Wanda Bennetts – Abstract 1

Medication Workshop – ‘A Spoonful of Sugar’

Medication is a very controversial topic and one that can create a lot of challenges for those taking medications. There are many issues and these can vary for each person. The topic is even more critical in light of the impacts that medications have on a person’s physical health particularly when they have no choice or legally compelled to take them.

This workshop is consumer led and asks participants to put themselves in the shoes of the person taking medication for a brief while. It invites the participants to reflect on their personal attitudes towards medications and how these attitudes impact upon practice. It also creates time and space for discussions to unpack the issues and consider how personal practice may change as a result of this reflection.

Advocacy
IMHA is the first Independent Mental Health Advocacy service in Australia. It is a statewide non-legal advocacy service that provides advocacy to people who are at risk of, or are subject to, compulsory treatment under Victoria’s Mental Health Act 2014. IMHA advocates work with people using a representational model of advocacy that is based on taking instructions from the person. Advocates work from a Supported Decision Making framework that allows a person to make their own decisions and express these to people in their lives.

Physical health, and the response to these needs, is a concern for many of the people that advocates work with, being an issue identified across the state over the past three years. This presentation will give you an overview of IMHA and some examples of how its advocacy model works in practice.

Wanda Bennetts – Abstract 2

The role of advocacy in maintaining the right to health

IMHA is the first Independent Mental Health Advocacy service in Australia. It is a statewide non-legal advocacy service that provides advocacy to people who are at risk of or are subject to compulsory treatment under Victoria’s Mental Health Act 2014. IMHA advocates work with people using a representational model of advocacy that is based on taking instructions from the person. Advocates work from a Supported Decision Making framework that allows a person to make their own decisions and express these to people in their lives.

Physical health and the response to these needs is a concern for many of the people that advocates work with, being an issue identified across the state over the past three years. This presentation will give you an overview of IMHA and some examples of how its advocacy model works in practice.

Jenny Bowman – Abstract

What works in system reform

‘Improving the physical health of people with a mental health condition’ is a complex, wicked problem. The myriad of interdependent factors at play – across levels that include individuals, organisations, communities and public policy – represent a system. Theory and research have helped identify strategies for achieving systems change… that can be helpful in whatever our own sphere of influence might be. Research with mental health services to increase the provision of preventive care for modifiable chronic disease risk behaviours is presented as an example of systems change strategies in action. Equally Well, and this symposium, can be seen as another.

Lisa Brophy – Abstract 1

Talking to people with serious mental illness about bowel cancer

Life expectancy in people with severe mental illness (SMI) is between 15 to 20 years less than that of the general population, a gap that is similar to that experienced by Indigenous Australians. The vast majority of excess deaths are due to chronic physical disease, including cancer. The team undertaking this study, led by Prof Steve Kisely at the University of Queensland, has undertaken previous research that has shown that cancer incidence rates in people with SMI are similar to those in the general population, but that cancer mortality is higher. Possible explanations include: 1) Poor cancer screening participation rates in those with SMI; 2) delays in diagnosis leading to more advanced disease at diagnosis; & 3) sub-optimal post-diagnosis management. I will be leading the qualitative component of this large study that will further investigate these issues using a range of mixed data collection methods. In focus groups, we will investigate the experience of people with SMI and colorectal cancer (and their carers) in relation to the barriers and enablers to screening, diagnosis and optimal care. The focus groups will ensure that the voices of people with lived experience of SMI and bowel cancer are heard and contribute to helping to understand what is happening when people are diagnosed and access care. The overall results of the study may indicate the actions required to decrease inequity and enhance this marginalised group’s access to optimal care, thereby improving their health outcomes. Findings may also have implications for other disadvantaged groups and other health problems.

Peggy Brown – Abstract

Navigating mental health in a digital world; how safe is it?

As digital technology extends its reach into mental health and physical health care through a range of e-health options, how well are consumers, carers and clinicians equipped to assess the safety and effectiveness of a digital service? This workshop will outline a project that is looking to develop a quality assurance framework for digital mental health services and will explore some of the key issues under consideration.

Debbie Childs – Abstract

The ‘C’ Word – Why carers matter

Better outcomes for people who are using mental health service can be achieved when staff are able to engage with the service user’s supportive family members or friends. However, it can be challenging to do so in busy work settings.

With the support of the WA Mental Health Commission and the North, South and East Metropolitan Health Services, HelpingMinds is working with clinical staff in mental health services to co-design resources and solutions that support greater engagement between staff and the family or friends identified as the service user’s supporters. This project is built on a nationally co-designed resource – A Practical Guide to Working with Carers of People with Mental Illness. The Guide was developed by people with lived experience of mental health issues, either as consumers or carers, and staff.

This national level collaboration has generated state-based pilot projects to test the usefulness of the Guide. In WA, a co-design approach has been adopted. A diverse team of paid consumer and carer consultants have been employed to guide the project. The staff in mental health services are partners in identifying and implementing practical strategies. Co-designed resources have been collated into a tool kit to assist staff in their engagement with family members and friends. If you are involved in cultural change processes in the mental health sector or looking to identify new ways of working with the family and friends of people using mental health services, this session outlines a straightforward yet very rewarding process of co-designing site-specific solutions.

Tara Clinton McHarg – Abstract

CMO Connect: a role for CMOs in connecting physical and mental health

Authors:
Tara Clinton McHarg*, John Wiggers, Luke Wolfenden, Kate Bartlem, Andrew Searles, Andrew Wilson, Magdalena Wilczynska, Joanna Latter, Lauren Gibson, Jenny Bowman

Background:
The ‘CMO Connect’ project will explore the potential role that mental health community managed organisations (CMOs) might play in providing chronic disease preventive care to people with a mental health issue. The project aims to identify: 1) current CMO preventive care practices; 2) barriers and facilitators to CMO staff providing preventive care; 3) consumer preferences for receiving preventive care; and 4) the organisational mechanisms that may support CMOs to provide preventive care systematically.

Method:
This collaborative project (utilising quantitative and qualitative methods) will be undertaken over 2.5 years with mental health CMOs in NSW. The methods of each of the project’s sub-studies will be described including: an online survey of CMO leaders to identify the chronic disease-focused programs and support they offer consumers; an online survey to explore CMO staff member roles in the provision of preventive care; telephone interviews with consumers to learn about their preferences for support; and in-depth focus groups with consumers, staff and managers to gain insight into what models of preventive care might work in the CMO setting.

Results:
The study will provide a comprehensive picture of the preventive care that is currently being provided by CMOs, the potential barriers and facilitators to its provision, and mechanisms that could enhance the systematic provision of such care. Based on the findings from the four sub-studies, one or more models of preventive care provision in CMOs will be developed and pilot tested in one CMO.

Conclusion:
Learnings from this study will assist other CMOs, and those who work with them, to understand how preventive care might be able to be integrated into practice in their organisation. The project also hopes to deliver one or more feasible, cost-effective models for the provision of preventive care that could be adopted and implemented by CMOs across Australia.

Nadine Cocks – Abstract

presented with Lisa Brophy

Quitlink: A Peer supported Smoking Cessation Research Project

People with severe mental illness (SMI) typically die 20 years earlier than the general population, largely due to smoking related diseases. Their smoking rate is alarmingly high and persistent, which contrasts sharply with the steady decline in the general population’s smoking rate. Smokers with SMI are equally motivated to quit smoking, but report less encouragement to quit by health professionals and are less able to succeed. When engaged in a program, some can quit successfully, but at lower rates than for the general population. Evidence-based smoking cessation interventions, such as quit lines, are underutilised by smokers with SMI. There is an urgent need to develop highly accessible, appropriately tailored cessation services for smokers with SMI to which mental health services can routinely refer smokers, and to explore why low smoking cessation rates persist among people with SMI receiving cessation treatment.

Quitlink, a research project led by the University of Newcastle will utilise peer workers to identify, support, and refer smokers with SMI in mental health services to Quitline, who will deliver a tailored, proactive and accessible smoking cessation intervention. We believe that the involvement of a peer researcher with lived experience of service usage, smoking and recovery, will enhance people’s interest in the study and their willingness to participate. We are already seeing this evidenced in the work to date. Additionally, we wish to investigate participant and health worker perceptions of the support provided by Quitlink, the nature of barriers encountered and their impact on initiating and succeeding with cessation.

Lynne Coulson Barr – Abstract

People’s right to have medical and other health and disability needs recognised and responded to by mental health services – data and insights from complaints to the MHCC

The principles of Victoria’s Mental Health Act 2014 require mental health services to recognise and to respond to people’s medical and other health needs, as well as other individual needs including disability supports and alcohol and other drug issues. Complaints to the Mental Health Complaints Commissioner over its first four years of operation have identified concerning examples of people’s physical and disability needs not being met by mental health services. This presentation will discuss the ways in which complaints can identify key areas for attention and service improvement and highlight service’s obligations under the Act and the Victorian Charter for Human Rights and Responsibilities 2006.

Indigo Daya – Abstract

presented with Chris Maylea

Physical health as a humans rights issue

For over a decade, international human rights law has demanded the right to health for mental health consumers. Physical health services and mental health services are bound ‘to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent by, inter alia, raising awareness of the human rights, dignity, autonomy and needs’ of consumers’. Both anecdotal experience and empirical data show that this has not occurred. In this presentation, we interrogate the right to health and frame a human rights-based response, focusing on practical approaches to embed human rights in health service provision. We consider supported decision-making and consumer-led responses as best practice in rights-based treatment, care and support.

Libby Dunstan – Abstract

Addressing the physical health of people with mental
health conditions – the Brisbane North PHN experience

Brisbane North PHN is one of 31 Primary Health Networks across Australia. We work with local communities, consumers, carers, health professionals, hospitals and community providers to understand our community and their needs. We then engage with stakeholders to design and commission programs and services to meet those needs. One of the Brisbane North PHN’s priorities is improving the quality, coordination and integration of mental health, suicide prevention and alcohol and other drug services.

A key area of focus has been the development of a Regional Plan for North Brisbane and Moreton Bay focusing on mental health, suicide prevention and alcohol and other drug services 2018-2023. The regional plan sets out the challenges facing us and what we can all do over the next few years to improve the quality, coordination and integration of services. This presentation will cover some of the experiences of the Brisbane North PHN, the opportunities and challenges as a PHN in addressing the physical health needs of those living with mental illness, delivering on the intent of the Equally Well Consensus Statement.

Caitlin Fehily – Abstract

Embedding a specialist preventive care clinician
in a community mental health service

Authors: Caitlin Fehily, Kate Bartlem, John Wiggers, Paula Wye, Richard Clancy, David Castle, Sonia Wutzke, Chris Rissel, Andrew Wilson, and Jenny Bowman.

Background:
People with a mental illness are more likely to engage in modifiable risk behaviours: smoking, poor nutrition, harmful alcohol consumption and physical inactivity, compared to the general population. Guidelines recommend that mental health services routinely provide ‘preventive care’ to address risk behaviours, however, provision of this care is low. This study aimed to assess the effectiveness of providing preventive care via the offer of an additional consultation with a specialist preventive care clinician in a mental health service.

Methods:
A randomised controlled trial was conducted within one community mental health service. Clients (n=811) were randomised to receive either usual care (preventive care directed by policy to be provided in routine consultations) or usual care plus the offer of an additional consultation with a specialist preventive care clinician (intervention group). Telephone interviews were undertaken at baseline and a one-month follow-up to assess participants’ views towards this model and receipt of preventive care.

Results:
82% of the intervention group stated that this model of preventive care provision was acceptable, and 95% agreed that it was a good idea. One third of clients allocated to the intervention attended the preventive care consultation, and participants who attended reported high levels of satisfaction. Preliminary intention to treat analyses indicated that the intervention group were significantly more likely to have been asked about their risk behaviours (RR 4.00), advised to change at-risk behaviours (RR 2.40) and offered referral(s) to specialist behaviour change services (RR 20.13).

Conclusions:
Clients of a community mental health service viewed the offer of an additional preventive care consultation to be acceptable and satisfactory. This model of service delivery resulted in significantly greater receipt of preventive care, as compared to usual care. This model may be a means of providing care to clients of community mental health services worthy of further testing.

Katherine Gill – Abstract

Consumer/Carer Experiences of FND: The Abyss between brain, mind and body

Functional Neurological Disorder [FND] is classified as a Mental Illness in the DSM-V, but involves a variety of disabling, distressing and debilitating neurological symptoms, including paralysis, gait disorder, tremors, fatigue, chronic pain, seizures and blindness. Historically FND was thought to be associated with trauma. Recent fMRI studies have identified abnormalities in the functioning of the brain1. Functional disorders are one of the most common diagnoses in neurologic practice2, but this is not reflected within mental health services, or the level of public awareness, funding and services available to people with FND.

A recent study funded by the National Mental Health Commission, surveyed 179 consumer and carers about their experiences of FND in Australia. The outcomes highlighted significant gaps in regards to knowledge, attitudes and services for FND. Many people [79%] reported distressing experiences when seeking care. Many struggled to obtain a diagnosis of FND. Failure to diagnose early, after onset of symptoms, can lead to iatrogenic harm, repeated testing and significantly worse outcomes. After diagnosis, treatment was difficult to access; only 36% of consumers accessed any form of treatment in the six months post-diagnosis, significantly increasing the risk for permanent disability.

FND crosses the divide between physical and mental health3. It lacks a medical home, with neither neurology nor psychiatry taking ownership for the care of people with FND. This is reflected in the lack of services, and poor awareness and knowledge of FND across health services and the community. The system gaps are having devastating consequences on the mental and physical wellbeing of consumers. Their quality of life is greatly affected; people are unable to participate in valued daily activities, including employment, leading to dire financial impacts for many families. The outcomes of the study will be presented at the symposium with recommendations to address the serious system gaps.

Fiona Glover – Abstract

presented with Nicci Tepper

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.

Rebecca Hallam – Abstract

Physical Health is Everyone’s Business: Let’s make it standard practice

Whilst at a societal level there have been challenges in bringing Mental Health to everyone’s attention, from a traditional Mental Health Care perspective Physical Health has not been at the top of the agenda. With a groundswell of attention towards considering the physical health perspective, perhaps the time is right to flip the focus. This requires a multi-faceted approach to increase knowledge, awareness and confidence of Mental Health Clinicians in addressing physical health concerns, as well as empowering consumers to make choices that improve their physical health and overall wellbeing.

Exercise Physiology is a discipline that considers health from that holistic perspective. Whilst many people benefit from specific exercise prescription to treat their condition, it is also about addressing the underlying barriers to participation. Accredited Exercise Physiologists tackle the challenges from the physical, psychological, emotional and social perspectives to support people to maximise their opportunity to exercise for both enjoyment and optimal health.

There are a number of Mental Health Services across the country where Exercise Physiologists have been a vital part in ‘flying the flag’ for addressing physical health concerns and implementing clinical exercise interventions. This presentation will explore the challenges and triumphs of one service’s experience in not only introducing Exercise Physiology into recovery, but also the multiple layers from which physical health must be approached in order to facilitate the changes in culture, practice and every day interaction that are necessary for embedding physical health in to standard care for those experiencing Severe Mental Illness.

Themes to be explored will include: Culture change – organisation wide, management, treatment teams and individual clinicians; training – improving knowledge for both clients and staff; infrastructure – what is required to support this to happen: equipment, staffing, resources.

Brenda Happell – Abstract 1

From understanding the problem to developing a solution: the
introduction of a specialist Physical Health Nurse Consultant Role

The physical health challenges and reduced life expectancy experienced by people accessing mental health services are clearly documented. Unfortunately, this knowledge has not translated into significant and widespread practice change. The Physical Health Nurse Consultant position was developed by a multidisciplinary research team and is directly informed by research undertaken with consumers, carers and nurses in mental health. With National Health and Medical Research Council funding, this position is being trialled in the ACT. A Randomised Controlled Trial is comparing the Physical Health Nurse Consultant to treatment as usual. A comprehensive evaluation will compare the two groups using clinical outcomes, access to and acceptability of treatment, quality of life, burden of disease and cost-effectiveness. This presentation will provide a brief overview of the development and implementation of this nurse-led position, reflecting the perspectives of consumers, carers and nurses. It will include a warts and all overview of the barriers encountered through the implementation process and the team is learning about major barriers to providing quality physical health care within mental health services. If evaluation is positive, this strategy could provide a model for the improvement of physical health care within mental health services and address a major health inequity.

Brenda Happell – Abstract 2

Someone has to do it! Carers experiences of physical
health care for consumers of mental health services

People diagnosed with mental illness have increased risks of physical illness and earlier death, problems able to be addressed through better physical health services. Carers of people with mental illness play a significant role in the mental health care system yet research examining their views is lacking. A qualitative exploratory study involving in-depth interviews with 13 mental health carers about their views and experiences pertaining to the physical health and availability of physical health care for the people they care for.

Analysis of carer responses identified two important themes: responsiveness and access, and a shortage of care coordination. Carers felt alienated from physical health care providers and were compelled to fill gaps in available care through persistence in ensuring access to physical health care services. The findings identify carers as key stakeholders in the physical health care of the people they care for. Their involvement in accessing and coordinating care provides vital perspective on health service capacity, which requires further consideration in the practice and research domains.

Ben Harris – Abstract

Australia’s Physical and Mental Health Tracker
– targeting action and accountability

The relationship between mental health and physical health is well known yet there is a persistent gap in morbidity and mortality.

Australia’s Mental and Physical Health Tracker is a national report card on chronic disease and their risk factors for people with mental and behavioural issues compared to the Australian population as a whole, and differentiated by gender. It examines issues such as smoking, risking drinking, obesity and overweight, physical activity, blood pressure and cholesterol levels which are the major risk factors for chronic conditions such as cardiovascular diseases, diabetes and cancer.

For the first time, data from the National Health Survey are used to quantify the differences in chronic disease risk factors for people with mental and behavioural issues, and to highlight the gender differences.

Australia’s Mental and Physical Health Tracker also quantifies, for the first time in Australia, the comorbidities associated with mental health conditions. Living with a mental health condition – including common conditions anxiety and depression – dramatically increases the chances of living with another chronic disease. Approximately 2.5 million Australians have both a mental and physical health condition.

We have known for a long time that people with mental health conditions are more likely to have physical health issues, and less likely to have those issues addressed. The Tracker demonstrates that this holds true for all mental health conditions, including those affecting millions of Australians.

Poor physical health experienced by people with mental health issues will continue to affect welfare and education, health systems and costs, productivity and employment, and social participation.

Improving the physical health of people living with mental health conditions must become a priority to improve the health of all Australians. Australia’s Mental and Physical Health Tracker provides data to help focus our efforts, and a tool to track our progress.

Fay Jackson – Abstract

Closing Address

Fay Jackson will use her passion, lived and professional experience and your leadership to challenge you, to take all that you have learned over the past two days and make a commitment to the next S.M.A.R.T thing you are going to do to improve the physical health of people with mental health issues.

The body, mind connection cannot be denied. Will you deny making a difference in people’s lives? Fay will run the shortest workshop consisting of three parts taking less than 5 minutes and may help you solve your largest challenge with a creative, innovative new program or outcome.

Will you take the 5-minute challenge to possibly close the life expectancy gap of countless numbers of people with mental health issues? There are no gimmicks, just one simple tool, your mind, your inspiration, your leadership and the passion to improve the lives of people with mental health and physical health needs. Be inspired, be engaged, be brave and be there.

Kate Jackson – Abstract 1

What do we know about the physical health of older people with
mental illness, and what does this mean for improving care?

The Australian population is ageing, and the number of older people with mental illness is projected to increase significantly. Some people develop a mental illness as they age, while others grow older with a continuing experience of mental illness that developed earlier in their lives. For older people, mental illness often co-occurs with other physical health conditions. There is significant evidence that older people with mental illness experience disadvantage in accessing appropriate physical health assessment and care, and poorer physical health and earlier mortality than the general population. This is particularly so for people who grow older with a continuing experience of severe and persistent mental illness, compared with older people who have developed mental illness in later life and generally have a history of better health care management. In general, the Australian population is ‘ageing well’ and the ‘younger old’ (65-75 years) experience better physical health. However, the growing ‘older old’ population are likely to present with more complex co-existing conditions.

This paper will explore mental health and physical health in the context of an ageing population. It will examine what we know about the physical health needs of older people with mental illness (including different sub-groups of older people) and how we are going in meeting those needs, particularly in mental health services and mental health service partnerships. It will highlight some of the challenges and lessons for improving care, drawing on the NSW experience in older people’s mental health (OPMH) services. It will provide the context for Rod McKay’s paper reflecting on the journey in NSW in this area, and our current work to improve physical health assessment and care for older people with mental illness, focussing on consumers of NSW OPMH services.

Kate Jackson – Abstract 2

presented with Rod McKay

Converting the lessons of implementation into effective action

Based on a combined 30 years of experience converting national and state policy into local action and service development, this workshop will briefly overview some of the essential enablers and difficult obstacles to effective implementation. The workshop participants will then consider ways of considering the populations that actions may target (eg different ages, settings, risk profile). Based on the principles of successful implementation, participants will be guided to draft specific actions they could apply to their particular context. Groups will then consider a set of recommendations for action for each population group. Finally the workshop will bring together and summarise recurrent themes from each of the workshop groups.

Kym Jenkins – Abstract

Process And Progress: The Physical Health of Those
with a Serious Mental Illness – An Advocacy Priority

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 experienced by this population, such as cardiovascular and respiratory diseases and cancer.

Recognising the devastating human cost, as well as the cost of serious mental illness to the Australian economy in terms of health care, welfare, and lost productivity, this presentation will outline the Royal Australian and New Zealand College of Psychiatrists (RANZCP) role in advocating for best practice health care for people with mental illness.

All of us in the health sector, including psychiatrists; allied health and other medical professionals; community, mental health and health organisations; can and should advocate for policy and clinical changes to improve the life expectancy of people with serious mental illness.

The RANZCP produced a series of reports examining barriers to health care and the economic costs associated with serious mental illness. Developments since the production of these reports will be highlighted during this presentation, as well as other endeavours where the RANZCP has tried to affect changes in this important area.

Katherine Johnson – Abstract

Improving the health of LGBT+ people: what does “early
intervention” mean in a landscape of social inequality?

The health of LGBT+ people is widely recognised as carrying numerous consequences across the lifespan, including but not limited to, elevated rates of psychological distress and life-time risk for suicide, weight-related health concerns (too fat, too thin) and diseases associated with increased rates of smoking, alcohol and recreational drug use. Despite the individualising tone of much health prevention literature, within the field of LGBT health the impact of social discrimination is offered as a key explanatory factor where health outcomes are related to ability to access appropriate and acceptable health services, and health-related behaviours can be seen as coping strategies for stigma, rejection, and safety. Drawing on examples* from community-based research with LGBT people in the UK this paper examines the entwined relationship between physical and mental health for LGBT people and asks what might an early intervention to improve the health and wellbeing of LGBT people look like in a landscape of social inequality?
* Content warning: the material presented contains some accounts of psychological distress including suicidal thoughts and experiences.

Kate Johnston-Ataata – Abstract

presented with Dave Peters

Intersections of mental and physical health: Healthtalk Australia
and the value of online health and illness experiences

by Kate Johnston-Ataata, Dave Peters, Nicholas Hill, Jacinthe Flore and Renata Kokanovi

People’s stories or personal accounts of health and illness experiences online are becoming increasingly important in relation to how we think about, make use of, and design health care services. For other people experiencing similar conditions who may be trying to make sense of a new diagnosis, seek information about symptoms, or make decisions about treatment and care, accessing other people’s lived experiences online can be helpful as a complement to clinical health information. Health service providers and policymakers also value people’s health and illness experiences online as a source of evidence about what is and isn’t working in healthcare systems. One noteworthy aspect of personal accounts of health conditions online is that they reveal the ‘messiness’ of lived experiences of health and illness vis à vis neat clinical diagnostic criteria or treatment guidelines. Stories highlight the prevalence of experiencing one or more health conditions at the same time, and in particular the inseparability of experiences of mental and physical health, a critical issue for people with a diagnosis of mental illness whose physical health experiences and needs are often overlooked.
In this talk, Kate Johnston-Ataata will introduce Healthtalk Australia (HTA), the leading research-based online repository of personal accounts of health and illness experiences in Australia and briefly outline its objectives and approach to collecting and disseminating personal stories online. Next, Dave Peters, a participant in the ‘Mental Health and Supported Decision Making’ HTA project, will reflect on sharing his lived experiences online and the interconnections between physical and mental health in his own story. The presenters will then discuss key findings from the ‘Mental Health and Supported Decision Making’ project relating to the intersection of mental and physical health, and offer suggestions for future research and online resource development on this important but neglected topic.

Natalie Jovanovski – Abstract

presented with Carolynne White

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.

Teresa Kelly – Abstract

Heartscapes: A new narrative for understanding the
complexities that underpin cardiovascular vulnerability

Authors:
Ms Teresa Kelly, Department of Nursing, School of Health Sciences, The University of Melbourne.
Associate Professor Bridget Hamilton, Department of Nursing, School of Health Sciences, The University of Melbourne.
Professor Sharon Lawn, Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University.
Professor Suresh Sundram, Department of Psychiatry, School of Clinical Sciences, Monash University; Monash Health.

People who live with mental illness such as schizophrenia and bipolar disorder are vulnerable to premature mortality. The leading cause of death is cardiovascular disease. Extensive research has produced important biomedical knowledge of this complex health problem. However, this knowledge has not translated into improvements in the cardiovascular health of people who live with mental illness. This PhD research project explored this real-world problem through the stories of ten people who live with mental illness.

Using an interdisciplinary and multi-perspective approach generated a new narrative for understanding the cardiovascular risks associated with living with mental illness; one that views the person and their cardiovascular vulnerabilities in the context of a much broader narrative.

This new narrative extends beyond the parameters of biomedical and biopsychosocial frames. It affirms mental illness to be a powerful generator of a complex array of interconnected cardiovascular risks. By shifting the lens from stories of illness to stories of transformation, this new narrative points to connection as a fundamental precursor to holistic heart health. From this perspective, heart health is not separate from recovery-oriented care; rather it depends on it.

The translation of the findings of this narrative research into policy in Victoria is already underway.

In this paper, we will showcase the Heartscapes. We will share the key discoveries and outline implications for policy, research, and practice. We will conclude with a call for a radical, relational and transformational approach to holistic heart health.

Vicki Langan – Abstract 1

presented with Whitney Lee

Pictorial Physical Health Prompt: A Co-Design Process

The Physical Health Prompt (PHP) is a tool consisting of 28 strengths based close-ended (yes or no) questions developed primarily to guide conversations between staff and consumers to address health care needs. The PHP adheres to the National Health guidelines and was written through a co-design process in response to the poor physical health needs of individuals accessing Neami services. The PHP is intended to facilitate conversations where physical health concerns can be identified and then addressed through improving health literacy and engagement with primary health care providers, GPs, allied health professionals, alternative practitioners or relevant services.

Following the introduction of the original PHP in a boarding house program, staff discovered approximately 65% of residents identified as illiterate. In response, a co-design process was implemented involving mental health consumers and staff to develop an innovative version of the PHP tool to cater for different learning styles. The outcome was a Pictorial Physical Health Prompt (PPHP) designed specifically by consumers for consumers in community mental health setting using images to support the comprehension of each written question.

There is a growing awareness of the need to identify successful models of co-design in mental health services and useful strategies to support consumer participation in developing services and practice tools. The PPHP demonstrates how consumer participation can result in a collaborative and dynamic partnership to create meaningful outcomes. This presentation explores the learnings from the co-design process to develop the PPHP including benefits, challenges and mitigating strategies used during the process. This contributes to the growing body of knowledge around methods to implement consumer participation when developing resources for people living with a mental illness.

VIcki Langan – Abstract 2

presented with Whitney Lee

Active8 – A Peer Lead Physical Health and Wellbeing Program

There is a growing body of evidence which suggests peer coaching in recovery-oriented practice is an effective approach to supporting consumers in mental health service settings. The value of peer support in mental health recovery lies in its ability to inspire hope, motivation and an increased ability to overcome challenges.

Neami National’s Active8 program in NSW is an innovative alternative to traditional approaches. In keeping with Neami’s recovery-oriented practice framework, the program is person-centered, collaborative and designed to maximise opportunities for participants to build skills in self-management.

The Active8 program offers a combination of an individual program of Coaching for Physical Health, delivered one-to-one by a peer support worker, and Eat, Plant, Learn a group program co-facilitated by the peer workers, who promotes healthy and sustainable eating. The programs support consumers to identify and work on physical health-related goals; as well as improve their health literacy, engagement with health services, self-management and self-efficacy. Consumers participate in either Coaching for Physical Health (CPH) or Eat, Plant, Learn (EPL) or both programs according to their identified needs and goals. Everyone is offered six one-to-one coaching sessions with an introductory session and an exit support session and access to several tailored group EPL sessions, dependent on their individual needs. The CPH sessions are delivered face-to-face at the consumers home, preferred community location, or over the telephone. One-to-one sessions are scheduled at intervals of two and four weeks to allow them work on their identified goals between sessions.

Unlike a counsellor or mentor, the peer coach does not rely on offering advice but rather helps the individual brainstorm ideas and develop achievable goals, they selectively use self-disclosure to inspire hope, self-determination and reduce stigma. Neami Peer coaches understand the link between physical and mental health and are passionate about supporting people through the challenges of making behavioural changes. The Active8 peer support workers specialise in techniques to support and guide consumers to find sustainable and meaningful strategies to achieve their physical health goals. They are skilled at keeping sessions on the topic of physical health, whilst being creative and flexible to respond to individual needs.

Whitney Lee – Abstract 1

presented with Vicki Langan

Pictorial Physical Health Prompt: A Co-Design Process

The Physical Health Prompt (PHP) is a tool consisting of 28 strengths based close-ended (yes or no) questions developed primarily to guide conversations between staff and consumers to address health care needs. The PHP adheres to the National Health guidelines and was written through a co-design process in response to the poor physical health needs of individuals accessing Neami services. The PHP is intended to facilitate conversations where physical health concerns can be identified and then addressed through improving health literacy and engagement with primary health care providers, GPs, allied health professionals, alternative practitioners or relevant services.

Following the introduction of the original PHP in a boarding house program, staff discovered approximately 65% of residents identified as illiterate. In response, a co-design process was implemented involving mental health consumers and staff to develop an innovative version of the PHP tool to cater for different learning styles. The outcome was a Pictorial Physical Health Prompt (PPHP) designed specifically by consumers for consumers in community mental health setting using images to support the comprehension of each written question.

There is a growing awareness of the need to identify successful models of co-design in mental health services and useful strategies to support consumer participation in developing services and practice tools. The PPHP demonstrates how consumer participation can result in a collaborative and dynamic partnership to create meaningful outcomes. This presentation explores the learnings from the co-design process to develop the PPHP including benefits, challenges and mitigating strategies used during the process. This contributes to the growing body of knowledge around methods to implement consumer participation when developing resources for people living with a mental illness.

Whitney Lee – Abstract 2

presented with Vicki Langan

Active8 – A Peer Lead Physical Health and Wellbeing Program

There is a growing body of evidence which suggests peer coaching in recovery-oriented practice is an effective approach to supporting consumers in mental health service settings. The value of peer support in mental health recovery lies in its ability to inspire hope, motivation and an increased ability to overcome challenges.

Neami National’s Active8 program in NSW is an innovative alternative to traditional approaches. In keeping with Neami’s recovery-oriented practice framework, the program is person-centered, collaborative and designed to maximise opportunities for participants to build skills in self-management.

The Active8 program offers a combination of an individual program of Coaching for Physical Health, delivered one-to-one by a peer support worker, and Eat, Plant, Learn a group program co-facilitated by the peer workers, who promotes healthy and sustainable eating. The programs support consumers to identify and work on physical health-related goals; as well as improve their health literacy, engagement with health services, self-management and self-efficacy. Consumers participate in either Coaching for Physical Health (CPH) or Eat, Plant, Learn (EPL) or both programs according to their identified needs and goals. Everyone is offered six one-to-one coaching sessions with an introductory session and an exit support session and access to several tailored group EPL sessions, dependent on their individual needs. The CPH sessions are delivered face-to-face at the consumers home, preferred community location, or over the telephone. One-to-one sessions are scheduled at intervals of two and four weeks to allow them work on their identified goals between sessions.

Unlike a counsellor or mentor, the peer coach does not rely on offering advice but rather helps the individual brainstorm ideas and develop achievable goals, they selectively use self-disclosure to inspire hope, self-determination and reduce stigma. Neami Peer coaches understand the link between physical and mental health and are passionate about supporting people through the challenges of making behavioural changes. The Active8 peer support workers specialise in techniques to support and guide consumers to find sustainable and meaningful strategies to achieve their physical health goals. They are skilled at keeping sessions on the topic of physical health, whilst being creative and flexible to respond to individual needs.

Helen Lockett – Abstract

presented with Caro Swanson

Equally Well New Zealand

Caro Swanson and Helen Lockett have both been instrumental in the development and continued expansion of the Equally Well movement in Aotearoa/New Zealand. The Equally Well collaborative is underpinned by evidence, both in terms of understanding the issues and in designing the solutions. It is also underpinned by principles, most importantly the principle of co-design with people with lived experience. In this presentation, Caro and Helen will take us through how the Aotearoa New Zealand Equally Well collaborative began, and some of the highlights from their five-year journey. They will also share some of their reflections on lessons learnt. As they share their experiences, they hope to inspire Equally Well Australian champions, outlining what make up the key ingredients of an ‘Equally Well action or set of actions’ and explaining the underpinning mechanisms and success factors which support the continued growth of this diverse and impactful collaborative.

Anna Love – Abstract

presented with Maggie Toko & Marie Piu

Equally Well in Victoria – Physical health framework
for specialist mental health services

Each time a consumer engages with a clinical mental health service provides an opportunity to explore physical health issues, consider how they might impact on recovery goals and offer help.

The Physical health framework for specialist mental health services is the first of its kind in Victoria. It describes a range of initiatives for organisations and clinicians to work in partnership with consumers and carers to discuss physical health in the context of a recovery plan. This framework provides information to help mental health services and clinicians to think about how to tailor treatment and strategies to the realities of the daily lives of consumers.

Under the leadership of Victoria’s Chief Mental Health Nurse, Chief Psychiatrist, in partnership with peak organisations Victorian Mental Illness Awareness Council and Tandem, the framework was developed as Victoria’s response to the Equally Well National Consensus Statement. The framework describes consumer, carer and clinician’s perspectives on how physical health issues can be worked on by mental health services.

An Expert Reference Group comprised of mental health consumers and carers, experts from mental health, general practice, community health and peak health organisations guided the approach and content of this document.

Five interconnected domains support physical health care in Victorian specialist mental health services. They are:

• Consumer physical health needs
• Collaborative planning and therapeutic interventions
• Healthcare setting
• Workforce considerations
• Supporting safety

The framework describes the necessary elements at the organisation and clinical practice levels to guide implementation of physical health in a consistent way across Victoria. It asks services and clinicians to use a recovery approach to physical health, and offer help to consumers that extends beyond biomedical screening, diagnosis and treatment. It asks clinicians to work in an interprofessional manner to understand each person’s recovery journey and using collaborative recovery plans to enquire about the person’s physical health, appreciating the complex interplay with mental illness and how this operates in the context of the person’s life.

The framework is an important first step for Victorian mental health services. Presented by Victoria’s Department of Health and Human Services Chief Mental Health Nurse, Senior Consumer Advisor and Senior Carer Advisor, this presentation will describe the framework in detail, as well as implementation plan for Victoria over the coming years.

Rod McKay – Abstract 1

Improving physical health care in mental health services for older people: reflections on a decade of local and statewide initiatives

2019 marks a decade since NSW released its first policy and guidelines regarding the physical health care of mental health consumers. As chair of the Expert Working Group that guided their development it also marks a decade of local and statewide activities by the author to improve such care: and other activities that promote good physical health care.

The breadth and nature of these activities reflects the broader approach to improving mental health services for older people in NSW, with state direction and facilitation encouraging local action. They also reflect the evolving recovery orientation of services, and increasing number of partners that entails. The presentation will provide reflections on lessons from activities over this time including development of guidelines, self audit tools, benchmarking and models of care.

Some lessons have been that whilst local ownership is important for ‘on the ground change’, this is difficult without connection to policy and broader networks supporting change. Another has been that partnerships enhance options for improving physical health: but the depth and orientation of local partnerships will, and probably should, determine local application.

NSW is currently applying these lessons in commencing a statewide project to improve physical healthcare of consumers of older persons mental health services. The presentation will conclude with a description of the methodology, partners and progress to date.

Rod McKay – Abstract 2

presented with Kate Jackson

Converting the lessons of implementation into effective action

Based on a combined 30 years of experience converting national and state policy into local action and service development, this workshop will briefly overview some of the essential enablers and difficult obstacles to effective implementation. The workshop participants will then consider ways of considering the populations that actions may target (eg different ages, settings, risk profile). Based on the principles of successful implementation, participants will be guided to draft specific actions they could apply to their particular context. Groups will then consider a set of recommendations for action for each population group. Finally the workshop will bring together and summarise recurrent themes from each of the workshop groups.

Chris Maylea – Abstract

presented with Indigo Daya

Physical health as a humans rights issue

For over a decade, international human rights law has demanded the right to health for mental health consumers. Physical health services and mental health services are bound ‘to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent by, inter alia, raising awareness of the human rights, dignity, autonomy and needs’ of consumers’. Both anecdotal experience and empirical data show that this has not occurred. In this presentation, we interrogate the right to health and frame a human rights-based response, focusing on practical approaches to embed human rights in health service provision. We consider supported decision-making and consumer-led responses as best practice in rights-based treatment, care and support.

Mark Morgan – Abstract

Ways in which GPs can manage physical illness alongside mental illness and suggestions to support team-based collaborative care

The presentation will describe the rationale, development and outcomes of a series of projects in general practice that managed mental illness alongside diabetes and heart disease in the TrueBlue trial. Dr Morgan will describe some of the recent policy recommendations that have come from the Medical Benefits Schedule Review and the government’s Health Care Home trial to support this work. The presentation will conclude with some thought-provoking suggestions for future policy directions.

Some lessons have been that whilst local ownership is important for ‘on the ground change’, this is difficult without connection to policy and broader networks supporting change. Another has been that partnerships enhance options for improving physical health: but the depth and orientation of local partnerships will, and probably should, determine local application.

NSW is currently applying these lessons in commencing a statewide project to improve physical healthcare of consumers of older persons mental health services. The presentation will conclude with a description of the methodology, partners and progress to date.

Katherine Moss – 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.

Katherine Moss – 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 anti-psychotic 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.

Anne Muldowney – Abstract

Counting Past One: The psychological and
physical well-being of carers in Australia

While the psychological and physical impacts of caring have been extensively documented for many years, addressing carer’s physical health has received significantly less attention in both research and practice than interventions targeted at psychological health. More than a third of Australia’s 2.7 million carers live with chronic illness and disability and many spend more than 10 hours a day on health-related activity, caring for both others and themselves.

While research demonstrates physical activity has psychological benefits for people of all ages, the benefits may be less certain for people caring for a relative or friend with an illness or disability, given the time-consuming and often stressful nature of the caring role.

Significant change in Commonwealth carer support services is scheduled for 2019, promising to deliver a range of low-cost, effective, preventative services with a proven ability to improve carer quality of life.

This presentation will include an overview of the limited evidence on the effectiveness of interventions to address carer physical health needs, including low intensity interventions with carers and people receiving care. There is emergent evidence that carer supports should include physical health promotion, such as offering opportunities for physical activity, nutrition and preventive health care visits. These may potentially also offer more cost-effective options to improve carer psychological health than more intensive mental health interventions. Emergent and promising practice examples of low-cost carer physical activity interventions will also be featured.

Emphasis will be given to the importance of recognising carers as health consumers, as well as partners in care. While implications for health professional practice in working with consumers and carers will be discussed, further research is required to address the personal and systemic barriers to carer participation in health promotion activities.

Marcus Nicol – Abstract

presented by Catherine Brown, National Mental Health Commission

Fifth Plan’s priority 5 – Improving physical health: Progress and update

The presentation will cover the National Mental Health Commission’s (NMHC) role in reporting progress on the Fifth National Mental Health and Suicide Prevention Plan (Fifth Plan), with a particular focus on Priority Area 5: “Improving the physical health of people living with mental illness and reducing early mortality relevant to physical health”.

High-level results from the NMHC survey of Fifth Plan stakeholders will be presented, providing insight into feedback from key stakeholders (Primary Health Networks, state, territory and Commonwealth governments) with regards to achieving progress in Priority Are 5 of the Fifth Plan.

Mandy-Lee Noble – 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

High-level results from the NMHC survey of Fifth Plan stakeholders will be presented, providing insight into feedback from key stakeholders (Primary Health Networks, state, territory and Commonwealth governments) with regards to achieving progress in Priority Are 5 of the Fifth Plan.

Dave Peters – Abstract

presented with Kate Johnston-Ataata

Intersections of mental and physical health: Healthtalk Australia
and the value of online health and illness experiences

by Kate Johnston-Ataata, Dave Peters, Nicholas Hill, Jacinthe Flore and Renata Kokanovi

People’s stories or personal accounts of health and illness experiences online are becoming increasingly important in relation to how we think about, make use of, and design health care services. For other people experiencing similar conditions who may be trying to make sense of a new diagnosis, seek information about symptoms, or make decisions about treatment and care, accessing other people’s lived experiences online can be helpful as a complement to clinical health information. Health service providers and policymakers also value people’s health and illness experiences online as a source of evidence about what is and isn’t working in healthcare systems. One noteworthy aspect of personal accounts of health conditions online is that they reveal the ‘messiness’ of lived experiences of health and illness vis à vis neat clinical diagnostic criteria or treatment guidelines. Stories highlight the prevalence of experiencing one or more health conditions at the same time, and in particular the inseparability of experiences of mental and physical health, a critical issue for people with a diagnosis of mental illness whose physical health experiences and needs are often overlooked.

In this talk, Kate Johnston-Ataata will introduce Healthtalk Australia (HTA), the leading research-based online repository of personal accounts of health and illness experiences in Australia and briefly outline its objectives and approach to collecting and disseminating personal stories online. Next, Dave Peters, a participant in the ‘Mental Health and Supported Decision Making’ HTA project, will reflect on sharing his lived experiences online and the interconnections between physical and mental health in his own story. The presenters will then discuss key findings from the ‘Mental Health and Supported Decision Making’ project relating to the intersection of mental and physical health, and offer suggestions for future research and online resource development on this important but neglected topic.

Barri Phataford – 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.

Marie Piu – Abstract 1

Catch 22 – Taking a holistic approach to health. The Mental
Health Family and Friends Experience in Victoria

Tandem is proud to be the trusted voice of family and friends in mental health in Victoria. In February 2018 Tandem was one of the organisations and individuals gathered together by the Office of the Chief Psychiatrist to advise on the Victorian response to Equally Well; quality of life – equality of life. As part of our contribution, a focus group and follow up interviews were held with Tandem members, particularly those family and friends with in depth knowledge in this area. The topic was explored through a series of questions to provide insight into physical activity and wellbeing for those living with mental health issues, through the lens of family and friends (mental health carers).

Marie Piu will present emerging themes from this work.

Marie Piu – Abstract 2

presented with Maggie Toko & Anna Love

Equally Well in Victoria – Physical health framework
for specialist mental health services

Each time a consumer engages with a clinical mental health service provides an opportunity to explore physical health issues, consider how they might impact on recovery goals and offer help.

The Physical health framework for specialist mental health services is the first of its kind in Victoria. It describes a range of initiatives for organisations and clinicians to work in partnership with consumers and carers to discuss physical health in the context of a recovery plan. This framework provides information to help mental health services and clinicians to think about how to tailor treatment and strategies to the realities of the daily lives of consumers.

Under the leadership of Victoria’s Chief Mental Health Nurse, Chief Psychiatrist, in partnership with peak organisations Victorian Mental Illness Awareness Council and Tandem, the framework was developed as Victoria’s response to the Equally Well National Consensus Statement. The framework describes consumer, carer and clinician’s perspectives on how physical health issues can be worked on by mental health services.

An Expert Reference Group comprised of mental health consumers and carers, experts from mental health, general practice, community health and peak health organisations guided the approach and content of this document.

Five interconnected domains support physical health care in Victorian specialist mental health services. They are:

• Consumer physical health needs
• Collaborative planning and therapeutic interventions
• Healthcare setting
• Workforce considerations
• Supporting safety

The framework describes the necessary elements at the organisation and clinical practice levels to guide implementation of physical health in a consistent way across Victoria. It asks services and clinicians to use a recovery approach to physical health, and offer help to consumers that extends beyond biomedical screening, diagnosis and treatment. It asks clinicians to work in an interprofessional manner to understand each person’s recovery journey and using collaborative recovery plans to enquire about the person’s physical health, appreciating the complex interplay with mental illness and how this operates in the context of the person’s life.

The framework is an important first step for Victorian mental health services. Presented by Victoria’s Department of Health and Human Services Chief Mental Health Nurse, Senior Consumer Advisor and Senior Carer Advisor, this presentation will describe the framework in detail, as well as implementation plan for Victoria over the coming years.

Sally Plever – Abstract

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

Authors:
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.

Marty Pritchard – Abstract

presented with Rachel Whiffen, Shane Sweeney & Suzanne Turner

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.

Russell Roberts – Abstract

How does promotion, prevention and early intervention
apply to people living with enduring mental illness?

Previous models of mental health promotion and prevention1 did not guide and inform actions addressing promotion and prevention, across the spectrum of health and illness and have overlooked the social determinants and other domains of health and wellbeing. This presentation presents a contemporary model of promotion, prevention and early intervention that seeks to overcome these limitations. This model2 was developed while the author presided as Chair of the NSW Promotion, Prevention and Early Intervention Committee. This contemporary model converts definitional terms such as primary, secondary and tertiary prevention to action-oriented, descriptive language. Using the framework of the new model, the presentation provides examples of actions across the spectrum of health and illness, across the various domains of physical health, and across the domains the social health of people living with mental illness.

1 – Haggerty, R. J., & Mrazek, P. J. (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research: National Academies Press.
2 – Roberts, R. Building Better Mental Health: A New Model of Promotion, Prevention and Early Intervention. The 21st Annual TheMHS Conference, Adelaide, Sept. 2011.

Simon Rosenbaum – Abstract

Lifestyle and Physical Activity

People living with mental illness are at high risk of experiencing poor physical health, including diabetes and cardiovascular disease. Modifiable risk factors including smoking, physical inactivity and poor nutrition contribute to the burden of poor physical and mental health in this group. Targeted lifestyle interventions that provide adequate support, are tailored to the individual and delivered by qualified professionals can be efficacious in improving both physical and mental health outcomes. This talk outlines the evidence for and components of effective lifestyle interventions for people living with mental illness.

Jade Ryall – 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.

Kym Ryan – Abstract

Nurses: Part of the solution

There are over 400,000 Nurses and Midwives in Australia, working across all health care settings and more geographically dispersed than any other health care professional. Building awareness, and increasing assessment and monitoring of people’s physical health, across this extensive workforce, will no doubt result in improvement of the physical health of people with mental illness. This presentation will discuss the work of the ACMHN to build knowledge and capacity across these workforces.

Cathy Segan – Abstract

Addressing tobacco smoking in people living with mental illness:
Existing interventions and future directions

Mental health practitioners are well placed to deliver brief advice for smoking cessation that can link consumers to effective smoking cessation treatments. The most effective treatments combine a multi-session behavioural intervention (eg groups courses, quitline) with pharmacotherapy (eg Nicotine Replacement Therapy (NRT), varenicline, bupropion). Routinely offering brief smoking cessation help to consumers, regardless of their level of interest in stopping smoking, empowers consumers by letting them know what works, and offering to link or enrol them into treatment increases uptake. Enabling factors that can improve the routine delivery of brief advice and ideas for improving the quality of current treatments are discussed.

Andy Simpson – Abstract

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.

Katie Stewart – 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.

Caro Swanson – Abstract

presented with Helen Lockett

Equally Well New Zealand

Caro Swanson and Helen Lockett have both been instrumental in the development and continued expansion of the Equally Well movement in Aotearoa/New Zealand. The Equally Well collaborative is underpinned by evidence, both in terms of understanding the issues and in designing the solutions. It is also underpinned by principles, most importantly the principle of co-design with people with lived experience. In this presentation, Caro and Helen will take us through how the Aotearoa New Zealand Equally Well collaborative began, and some of the highlights from their five-year journey. They will also share some of their reflections on lessons learnt. As they share their experiences, they hope to inspire Equally Well Australian champions, outlining what make up the key ingredients of an ‘Equally Well action or set of actions’ and explaining the underpinning mechanisms and success factors which support the continued growth of this diverse and impactful collaborative.

Shane Sweeney – Abstract

presented with Rachel Whiffen, Suzanne Turner & Marty Pritchard

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.

Nicci Tepper – Abstract

presented with Fiona Glover

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.

Maggie Toko – Abstract 1

Healing – I couldn’t do it without you – a modern day posse

This paper takes the audience on a journey of the last 2 year period in my life where I was lucky enough to gather a team of friends and professionals to assist me with the biggest fight of my life – being diagnosed with Cancer not once but twice. I talk about what it is like having a diagnosis of schizophrenia and how that impacts on my physical and mental health. I talk about human survival when you feel like nothing is going to pick you up – when paranoia and pain collide. The challenge isn’t about surviving’- its about making it through the day.

Maggie Toko – Abstract 2

presented with Marie Piu & Anna Love

Equally Well in Victoria – Physical health framework
for specialist mental health services

Each time a consumer engages with a clinical mental health service provides an opportunity to explore physical health issues, consider how they might impact on recovery goals and offer help.

The Physical health framework for specialist mental health services is the first of its kind in Victoria. It describes a range of initiatives for organisations and clinicians to work in partnership with consumers and carers to discuss physical health in the context of a recovery plan. This framework provides information to help mental health services and clinicians to think about how to tailor treatment and strategies to the realities of the daily lives of consumers.

Under the leadership of Victoria’s Chief Mental Health Nurse, Chief Psychiatrist, in partnership with peak organisations Victorian Mental Illness Awareness Council and Tandem, the framework was developed as Victoria’s response to the Equally Well National Consensus Statement. The framework describes consumer, carer and clinician’s perspectives on how physical health issues can be worked on by mental health services.

An Expert Reference Group comprised of mental health consumers and carers, experts from mental health, general practice, community health and peak health organisations guided the approach and content of this document.

Five interconnected domains support physical health care in Victorian specialist mental health services. They are:

• Consumer physical health needs
• Collaborative planning and therapeutic interventions
• Healthcare setting
• Workforce considerations
• Supporting safety

The framework describes the necessary elements at the organisation and clinical practice levels to guide implementation of physical health in a consistent way across Victoria. It asks services and clinicians to use a recovery approach to physical health, and offer help to consumers that extends beyond biomedical screening, diagnosis and treatment. It asks clinicians to work in an interprofessional manner to understand each person’s recovery journey and using collaborative recovery plans to enquire about the person’s physical health, appreciating the complex interplay with mental illness and how this operates in the context of the person’s life.

The framework is an important first step for Victorian mental health services. Presented by Victoria’s Department of Health and Human Services Chief Mental Health Nurse, Senior Consumer Advisor and Senior Carer Advisor, this presentation will describe the framework in detail, as well as implementation plan for Victoria over the coming years.

Suzanne Turner – Abstract

presented with Rachel Whiffen, Shane Sweeney & Marty Pritchard

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.

Andrew Watkins – Abstract

Keeping the Body in Mind: A lifestyle intervention
program for people with Severe Mental Illness

Research literature consistently points towards the benefits of integrating lifestyle interventions into mental health services to address cardiometabolic disease in people that experience Severe Mental Illness. Despite this weight of evidence mental health services have largely struggled to find ways to implement lifestyle interventions into their activities.

Keeping the Body in Mind (KBIM) is a lifestyle intervention program that commenced in 2013 and has been successfully implemented in South East Sydney Local Health District. KBIM has been implemented in a staggered manner commencing with youth with psychosis, followed by consumers taking clozapine and then those on Long-Acting Injectable medications. This method has been followed to allow for culture change amongst service users and to ensure that lifestyle interventions can be assertively offered to all mental health service participants.

Another area of focus for KBIM has been culture change for management and clinicians within the mental health service, this has been achieved through extensive education and a lifestyle intervention program for staff. This program called Keeping our Staff in Mind has demonstrated improvements in attitudes, confidence and knowledge around metabolic health screening and interventions.

This presentation will describe the evolution of KBIM and discuss the progression of each stage of the rollout of the service along with evaluated outcomes of its implementation.

Rachel Whiffen – Abstract

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.

Carolynne White – Abstract

presented with Natalie Jovanovski

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.

Emma Wood – Abstract

What makes for successful collaboration

Working in a collaborative like Equally Well needs us to work in partnership, both with people with mental health, and addiction needs and with other organisations and roles that we may not have worked with before.

The workshop will focus on understanding the different types of collaborations, what makes these successful and how we go about ensuring we equip both ourselves and our organisations to do these well.

Murray Wright – Abstract

The national perspective

The Fifth National Mental Health and Suicide Prevention Plan states that ‘All Governments and mental health commissions will embed the elements of Equally Well and take action in their areas of influence to make changes towards improving the physical health of people with mental illness.’

In this presentation, Murray Wright will describe from the perspective of a national governance committee how this will be monitored, and ways in which this monitoring role can actually influence and accelerate change.