1. Level Health Equally Well Key findings from a literature review informing collaborative efforts to improve the physical health outcomes of people with mental illness and/or addiction Candace Bagnall Senior Policy Analyst Te Pou o Te Whakaaro Nui

2. Level Health Overview Introduction to Equally Well Results of literature review Suggested areas for action based on the review What’s next?

3. Level Health About Equally Well We are a group of individuals and organisations who are taking action on a longstanding, ‘wicked’ problem – the relatively poor physical health of people with serious mental illness and/or addiction

4. Level Health About Equally Well Initiated by members of Platform and Te Pou Helen Lockett has been leading the project on a part-time basis, funded through Te Pou’s contract with the Ministry of Health, and with their agreement

5. Level Health Progress to date Brought together research- based information and good practice examples from around the country Developed a shared position statement based on the evidence review This is supported by a growing number of organisations and representative bodies

6. Level Health Scope of literature review Life expectancy and the prevalence of physical health conditions amongst people with serious mental illness and/or addiction Explanations for poor physical health relative to the NZ population as a whole Promising interventions for improving health outcomes for this group

7. Level Health Mortality and morbidity International reviews indicate life expectancy up to 25 years shorter than the general population NZ research indicates mental health services users have more than twice the mortality rate of other New Zealanders Significantly higher rates of CVD, diabetes, metabolic syndrome, and higher death rates from cancer

8. Level Health Causes of premature death in New Zealanders using mental health services Women Men Cunningham et al. NZMJ 2014 127:1394

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10. Explanations for relatively poor health Greater exposure to known risk factors – low SES, smoking, reduced physical activity, poor nutrition Psychotropic medication effects – contribution to obesity, metabolic syndrome, CVD and type 2 diabetes Reduced access to and quality of healthcare – due to financial barriers, stigma and discrimination, lack of clarity about responsibilities for physical health across primary and secondary care

11. Level Health Psychotropic medication (Pharmac)

12. Level Health Solutions - systems level Formal acknowledgement in national policy as a priority health group Better co-ordination of treatment for physical health problems across primary and secondary care Guidelines outlining roles and responsibilities for physical health problems across primary and secondary care Workforce development to address stigma amongst health practitioners

13. Level Health Solutions – service level Provide effective physical health monitoring and screening processes for people using mental health services, especially those on psychotropic medication Invest in early intervention in psychosis services Reduce impact of low SES by supporting access to employment and housing

14. Level Health Solutions – service level Combine smoking cessation, physical activity and healthy nutrition promotion with cognitive behavioural support where possible Service user-directed, involving staff Focus on achieving long-term sustainable lifestyle changes Improve access to dental health services for mental health and addiction service users

15. Level Health What works for service users Build on therapeutic alliance Combine cognitive and behavioural strategies Realistic goals Flexibility to accommodate individual needs Provide ongoing support Include a social component Acknowledge barriers faced by people with SMI in participating in wellbeing programmes

16. Level Health Research and evaluation Trial alternative and complementary treatment options for psychosis to minimise the effects of medication Options include the use of psychological therapies and comprehensive wellness programmes using evaluation to develop best practice in different settings Qualitative research to better understand needs of service users

17. Level Health What’s next for Equally Well Summit in Wellington to generate action on 10 November Use of online software (Loomio) to generate discussion prior to the Summit Encouraging organisations to sign up to the consensus paper A programme of collaborative action

18. Level Health A programme of collaborative action Heart disease and mental health Increasing visibility - policy Clarity of roles - clinical guidelines Early intervention in psychosis wellbeing interventions Cancer and mental health Improving pathways of care for physical health issues Research – informing solutions Increasing access to oral health Addressing stigma and discrimination Equally Well champions

19. Level Health Thank you