Parity of Esteem People with mental health conditions will receive the same quality of physical healthcare as their peers. Marie Band Physical Health lead Christopher Burton Physical health coordinator Introductions what we do What aims are background setting the scene

Disparity Despite the multitude of physical and mental health benefits of physical activity, many of us struggle to meet the recommended targets of 150 min a week. If you have a diagnosis of a SMI you are 50 % less likely to meet these recommendations than your peers of same age and gender. If you have SMI more likely to die younger than your peers without a diagnosis, with a reduced life expectancy of 20 years due to increased risk of CVD/ diabetes. Weight gain is an unpopular side effect of treatment making weight loss extremely difficult. Dilemma faced is poor physical health through side effects of medication or onset of illness. IF have SMI already at disadvantage as well as social and economic factors / anxiety /

Essential actions We require practical ways to improve physical health for people with SMI. There is no room for complacency, we need to make a difference now. Medical Royal colleges, general practitioners, nursing, pathologists, physicians, Royal pharmaceutical society, Public Health England. (2016)

Our Mission To improve the overall assessment and quality of the physical health monitoring of our patients. To provide interventions to reduce / prevent future risk of metabolic syndrome in patients. To improve health and well being of patients To provide staff support and training to feel more confident in undertaking screening of physical health. To provide effective interventions to sustain positive health outcomes. To ensure needs are communicated re future risk Promote self efficacy / responsibility What we have done so far history NICE guidelines support delivery and improvement CQUINS drives targets ensures we meet recommendations - writing programme evidence based targeted at population SMI Increase staff confidence / push barriers/ evaluate

Metabolic Syndrome Pre Diabetes So – our patients present with an already raised BMI and poor self care. If the waist circumference is over 90 cm ( central obesity ) Plus one of the following – Raised triglycerides (type of fat found in blood which increases risk of heart disease - equals low HDL (GOOD CHOLESTEROL) High blood pressure High glucose levels or raised HbA1C = Metabolic syndrome and increased risk CVD & Diabetes The challenge ! Plus smoking/ alcohol/ sedentary lifestyle/ negative symptoms co morbidity

What we know Lack of activity (a lot less) Poorer quality of diet Higher prevalence of smoking (85%) Every risk factor is increased Evidence of clinical practice shows us this and highlights the need for holistic assessment and regular monitoring. Not enough of the intervention! Don't just screen, intervene! As well as ! Ref LESTER tool

Question How much weight would you expect a patient to gain within the first 3 months of treatment ?

Alvarez-Jimenez et al; CNS Drugs, 2008 22: 547-562 Antipsychotic-Induced Weight Gain in Chronic and First-Episode Psychotic Disorders: a Systematic Critical Reappraisal 20 Established Psychosis RCTs Established psychosis RCTs 3 kg 15 4 kg kg 10 12 kg Within 7 weeks can gain 7 kg 5 First episode of psychosis RCTs 12 24 36 48 Months Alvarez-Jimenez et al; CNS Drugs, 2008 22: 547-562

Shape referral process / criteria Physical Health Check complete 1st episode – Schizophrenia/Psychosis and/or Cluster 10+ SMI & LTC Refer for lifestyle interventions identified   Refer to SHAPE Review referral *1 to 1 Group Signposting Review Baseline physiological measures REFERRAL PATHWAY identify risk following screening – Brief intervention – refer – monitor – review 12 week review of measures Update GP Intervention/Signpost Monitor in services Pharma interventions GP

Challenge Culture Training Networks Internal Process Collabora- tions Physical Health Training for staff and patients Other teams: NHS, CVS etc. Challenge Culture Training Networks Policies/systems Research Internal Process Collabora- tions CQUIN/KPI’s Students Quality aims Peer Support Social Prescribing In-patient Marketing Social media Interventions Signpost 1 to 1 Internet/Intranet Literature Quality Improvement!! Groups

SHAPE 12 week outcomes (n=26) Mean weight, BMI and waist circumference for group held constant (typically would expect these to increase without intervention) 12 maintained baseline weight 7 decreased weight (2-7 kg) 7 increased weight (2-9 kg) Only 1/7 exceeded weight gain guidelines of <7 kg in 12 wk Results compare favourably with only published study of a similar intervention programme in Australia (Curtis et al., 2015) OUTCOMES after INTEVRENTION 12 weeks 12 months what we need to do stop increase and preventative care only one out of those increased more than expected trajectory

SHAPE 12 Month Outcomes (n=16) Mean weight, BMI, waist circumference and other risk indicators held constant (typically would expect these to increase without intervention) 2 increased weight > 5 kg Positive impact on healthy lifestyle behaviours: 7 reported eating healthier (eating 5 fruits and vegetables per day) 2 ceased substance use 2 ceased alcohol use 4 ceased smoking 5 were less sedentary (>90 minutes per week) 2 increased weight but less than 7 kg exercise – moved more increased routine

What does good quality look like improve and sustain Physical health monitoring and provide access to targeted timely interventions. Patient feedback and involvement Using Multidisciplinary skills/ Expertise Sharing good practice with other areas / Shared learning – meeting standards 4 points Staff competencies training more expectations Define shared care discharge pathway – LESTER tool

Participant Feedback “ …I quite liked how it structured my day, because before, I would not do anything, so you feel like you’ve accomplished after coming and that’s good for my self-esteem”. “…because of the nutrition side of things, I’m trying to concentrate more on healthy eating and things.” “…once I’ve done the exercise, I feel loads better, like a weight has been lifted, it enables me to carry on for the day, for the rest of the week. It really motivates me, just by the fact that it lifts me. “ WHAT IS SHAPE HOW TO REFER EXAMPLE OF PARTICIPANT STORY

Participant Feedback The following audio clip is a participant of SHAPE answering a number questions to support their quantitative outcomes. Example participants perspective of impact of mental health on physical health.

Future Plans/ Spread improvement www.mySHAPE.org.uk supports health care teams to deliver the SHAPE programme in local areas. Staff training sessions to other NHS organisations who wish to adopt the SHAPE programme. Roll out 12 week programme county wide WHACT. Develop 1:1 support pathways In patient access to interventions Standardise process Communicate to GP s – shared care / exit WHAT WE DO AND FUTRE HOPES

Conclusions At a time of shrinking resources, we need to recruit service users as partners in their own recovery in order to maintain reasonable services. Peer support champions Innovative use of skills and resources Be innovative look to wider community promote self efficacy early on in treatment INTRODUCE CHRIS

Healthy Active Lives (HeAL) international consensus statement Resources Lester Positive Cardio metabolic Health Resource www.rcpsych.ac.uk/quality/NAS/resources or http://www.nice.org.uk/guidance/cg178/resources www.mySHAPE.org.uk Healthy Active Lives (HeAL) international consensus statement http://www.nice.org.uk/guidance/cg178/resources REF