SHAPE (Supporting Health And Promoting Exercise) Project for Young People with Psychosis Professor Jo Smith, Consultant Clinical Psychologist and EI Lead Worcestershire Health and Care NHS Trust and University of Worcester

Young People with Psychosis are on a path to obesity, type 2 diabetes, cardiovascular disease and premature death Acknowledgement to sculptor Keld Moseholm Rolling pin (Sculpture By The Sea 2011 Bondi) 2

NOW! 12 kg 12 kg 4 kg HERE STOP natural history Antipsychotic-Induced Weight Gain in Chronic and First-Episode Psychotic Disorders: a Systematic Critical Reappraisal Alvarez-Jimenez et al; CNS Drugs, 2008 20 Established psychosis RCT 3 kg Established psychosis RCT 15 4 kg kg Start HERE NOW! 10 12 kg STOP natural history 5 12 kg First episode of psychosis 12 24 36 48 Months Alvarez-Jimenez et al; CNS Drugs, 2008 22 (7): 547-562

The same life expectancy and expectations of life as peers without psychosis

The problems we are trying to solve… High risk group for CVD, type 2 diabetes and other metabolic disorders yet… Physical health needs neglected Physical health monitoring not systematic Care plans do not routinely address physical health needs Health interventions often not coordinated Poor engagement and uptake by young people Interventions difficult to sustain due to lack of facilities and clinician time

SHAPE programme A physical health and wellbeing intervention programme Structured, intensive, group intervention utilising peer group support Delivered weekly over 12 weeks Employs nutritionists, exercise and health trainers expertise A co-ordinated, multi-professional , bespoke health and wellbeing programme For young people with psychosis Delivered in a positive, youth focused, socially inclusive setting

SHAPE Programme Purpose Engage young people with psychosis in relation to their physical health needs Maintain pre-illness weight levels or support weight loss and maintain/reduce other key physical health parameters Improve cost efficiency by offering access to a co-ordinated ‘one-stop-shop’ rather than multiple appointments for different physical care needs. Encourage adherence with physical health monitoring and intervention Improve access to health advice and quality of care plans addressing physical health concerns. Reduce tobacco smoking, substance use, improve diet and healthy lifestyle behaviours

SHAPE Programme Components Physical health ‘MOT ‘ assessment at baseline, 12 weeks and 12 months Group health educational programme on healthy eating, smoking cessation, substance misuse, dental care, sexual health care and stress management. Group exercise cardiovascular session group exercise and use of exercise suite gym Personalised nutritional advice. Smoking cessation advice. Mindfulness and relaxation training. Motivational and goal setting sessions to review goals and maintain focus. Collaboration with primary care practitioners to reduce physical health risks Referral for specialist assessment and treatment where required.

SHAPE Programme location McClelland Centre for Health and Wellbeing, University of Worcester City Centre Campus Facilities for exercise, health and therapy including private consultation rooms, a large exercise suite with gym equipment and a group meeting room. Offers health MOT’s, fitness assessments and advice, access to physiotherapy, counselling, smoking cessation, occupational therapy, sports injury, massage and nutritional therapy

Target Client Group The SHAPE programme will be offered to young people from the Early Intervention in Psychosis Service in Worcestershire Health and Care NHS Trust 15-20 individuals per 12 week programme which will run 3 x in the year 60 young people with psychosis will have access to the SHAPE programme during the 12 month piloting and evaluation phase

SHAPE Evaluation To test the feasibility and acceptability of the SHAPE programme Evaluate the physical health care and wellbeing benefits for young people with psychosis

Monitoring and Evaluation (baseline, entry, 12 weeks and 12 months follow up) •Key physical health risk markers including BMI, waist-to-hip ratio, resting blood pressure, blood glucose and total serum cholesterol •Weight, fitness levels, readiness to exercise •Self-reported lifestyle behaviours and healthy coping strategies in relation to target health behaviours. •Patient related experience engagement with and acceptability of/satisfaction with the programme and challenges/barriers to programme adherence. •Engagement (enrolment, utilisation, adherence) and dropout rates •Clinical outcomes in terms of recovery, changes in functioning and symptom improvements •Cost-efficiency: service usage data, staff time, use of personal budgets

SHAPE Funding Health Foundation 2014/2015 SHINE award Funded from beginning of June 2014 to end of September 2015 Ongoing access for SHAPE programme participants funded from personal budgets

SHAPE Project Team Project partners: Worcestershire EI in Psychosis Service (WEIS) McClelland Health and Wellbeing Centre, University of Worcester The University of Worcester Public Health trainers Smoking cessation Sexual health South Worcestershire Clinical Commissioning Group (CCG) Project Lead: Professor Jo Smith, Consultant Clinical Psychologist and Worcestershire EI Service Lead JoanneVE.Smith@hacw.nhs.uk Tel: 01905 681308 (WEIS)