). There is, therefore, an increasing requirement for an emphasis on preventative measures rather than reactive measures. Many mental health services around Australia are now implementing physical health screening protocols for mental health patients, with some states well ahead of others (New South Wales Department of Health, 2009). In Western Australia, the South Metropolitan Health Service (SMHS) Mental Health Physical Health Care Strategy Working Group acknowledged a need for the additional training of mental health staff. In order to assist with this process, we have developed a number of algorithms to aid clinical staff (doctors/ nurses) in the management of patients’ physical health and we present these algorithms here. These algorithms complement our Clinical Guidelines package (Stanley and Laugharne, 2011), which takes an holistic approach to physical health assessment and ongoing monitoring in the areas of lifestyle, medication effects, alcohol and drug problems, pre-existing or developing physical disorders and allergies, and social supports. The metabolic syndrome (MetS) algorithm (Figure 1) assesses blood pressure, waist circumference, fasting lipids and fasting blood glucose. Additional algorithms have been included in this paper covering clinical decision pathways for a number of key investigations – full blood count, liver function tests, urea and electrolytes (Figure 2), thyroid function tests, electrocardiogram (ECG) and serum prolactin (Figure 3). All algorithms were reviewed by a number of health professionals, including general practitioners, psychiatrists, and nursing staff. They were then endorsed for use in local mental health clinics by the Stokes Mental Health Review Implementation Steering Committee, a taskforce formed to ensure the consistent implementation of effective services, policies and practices within Western Australia mental health.

Fostering Psychiatry in Ghana: The Impact of a Short Review Course Through an International Collaboration

ObjectiveThe aim of the current study was to evaluate a short review course in psychiatry conducted at the Kwame Nkrumah University of Science and Technology medical school and any change in student interest in a career in psychiatry.MethodStudents were asked to complete a general psychiatric knowledge questionnaire before and immediately after the course. They were also asked to rate their attitude toward psychiatry as a career. The same questionnaire was readministered 1 month later.ResultsThe average results on the knowledge test pre-course was 52% (N=129) and post-course was 78% (N=122), constituting a 50% increase in knowledge for the average student. The proportion of students showing considerable interest in a psychiatric career increased from 19% pre-course to 32% post-course. At 1-month follow-up, the average result for the knowledge test was 76%, and considerable interest in psychiatry as a career was noted at 21%.ConclusionResults indicate that the course significantly improved core psychiatric knowledge and that this improvement was retained after 1 month. An initial increase in interest in psychiatry as a career decreased almost to baseline at 1-month follow-up. Study limitations include the use of the same questionnaire at each stage knowledge was tested and the absence of a control group.

Eye Movement Desensitisation and Reprocessing Treatment of Posttraumatic Stress Disorder, Comorbid Disorders and Personality Traits: A Case Series with 12 Month Follow Up

Eye movement desensitisation and reprocessing is an established treatment for posttraumatic stress disorder. Patients with posttraumatic stress disorder have elevated rates of comorbid psychiatric disorders and personality disorder. This paper reports on a series of seven cases of posttraumatic stress disorder, drawn from a secondary level care outpatient clinic, for which systematic clinical data was recorded using validated instruments, before and after treatment with eye movement desensitisation and reprocessing and at 12 month follow-up. All patients improved significantly in terms of posttraumatic stress disorder symptoms. There were significant reductions in paranoid, depressive and borderline traits post treatment and at follow-up. There was a reduction in comorbid psychiatric diagnoses and in personality disorder diagnoses post treatment and maintained at follow-up. These results suggest that eye movement desensitisation and reprocessing may be effective in treating comorbid disorders as well as PTSD and indicate a need for further studies with appropriate controls.

The ‘Fit for Life’ exercise programme: improving the physical health of people with a mental illness

ABSTRACT People with a mental illness have very poor physical health parameters when compared to the general population. This paper outlines an exercise programme developed to improve overall fitness and curb weight gain. Seventy-two mental health service inpatients completed the general or individualised gym exercise programme within 12 weeks. Baseline and end of course physical health parameters were recorded, along with test results on a number of fitness, strength and agility tasks. No statistically significant differences were found between average pre and post programme weight scores, and weight did not increase over time. Significant differences were found on strength and agility tasks, and a decrease was observed in average resting and post exercise heart rates. Average blood pressure did not change, but the number of baseline readings indicating hypertension reduced from 14 to 8 people. The exercise programme was successful in improving the physical capacity of the individuals who participated.

Mind (is) your body

The majority of people who experience mental health issues also have poor physical health resulting in decreased life expectancy. Fortunately, many physical health issues can be identified and rectified by monitoring various health indicators over a time period. The Physical Health Diary is a tool that people can use by themselves and/or with others to track, monitor and improve their physical health over time.

Kimberley Indigenous mental health: An examination of metabolic syndrome risk factors

OBJECTIVE There is an increased risk of physical health comorbidities in people with a mental illness. This paper examines the metabolic syndrome parameters for the general population, indigenous Australians and people with a mental illness, and compares them to a sample of predominantly indigenous adults with mental health problems. DESIGN A longitudinal (24 month) audit of patient medical records was conducted between February 2011 and March 2013. SETTING The Kimberley Mental Health and Drug Service in Broome, Western Australia. PARTICIPANTS Largely indigenous adults with a mental illness. Sample numbers increased from 56 at baseline (80% indigenous) to 136 at 18 months (70% indigenous). MAIN OUTCOME MEASURES Waist circumference, blood pressure, fasting lipids, and fasting blood glucose. RESULTS Preliminary assessment of the data indicates a high percentage of abnormalities at baseline and at the 18 month period on all four parameters, yet not all patients were assessed on a regular basis. CONCLUSIONS Abnormalities in metabolic profiles consistent with the non-Indigenous mental health population were found. There are considerable challenges to implementing regular monitoring of physical and metabolic profiles of indigenous people in rural and remote communities.Objective There is an increased risk of physical health comorbidities in people with a mental illness. This paper examines the metabolic syndrome parameters for the general population, indigenous Australians and people with a mental illness, and compares them to a sample of predominantly indigenous adults with mental health problems. Design A longitudinal (24 month) audit of patient medical records was conducted between February 2011 and March 2013. Setting The Kimberley Mental Health and Drug Service in Broome, Western Australia. Participants Largely indigenous adults with a mental illness. Sample numbers increased from 56 at baseline (80% indigenous) to 136 at 18 months (70% indigenous). Main outcome measures Waist circumference, blood pressure, fasting lipids, and fasting blood glucose. Results Preliminary assessment of the data indicates a high percentage of abnormalities at baseline and at the 18 month period on all four parameters, yet not all patients were assessed on a regular basis. Conclusions Abnormalities in metabolic profiles consistent with the non-Indigenous mental health population were found. There are considerable challenges to implementing regular monitoring of physical and metabolic profiles of indigenous people in rural and remote communities.