Health Services Ambassador
Q: What are your goals for Equally Well? What inspires you about Equally Well?
A: There needs to be a national voice that brings together all the resources available but in pockets around the country. Equally Well is that national voice. It brings together resources from around Australia and in doing so inspires consumers, carers and clinicians to promote equity of access to quality health care.
Q: How do you see Equally Well benefiting carers/consumers/practitioners?
A: As a national body that can execute a consensus statement that states, this is our vision, this is what we expect, it encourages change. On a national level it can shape policy agenda. It also inspires connection and collaboration. As we witnessed at the 2019 Symposium, the sharing of information and programs can inspire others to implement new initiatives in their local area and provide information to carers, clinicians and consumers to take away with them.
Q: What hurdles do you currently see Equally Well facing and will have to face in the future? Is there a particular area you believe needs more focus that Equally Well can develop on?
A: Culture change. The status quo has created a scenario where people with a severe mental illness have a much lower life expectancy compared with the general population. If we wish to change these outcomes, cultural change at a number of levels is necessary. The physical health of people with a mental illness needs to be recognised; the majority of the Australian population are unaware of the physical health inequities that are experienced by those with a mental illness. Peak consumer bodies and peer support workers need to assist consumers navigating physical health as an integral part of delivering quality mental health and wellbeing. The biggest need for change are mental health systems themselves that are not currently set up with physical health in mind. There is no overnight fix unfortunately, we require policy changes, but we also require a persistent effort on the ground to address physical health inequities and ensure that mental health care is delivered holistically.
Q: Your Keeping the Body in Mind program focuses on metabolic monitoring and lifestyle interventions. What were you seeing or not seeing within the mental health system that influenced you to start Keeping the body in mind?
A: In 2004 there was little literature on the topic of physical health care of people living with a mental illness. We noticed as clinicians in the Early Psychosis Program at Bondi that young people who were coming into our program seemed to change body shape in a matter of months. The concern arising from this meant that we started routinely measuring consumer’s metabolic health. We were shocked seeing the numbers on how fast people were gaining weight and their health deteriorating after commencing on anti-psychotic medication. These young people, who should otherwise be healthy aside from a new diagnosis of psychosis, were having the seeds of future ill-health and premature death being sown right before our eyes. It seemed hypocritical to be delivering early intervention to prevent long-term disability and impairment of people’s mental health while ignoring their physical health which could impact significantly on their quality and quantity of life. Keeping the Body in Mind was gradually born from the desire to deliver a holistic program that promoted a program of ‘don’t just screen, intervene’.
Q: What have you personally learnt and has this knowledge impacted your life and/or the lives of those around you?
A: First and foremost – patience. I have been on a journey to improve physical health care outcomes for people living with a mental illness for about 15 years. I have been very heartened in that period of time to see an increasing number of people advocating in this area and some amazing changes being achieved, but there is still a very long way to go with this topic. I have learnt whilst it is important to have passion about a topic to implement positive change and to change the status quo, patience and persistence are required (and in high doses).
Q: As an Equally Well Ambassador, you are an advocate for improving the physical health of people living with a mental illness, since the symposium, have there been any new developments or research in your field?
A: New studies are always being done which provide us with new information. I would rather take the time to discuss what we already know and what could be implemented now. There are six areas where clinicians can work with consumers to improve physical health outcomes:
- Screening of metabolic health and physical health checks. Understanding a person’s health challenges makes it much easier to design interventions to address poor physical health. Screening people for metabolic health can be done in as quickly as 2 minutes (weight, blood pressure, waist circumference). People should be encouraged to see their GP and get regular pathology testing done.
- Mindful prescribing: many medications, including antipsychotics, play a beneficial role in improving mental health. These medications should be reviewed on a regular basis to do a cost-benefit analysis. Switching and streamlining strategies should be considered in order to reduce the risk of physical health issues whilst maintaining mental health care. This is especially the case with high-dosing and/or polypharmacy which often occurs after a period of hospitalisation.
- Promoting physical activity: sedentary behaviour is problematic in attempting to maintain good health. Setting small and achievable (SMART) goals that increase physical activity and keeping these goals on the agenda (brief interventions) at each meeting. These goals might be as simple as encouraging a walk around the block or walking the long way to the dining hall in hospital.
- Promoting good nutrition: excess energy consumption and a lack of fibre and micro-nutrients can cause weight gain, cardiovascular disease and other physical health problems. Again setting small and achievable (SMART) goals in nutrition and keeping these goals on the agenda (brief interventions) at each meeting. These goals might be as simple as reducing the amount of soft drink a person consumes per day, for example, reducing from 2 litres to 1.5litres or switching from white to wholemeal bread.
- Advocating that people are prescribed pharmacological interventions for their health conditions. Diabetic medications, anti-hypertensives, and statins are among some medications that are underutilised in people living with mental illness. Prescription of metformin has been shown to help prevent antipsychotic weight gain and assist with weight loss.
- Smoking cessation: people living with a mental illness are greatly over represented amongst smokers. All smokers should be encouraged to quit. Smoking cessation rates are significantly improved using pharmacological interventions such as nicotine replacement and varenicline (now shown to be safe in use with people living with a mental illness). Support from health professionals has been found to be a key determinant in assisting people living with a mental illness to quit. Brief intervention can be very helpful and referring to the QUIT line increases the levels of support people receive.
Q: What do you see is your role for Equally Well as one of our ambassadors?
A: It is advocating and championing for equality of access to quality health care, to improve the life expectancy of those living with mental illness. Perhaps more importantly improving quality of life so people don’t have to deal with multiple morbidities. I hope to do this by demonstrating what is possible through what we have developed in the Keeping the Body In Mind program. Hopefully I can continue to inspire and raise awareness to create positive change.