Initially trained as a Psychiatrist in AIIMS, New Delhi, I completed my Fellowship in Australia in 2011. Since then, I have been practicing in the field of Adult Psychiatry, in both acute and non-acute. Over time, I have developed a keen interest in Rehabilitation Psychiatry, my current clinical work area. My particular interest and commitment have been in implementing evidence-based psychosocial interventions in the service.
I have also worked and thoroughly enjoyed the role of Chief Training Supervisor in Cairns from 2014 to 2020. I have relinquished this role recently to dedicate some time to research and to widen my clinical experience.
Title: An Endocrinologist-led multidisciplinary clinic for managing metabolic risk factors in case-managed consumers with severe mental illness: A presentation of model of care and service implementation
Author(s): Mridula Kayal
People with severe mental illness (SMI) experience a twenty-year mortality gap compared to the general population related to the high rate of CVD. Isolated interventions are unlikely to improve cardiovascular fitness or induce weight loss in these population. The Lancet Psychiatry Commission: A Blueprint for Protecting Physical Health in People with Mental Illness, outlines multidisciplinary approach to a multi-morbidity as an effective method to treat metabolic syndrome in SMI. They recommend implementing the “Diabetes Prevention Program (DPP)”, the gold-standard lifestyle intervention, in people with SMI. To our knowledge, this is yet to be brought into practice in Australia.
We have developed a model of care for implementing the DPP through a multidisciplinary team approach. The team consists of an endocrinologist, psychologist, dietician, exercise physiologist (partnership with PCYC), smoking cessation nurse, and a care coordinator. The program will run as a two-hour 16-week group intervention which includes one hour of education (as per the DPP program manual) and another hour of exercise, under the supervision of an exercise physiologist. The consumers will also have access to 3 monthly Endocrine reviews and three monthly MDT case reviews.
A structured service evaluation will investigate the outcome of metabolic risk factors, diet, physical activity level, and smoking level of the case managed consumers with one or more risk factors for MS in an open-label pre-post design along with the acceptability of the program.
I want to present the model of care, the information around the implementation and feasibility of this program which starts on 2nd July, 2021.
The importance of the program lies in its ability to showcase work around social and clinical prevention, working in partnerships (with medical colleagues, allied health, and NGOs), converting policy into practice and an example of integrated care.
When successfully implemented, this model that has the potential to be replicated in other health care facilities in Australia.