PROFILE – Dr Katherine Moss is in her final year of advanced training in forensic psychiatry. She recently was awarded one of the Royal Australian and New Zealand College of Psychiatry’s New Investigator Grants. She is using this grant to investigate the physical health and activity of patients with severe mental illness who reside in forensic institutions. She is passionate about improving the physical health of forensic mental health patients. Dr Moss currently works as a clinician in the high secure unit of The Park, Centre for Mental Health and as a researcher in the Forensic Mental Health Group at the Queensland for Centre Mental Health Research.

ABSTRACT (1) – Physical Health And Mental Illness: Giving A Voice To Consumers
Authors:
K Moss1,2, E Heffernan2,3, C Meurk2.3, M Steele2,3

1 West Moreton Hospital and Health Service, Brisbane, Australia
2 Faculty of Medicine, University of Queensland, Brisbane, Australia
3 Queensland Centre for Mental Health Research, Brisbane, Australia

Background:

Implementation science developed out of the finding that evidence-based practices take, on average, seventeen years to be incorporated into routine practice in health. There is now widespread evidence documenting the benefits of physical activity for patients with severe mental illness. A forensic setting poses unique challenges with regards to implementing physical activity interventions for patients. Despite this, incorporating physical activity into treatment programs for patients who reside in government run secure settings can be regarded as an important component of recovery and care.

Objectives:

This presentation will report the preliminary findings of a questionnaire informed by implementation science (theoretical domains framework) and semi-structured interviews with patients exploring barriers and facilitators to physical activity for patients with severe mental illness residing in a secure facility.

Methods:

This study will gather qualitative data using a questionnaire and semi-structured interviews.

Findings:

The following data regarding physical activity in a high secure setting will be reported on: (i) patient knowledge, (ii) environmental context and resources, (iii) motivations and goals, (iv) beliefs about capabilities, (v) skills, (vi) emotions, (vii) social influences, (viii) beliefs about consequences, (ix) action planning, (x) coping planning and (xi) goal conflict.

Conclusions:

This study highlights the barriers and facilitators to physical activity as reported and experienced by forensic patients with severe mental illnesses residing in a secure facility. Implementation science can assist in identifying these factors.

ABSTRACT (2) – The Physical Health And Activity of Forensic Mental Health Patients
Authors:
K Moss1,2, E Heffernan2,3, C Meurk2,3, M Steele2,3

1 West Moreton Hospital and Health Service, Brisbane, Australia
2 Faculty of Medicine, University of Queensland, Brisbane, Australia
3 Queensland Centre for Mental Health Research, Brisbane, Australia

Background:

Addressing the physical health needs of forensic patients in high security settings is complex. The physical health of patients is often compromised by the requirement of long term inpatient stays, limited access to physical activity and a high prevalence of psychotic illness and antipsychotic treatment. It is important to consider diverse treatments, learn from previous research findings and address whether specific treatments will fit within the culture of an organisation.

Objectives:

This presentation will explore: (1) the current physical health status and health risk factors (2) current physical activity and (3) patient activation measures of patients at the High Secure Unit of The Park, Centre for Mental Health.

Methods:

This study is a descriptive study using a mixed methods approach. Both quantitative and qualitative date will be reported on.

Findings:

The following data will be reported on:

• Metabolic factors (height, weight, waist circumference, blood pressure, fasting glucose, triglycerides/cholesterol, HDL/LDL), weight change since admission, rates of metabolic syndrome/type 2 diabetes
• Medical history, family history of cardiovascular risk factors
• IPAQ – SF (International Physical Activity Questionnaires Short Form)
• PAM (Patient Activation Measure)

Conclusions:

This study will demonstrate the ongoing poor physical health status of long stay psychiatric patients. By considering diverse treatments and taking into consideration the culture of an organization, it is anticipated that improved treatment options can be devised.

PROFILE (unavailable)

ABSTRACT – Promoting health without stigma: Delivering a weight-neutral behaviour change program

Severe mental illness is characterised by a 20-year mortality gap due to cardiometabolic disease (Teasdale et al., 2016). Research dietitian Scott Teasdale from the University of New South Wales demonstrated a lifestyle program could improve dietary quality and physical activity in a group of people who had recently commenced antipsychotic medication. Healthy Bodies, Healthy Minds (HBHM) is designed to address this identified need. HBHM is an 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. Since beginning in 2015, over 35 programs at 13 PCYC sites across Queensland. Richmond Fellowship Queensland (RFQ) have been the strongest partner in these initiatives, co-delivering half of these programs. Delivery of the programs by RFQ dietitians lies within the HAES® paradigm promoting all of the five HAES® principles: Weight Inclusivity, Health Enhancement, Respectful Care, Eating for Well-being and Life-enhancing Movement. The program involves a weekly two-hour group session. In the first hour participants eat together with a dietitian and discuss nutrition-related goals such as: realistic goal setting for health, accessing nourishing foods within a budget, enjoyment of eating. In the second hour the participants work with an exercise physiologist to build an enjoyable exercise program within their individual physical abilities. This program is currently being evaluated in a randomised controlled trial with QIMR Berghofer Medical Research Institute, Metro North Mental Health and Metro South Addictions and Mental Health Service. PCYC Queensland received the 2018 Open Minds Not-for-profit Large Mental Health Week Achievement Award, and Program Manager Dr Justin Chapman received the 2018 Open Minds Individual Achievement award for work associated with this program. An overview of the program and future directions will be provided in this presentation.

Teasdale, S. B., Ward, P. B., Rosenbaum, S., Watkins, A., Curtis, J., Kalucy, M., & Samaras, K. (2016). A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with first-episode psychosis. British Journal of Nutrition, 115(11), 1987–1993. https://doi.org/10.1017/S0007114516001033

PROFILE – (unavailable)

ABSTRACT – Self-harm and suicidality in Australian run immigration detention system

Since 2012 Australia has been sending to remote Pacific islands refugees and asylum seekers who arrive by boat, in direct violation of our UNHCR obligations and agreement. Since 2014 there have been 14 deaths in these offshore centres, several of which were suicides.

The lengthy incarceration period, on a background of recognised prior trauma, as well as the prospect of indefinite detention has had a devastating impact on these individuals. Many have expressed a wish to die and have swallowed items such as bleach, shampoo, and razor blades. This is compounded by the physical diseases stemming from offshore such as respiratory conditions from the mould and toxic phosphate dust, kidney stones from the lack of drinking water, parasitic infections and assaults such as machete attacks and gang rapes. That the perpetrators of the crimes are rarely brought to justice reinforces the hopelessness experienced by these individuals. The knowledge that several have died while under Australia’s care is also terrifying for many and several appear to have ‘given up’.

Children are at a particular risk in this environment with many displaying developmental regression – meaning they are able to perform fewer activities and tasks at four years than they could at two or three. The emergence of ‘Resignation Syndrome’ has seen children progressively shut off from communicating, losing the ability to eat, drink, pass urine and in severe cases their basic reflexes. Studies have shown that a major predictor of resignation syndrome is witnessing attacks on their parents. Children see their parents as their protective interface between them and the rest of the world, so when parents are degraded, assaulted and otherwise rendered impotent the mental trauma for the child is catastrophic and the body starts shutting down.

PROFILE – (unavailable)

ABSTRACT – Physical Health and Mental Health – Multi-site clinical practice improvement.

Sally PLEVER1, Irene MCCARTHY1, Brett EMMERSON1, Melissa ANZOLIN1, John ALLAN2
1. The Qld Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, Australia.
2. Mental Health Alcohol and Other Drug Branch, Queensland Health, Brisbane, Australia.

Aims
Despite well-documented poor physical health outcomes for mental health consumers the provision of routine physical health assessment and smoking care is not the norm in mental health facilities. The following outlines a service improvement initiative applied across Queensland public mental health facilities to introduce routine six-monthly physical health assessment for people with Schizophrenia and universal screening of smoking with delivery of a brief smoking cessation intervention to identified smokers.

Methods
Over a five-year period, sixteen adult mental services across Queensland voluntarily participated in the statewide Queensland Mental Health Clinical Collaborative (Qld MHCC) to improve clinical practice in physical health. In 2012 services prioritised six-monthly routine physical health assessment for people with a diagnosis of Schizophrenia in community mental health services. Then in 2015 the provision of smoking care in inpatient services was introduced with universal smoking screening and delivery of clinical pathway brief intervention for identified smokers. In 2017 routine smoking care was extended to community mental health services. Services were supported to implement local clinical practice changes by the Qld MHCC through development of clinical indicators to monitor progress and promote benchmarking and in the delivery of six-monthly statewide forums to share experiences, hear from experts and set service-specific goals.

Results
Improvements across all three areas were seen during the staggered implementation of practice change. The MHCC physical health assessment indicator demonstrated a significant statewide improvement over a five-year period from 12% to 65%. The delivery of smoking cessation in inpatient services also demonstrated significant statewide improvement over a two-year period moving from 38% to 73% and early results from the community implementation of routine smoking care delivery indicate promising improvements.

Conclusions
The improvements seen support the application of a service improvement collaborative approach to achieving widespread clinical practice change across multiple services. Given the dire physical health outcomes for people with a serious mental illness, mental health services need to implement approaches that can support policy and demonstrate real-world changes. The next step will be to determine whether the clinical practice change translates to improved physical health outcomes for consumers.

PROFILE – (unavailable)

ABSTRACT – Let’s talk: Conversations for better health and wellbeing

Flourish Australia’s Back On Track Health (BOTH) Program focuses on health promotion and prevention embedding physical health and wellbeing conversations in everything we do.

The BOTH program supports people to learn skills to self-manage their own physical health and wellbeing; to regularly review their physical health and wellbeing; and to take action by regularly accessing primary health care services, particularly GPs, to address their health concerns. To support conversations and self-management activities, Physical Health Cards, a Physical Health Microsite and information sheets, have been co-designed with people accessing services and staff. An evaluation of the resources has shown promising results in supporting people to review their physical health and connect with a GP to address their needs.

A new recordkeeping process, focussed on physical health and wellbeing, has been developed to support people to record key activities that promote physical health, and to assist the organisation to evaluate the effectiveness of the resources and supports offered. Early data is showing promising results.

This paper will outline the resources and procedures that have been developed, including the processes used in co-design, piloting, and evaluating the new resources. It will detail the resource evaluation outcomes, including perspectives from people accessing the service and staff; and provide preliminary data about the effectiveness of the BOTH program in connecting people with primary health care services.

PROFILE – Andy Simpson completed psychology and then mental health nursing training in the UK where he worked for 12 years across various inpatient mental health settings. Since moving to Sydney 9 years ago he has worked as a care coordinator, clinical nurse educator, community mental health team leader, and is now the program manager for Living Well Living Longer, which aims to improve the physical health of mental health consumers across Sydney Local Health District. He is committed to improving the physical health and wellbeing of mental health consumers to address the 20-30 year life expectancy gap.

PROFILE – Marc Lamond has been working as registered nurse since 2015, largely in the area of mental health under the trauma informed and recovery/strengths based model of care. He has both inpatient and community experience in mental health and is currently working as a clinical nurse specialist with the community mental health team based in Marrickville. He is enrolled as a post graduate student of Western Sydney University with an aim to complete a master’s degree in Mental Health Nursing by 2020. He has an interest in improving the physical health and wellbeing of consumers accessing community mental health services and strives to provide assistance in access to primary health care services.

ABSTRACT – Theme – General Presentation

Title – The Development of a Side Effect & Preventive Health Screening Tool in a Community Mental Health Setting

Mental health consumers typically experience a range of side-effects from anti-psychotic medication which are often under-reported. Many neglect their physical health, and life expectancy for people with severe & enduring mental illness is 20-30 years less than the population average. Currently, mental health services routinely check metabolic monitoring every 13 weeks and recommend annual physical health reviews with the GP, but there is no routine monitoring of side effects or preventive health screening status. The M-SEPHS: Marrickville Side Effect & Preventive Health Screening Tool has been developed to quickly and concisely identify side-effects and preventive health screening status and is designed to be completed every 13 weeks alongside metabolic monitoring. A 12-month pilot of consumers who attend Marrickville Health Centre for their Long-Acting Injection has been completed. During this pilot, 100 individuals completed 149 screening tools, with a total of 235 side effects reported. While 28% of individuals reported no side-effects, 31% experienced three or more. Adherence to best practice guidelines for preventive health screening was extremely low. For individuals who were screened twice or more (n=41) there was no significant change in number of side effects reported or preventive health screening status, but there was a significant improvement in engagement with GP and dentist and a reduction of smoking. Recommended interventions will be developed to assist clinicians to respond appropriately to the findings. In addition, a consumer feedback survey has been implemented. From 23 surveys reviewed, 85% of respondents report that they think the tool is useful, with 50% reporting that new side effects were identified and 20% believing this led to a change of dose or treatment. 45% of respondents said that they followed up identified preventive health gaps with their GP. The tool is now being implemented further across Sydney Local Health District.

PROFILE – After graduating from Southern Cross University in 1996 Katie went to work for high-performance triathlon coach, Kieran Barry, in Sydney.
Her husband’s work took her to Perth in late 2000 where she opened The Beach Lifestyle Club in Cottesloe. One of Perth’s first health studios to successfully offer exercise physiology and sports science focused services.
In 2010 she sold The Beach Lifestyle Club when she fell pregnant with her fourth child. Katie then managed the development of Crown towers $17M health and wellness offering ISIKA.
After intensive research, Katie started The Exercise Therapist & The Thrive Clinic in 2015. The Thrive Clinic uses a unique exercise medicine protocol that effectively removes psychological objections to exercise, improving adherence and capacity for work once engaged in exercise.
This protocol has achieved significant reductions in combined mental and physical symptoms of all chronic conditions treated. The Thrive Clinic has quickly grown with the support of local GPs and specialists.
With a research paper pending publication under the guidance of Chief Scientist of WA Prof. Peter Klinken, Katie has a clear focus on servicing the gap in chronic mental and physical illness and injury in the Public and private primary health care sectors.

ABSTRACT – Exercise medicine: Improving the physical health of people living with mental illness.

Of the four million people in Australia currently living with a diagnosed mental illness 59.8% have a chronic physical health condition including, but not limited to, coronary heart disease, chronic obstructive pulmonary disorder, back pain, cancer & type 2 diabetes. They can also expect to live ten years less than the national average (14 years less if they live in Western Australia). One of the most telling statistics is the reality that 54% don’t seek treatment.

By using a clinically proven, evidence-based exercise medicine intervention to treat, manage and prevent mental illness at a primary care level, along-side chronic conditions. We offer the patient, medical system and government health funding agencies a fiscally viable & clinically effective primary health care solution to the current combined mental health and chronic disease crisis.

The efficiencies of combining health promotion, prevention and treatment of mental and physical chronic illness in combination at a primary care level supported by GP and specialist referral offers a natural extension to the already approved government health care homes project.

A repeatable clinically based exercise medicine intervention has just been validated in a three year efficacy and compliance study with the guidance and support of the chief Scientist of Western Australia in Perth, WA. We hope to present this research paper for the first time at the Equally well national symposium.

A secondary impact study is in planning with private and public health stakeholders to develop the concept into a model able to be rolled out nationally.

The opportunity to present and share this research at the Equally Well symposium will assist in this process and enable us to translate this simple research into practice all Australians with mental illness can benefit from.

PROFILE – Nicco Tepper – Nicci manages the MindStep program at Remedy Healthcare, working with customers to tailor the service to meet their business needs and providing the phone based low intensity cognitive behavioural therapy to people with anxiety and depression. Previously, Nicci was delivering coaching programs for people with chronic physical health conditions in her role as an accredited practising dietitian. Nicci is passionate about empowering people to improve their physical and mental health both in the present and into the future.

PROFILE – Fiona Glover – Fiona Glover is an Accredited Mental Health Social Worker and currently works as a Lecturer and clinical supervisor at Flinders University. Fiona coordinates the Low Intensity Cogntive Behaviour Therapy Training and Supervision Programs training both mental health and non-mental health professionals in LiCBT. Fiona has worked in the field of mental health for over twenty years as clinician in both public and private settings. Fiona has a passion for making quality evidence-based psychological interventions accessible to all people and delivered in ways that are collaborative and enhance the capacity and strength of people to self-manage.

ABSTRACT – Low intensity CBT for clients with chronic disease identified by allied health professionals.

Supporting people with long term-conditions is a major challenge of health services globally (UN Secretary-General, 2011). An increasing prevalence of long-term conditions and soaring costs create an urgent need to redesign health services (Tinetti, Fried, & Boyd, 20132). The case for integrating physical and mental health care is compelling. However, its translation into practice, both locally and internationally, is beset by health system siloes, service gaps, care coordination governance, agreement on what constitutes ‘value’ and cultural difference between professional groups (Naylor et al, 2016).

Individuals with a mental health diagnosis often experience many barriers to engaging in physical activity such as lack of motivation, increased physical comorbidities, pain and the side effects of medication (Firth et al, 2016a, 2016c). Evidence suggests that people who are “activated:, that is, have the knowledge, skills and confidence to manage their health effectively, are more likely to make healthy lifestyle choices and have better health outcomes and care experiences (Hibbard & Greende, 2013). Time spent with collaborating with health care providers is therefore key to providing resources and coaching that encourage self-management.

Remedy Healthcare delivers a broad range of health services across Australia, our multidisciplinary team, with expertise across both physical and mental health, provide us a unique opportunity to implement strategies to improve the overall health of clients. Recently, we have implemented an innovative model of care that leverages existing chronic disease management and care coordination programs with MindStep; a co-located Low intensity cognitive behavioural therapy (LiCBT) program to successfully integrate physical and mental health care in the private sector. This service now has the capacity to provide “dose-specific” levels of coaching required by the person to “activate” clients to engage in healthy lifestyle interventions such as physical activity, diet, sleep, and social engagement and address co-morbid mental health concerns, such as anxiety and depression.

During this presentation we will share outcomes of both the health coaching programs and MindStep Low-intensity cognitive behavioural therapy program and preliminary results for people when both programs are used in concert. We will also share our exciting plans for future service directions.

PROFILE – Rachel Whiffen – Manager, Communities and Program at Quit Victoria. Rachel joined Quit in November 2017 after six years coordinating Cancer Council Victoria’s Clinical Network program. During this time Rachel oversaw the program’s policy and advocacy in cancer care portfolio. With Quit, Rachel leads a dedicated team who work with communities and support organisations, where rates of tobacco use are high, to co-develop initiatives that enable all Victorians the opportunity to become smokefree and reduce the health, financial and social disadvantage that is directly impacted by tobacco use. Priority populations include people living with a mental illness, Aboriginal and Torres Strait Islander people, people upon release from prison and the LGBTI community. Rachel holds a Masters in Public Health and degrees in Exercise Science and Psychology.

PROFILE – Suzanne Turner – Senior Quality and Service Improvement Coordinator (NWMH). Suzanne has worked for over 15 years in public mental health in clinical, research and project management positions. She has a keen interest health program evaluation and translating research into practice.

PROFILE – Shane Sweeney – Manager, SUMITT NWMH. Shane is a social worker with over 30 years’ experience in clinical mental health and alcohol and other drug services. He is particularly interested in organisational change and service improvement initiatives. He is passionate about involving people with lived experience in the planning and execution of projects.

PROFILE – Marty Pritchard – Quit Evaluation Coordinator. Marty has over 16 years of monitoring and evaluation experience in a variety of domestic and international community based, not-for-profit program settings. He has a particular interest in evaluation capacity building and loves to assist others to bring together multiple lines of evidence that form a cohesive story of program performance- making sure that key stakeholders are indeed key in this process!

ABSTRACT – Theme: Prevention and promotion / providing quality care)

Title: Tackling Tobacco in Mental Health Services – translating evidence into practice.

Recognising the significant impact that smoking has on the health of mental health consumers, Quit Victoria, NorthWestern Mental Health partnered in 2016 to embed evidence based smoking cessation into routine care. The pilot sites chosen work with more than 1,000 consumers annually and employ approximately 280 staff.

The Tackling Tobacco Framework1 was used to address challenges identified during initial consultations with consumers and staff and identify best-practice smoking cessation strategies. In 2017-2018, strategies implemented included:

• Establishment of executive leadership group
• Revision of smoke free policies and the development of smoking cessation clinical pathways
• Delivery of staff training using the Ask, Advice, Help model, pharmacotherapies and behavioural support
• Implementation of a range of consistent quit supports including smoking cessation peer support worker, tailored stop smoking resources for consumers and carers, and skilling of Quitline Specialists
• Focused efforts to record consumer smoking status through a new smokefree screening and assessment tool.

Midpoint learnings based on analysis of 130 staff surveys, 180 training evaluation forms, key informant interviews, and 165 file audits indicate:

• Staff knowledge and confidence in providing smoking cessation increased by 34%
• 60% of staff now rate their service’s capability to provide cessation support as extremely or very capable
• Staff members are more actively supporting consumers to quit with an increase in referrals made to Quitline.
• The smoking cessation peer support worker is a key role to support consumers to quit.
• Appropriate resources are important. To date, a total of 23,000 hard copies of the ten new Tackling Tobacco resources have been disseminated.
• The collection of consumer’s smoking status has increased
• That the TT Framework is adaptable across a range of service types.

The presentation will detail implementation activities and evaluation findings to date.

PROFILE – Dr Carolynne White is a registered occupational therapist and lecturer in health promotion at Swinburne University of Technology. Carolynne is interested in person-centred health care and empowering all people to participate in activities that benefit their health and well-being. Carolynne has worked extensively in health promotion and occupational therapy with adults in mental health (community and forensic), community health, and research settings. Carolynne values equity in health and uses collaborative, strength-based approaches to address health inequalities.

PROFILE – Dr Natalie Jovanovskiis a sociologist and research fellow at Swinburne University of Technology. Dr Jovanovski’s research focusses specifically on women’s relationships with food and eating.  In 2014, Dr Jovanovski completed her PhD, which examined body-policing attitudes in popular discourses on food and eating.  Dr Jovanovski translated the findings from this research for a wider audience in her publication, “Digesting Femininities”.  As a post-doctoral fellow, Dr Jovanovski has conducted research with low-income single mothers in receipt of welfare benefits and investigated how socio-economic status affects women’s relationships with food, eating and mental and physical health.

ABSTRACT – Theme: Prevention & Promotion

Title: Re-focusing weight-related public health initiatives to promote mental and physical health

Public health initiatives designed to promote the physical health of the general population rarely consider their impact on a person’s mental health. “Obesity prevention” initiatives provide one such example. “Obesity” has become the target of public health campaigns as it a risk factor associated with chronic diseases, including cardiovascular disease and diabetes.

Currently, discourses about the relationships between body weight and health are framed in a way that shame people for their weight, size or shape, or their lifestyles, contributing to weight stigma. Research indicates that weight stigma has negative consequences, especially for women, and is associated with anxiety, depression, and body dissatisfaction, which is an established risk factor for eating disorders. Such evidence emphasises the need for public health initiatives that promote both physical and mental health.

In May 2018, Swinburne University of Technology and Women’s Health Victoria co-hosted a symposium with 38 key stakeholders and professionals from across public health, community, and government sectors to critique and challenge current discourses around women, food, and their bodies.  The symposium showcased evidence from policy, research, and practice and identified innovative new directions for public health initiatives that are both holistic and empowering.

This presentation will highlight the findings from the symposium, which has been a catalyst for action, including a submission to the Senate Select Committee into the Obesity Epidemic in Australia. This submission was one of few that considered the impact of obesity policy on people’s mental health, and resulted in two recommendations to address weight stigma in public health and clinical practice.

Mental health advocates are well positioned to address the health inequalities faced by people living with mental illness by challenging weight stigma and helping shift the focus of public health discourse and clinical practice from weight to wellbeing.