RICHMOND FELLOWSHIP QUEENSLAND A future recovered for people facing mental health challenges Healthy Futures: Integrating Body and Mind Sarah Childs Executive Manager Clinical and Services

Acknowledgement Dr Justin Chapman Healthy Bodies, Healthy Minds Program Manager E: Justin.Chapman@pcyc.org.au M: 0432 299 240

Physical Health and Mental Health Poor health outcomes for people with mental illness Live 10 – 32 years less Cardiovascular disease Respiratory Disease Diabetes Smoking Substance Use Physical inactivity Poor diet   Physical Health and Mental Health The evidence clearly shows that people with severe mental illness have poorer physical health outcomes. The Royal Australian and New Zealand College of Psychiatrists (2015) report that people with serious mental illness typically live between 10 and 32 years less than the general population. Around 80% of this higher mortality rate can be attributed to the much higher rates of physical illnesses, such as cardiovascular and respiratory diseases and diabetes experienced by this population. The poor health outcomes of people with mental illness is described internationally as a human rights issue, and national mental health plans promote early intervention. Physical inactivity and poor diet contribute significantly to the observed early mortality and increased risk of preventable physical conditions in this group. The implementation of programs (such as our HBHM program) to assist people with mental illness to make positive lifestyle changes is an important component in achieving health equality for this group. Interventions which promote a healthy lifestyle and involve a focus on diet, physical activity and behavioural therapy have shown to be a key factor in improving health outcomes for people with a severe and persistent mental illness (NSW Mental Health Commission 2016).

Physical activity Supports Recovery Protects against chronic disease Reduces depression and anxiety Improves quality of life and wellbeing Improves self-efficacy, self-esteem, self-confidence Physical activity can be a facilitator of recovery for people with mental illness. Protects against chronic disease Reduces depression and anxiety Improves quality of life and wellbeing Self-efficacy, self-esteem, self-confidence

social isolation low income “exercise makes people feel better” The simplicity of the truism masks the complexity of the problem low mood lack of motivation social isolation low income low self-esteem symptoms……. Exercise makes people feel better. In fact, for some mental health problems, physical exercise may be the best treatment available. People with mental illness generally enjoy exercise, believe in its benefits, and have a desire to live healthier… … so it’s good for you and you enjoy doing it… so what is stopping people from getting out there – joining the gym, getting fit and healthy? The simplicity of this statement masks the complexity of the problem. People with mental Illness typically face significant barriers getting started with exercise. Low mood, low motivation, social isolation, low income, low self-esteem and the symptoms of mental illness often combine to make physical exercise difficult.

Partnership between PCYC and RFQ 8 Week Exercise Physiology and Dietetics program for people with mental Illness Partnership between PCYC and RFQ HBHM has been designed specifically with these barriers in mind HBHM is an 8 week exercise and nutrition program for people with mental illness, delivered by exercise physiologists and dietitians. The program is held at gym facilities of PCYC Queensland and collaboratively delivered with a partnering mental health organisation: the exercise physiologist is supplied by PCYC Queensland and the partnering mental health organisation supplies the dietitian for co-delivery. Both the exercise and nutrition components of the program are manualised for consistent implementation across multiple sites. The exercise component is designed to improve participants’ knowledge of exercise concepts, and confidence in exercising in the gym to achieve goals appropriate to individual’s health and fitness presentations. Participants work closely with each other throughout the program by incorporating a ‘buddy system’ which improves social interaction, and they receive a free gym membership to enable self-initiated exercise and support maintenance of exercise after the program finishes.

Enabling Participation Local and personal: the key to helping people get active and stay active So what’s the key to overcoming the multiple barriers to participation in exercise and healthy eating programs faced by people with mental illness? Creating a Personalised and Local program that is welcoming and supportive…

Enablers… Location – local PCYC, inclusive and affordable Experienced Professional Staff – Mental Health friendly Exercise Physiologist and Dietitian Individualised Recovery Support – motivation, practical support, problem solving Peer Support We can share things with the group. We understand each other and we can help each other. We can celebrate that we all got here today! The supportive program encourages and enables participation in a number of ways: • Socially inclusive location – Programs are offered in the local community at a PCYC gym. These venues are welcoming and inclusive environments. They are low cost (gym membership is free during the program) • Staffing – The programs are run by a qualified Exercise Physiologists and Dietitian. Both have experience of working with people with mental Illness and are offered professional Development opportunities to develop this expertise further. • Support -All programs are delivered in partnership with partnership with mental health community organisations to enhance the program’s holistic, recovery-oriented and person-centred focus. Mental health support staff assist participants by providing encouragement, motivation and practical support, and problem-solving barriers to attendance as they arise Peer Support component – participants work closely with each other during the program, and a buddy system is incorporated into the program.

Program Overview Exercise Physiology: exercise concepts, confidence in use of equipment, individualised health and fitness goal (pre and post assessment) The exercise component is designed to improve participants’ knowledge of exercise concepts, and confidence in exercising in the gym to achieve goals appropriate individual health and fitness and health presentations. Participants will meet with the Ex Phys for an individual assessment session prior to commencing the program. Participants work closely with each other throughout the program by incorporating a ‘buddy system’ which improves social interaction, and they receive a free gym membership to enable self-initiated exercise and support maintenance of exercise after the program finishes.

Program Overview Dietetics: Healthy Eating Guide, nutrition, mindful eating, label reading, diet myths, goals setting, healthy snack preparation The Dietitian sessions provide information and support on healthy diets, nutrition and it’s impact on mental health (including the impact of nutritional deficiencies such as iron deficiency), ,label reading, diet myths, mindful eating, getting ready for change and goal setting. The session each week includes preparing and sharing a healthy snack together. Participants are also offered the opportunity to visit the local supermarket to put their knowledge into action

Programs across Queensland 29 Programs delivered in three years in 13 PCYC sites across Queensland (n=193) 18 programs delivered in partnership with RFQ (n=103) Since beginning in 2015, the PCYC have implemented a total of 29 programs at 13 PCYC sites across Queensland, benefiting a total of 193 participants. RFQ have been the strongest partner in these initiatives, co-delivering 18 of these programs for 103 participants.

Outcomes 2015/2016 programs 58 participants 66% completed program (high attendance) Statistically significant reductions in psychological distress and symptoms of depression (K6 scale) Improved self – worth, relationships, coping and general mental health (Aqol-8D) and hope (RAS) 2017/2018 programs attendance median 62.5% Pre and post evaluations to include how the program impacts motivation and attitudes towards nutrition. We evaluated the 2015/2016 programs using measures of quality of life and recovery. In the 2015/2016 evaluation with 58 participants, 66% of those who began completed the program, and those who completed did so with high attendance (Median=75%). Participants experienced statistically significant reductions in psychological distress (assessed using the K6 scale), and symptoms of depression (assessed using DASS scale). Mental health related quality of life significantly improved, along with self-worth, relationships, coping and general mental health (assessed using AQoL-8D), and hope assessed using the Recovery Assessment Scale. Attendance for the 2017/2018 programs has been a median of 62.5%; we are building in pre/post evaluation of the current programs to assess how the programs impact motivation and attitudes towards nutrition. Intuitive Eating Scale, Nutrition Self-Efficacy and Australian Food Score. Feasibility and acceptability of the program is measured through attendance and satisfaction survey.

Take – home messages There is a need for community exercise and nutrition programs that overcome barriers to participation for people with mental illness The HBHM program is well-received by participants and staff Collaborative partnerships support the successful implementation of such a program (location, expertise and support) It is feasible for these programs to be delivered across a broad region Positive impacts on mental wellbeing achieved by the program Further evaluation of current programs in progress More work is needed to help people maintain a healthy lifestyle

Winners are Grinners!! Queensland Mental Health Week Awards