Enablers & barriers to increasing physical activity in those using mental health services LYNN SPEED, MENTAL HEALTH PHYSIOTHERAPIST SHIRLEY HAMILTON, SENIOR HEALTH PROMOTION OFFICER

2 hospitals & CMHTs Consecutive in and outpatients surveyed All staff survey in General Adult Psychiatry METHODOLOGY Power calculation Quantitative but mainly qualitative data GPPAQ NVIVO

127 out of 208 patients QUANTITATIVE RESULTS – PATIENTS

QUANTITATIVE RESULTS – STAFF 186 staff out of 308 staff

Qualitative results: patients Patient identified negative effects of inactivity Ongoing poor physical health Weight gain Ongoing poor mental health Not sure / don’t know Hopelessness Patient identified benefits of increasing physical activity Better mental health Better physical health Not sure / don’t know Weight loss Improved self confidence

Patient quotes: ongoing poor physical and mental health “I am storing up trouble such as heart trouble, deep vein thrombosis, (and) many other things I don't want to think about” “I think it's a slippery slope and basic living and mobility and stability goes down hill. Fitness is key!” “I will become lazy, bored, fed up, gain weight” “Current mood would probably deteriorate” “I might not last too long and generally be in poor health.” “I will continue to exist not live”

“(with inactivity the) Future would be bleak, physically and mentally” “I (will) Loose the will to get better” “There will be no way to succeed in life” “I'll just stay depressed/ suicidal” Patient quotes: hopelessness

Patient identified barriers Physical health Pain symptoms Weight Lack of fitness Lack of energy Disability “(I) Will not get better through physical activity”

Environmental Being an Inpatient Lack of Local access Weather “Not be an inpatient, or being able to use the gym without someone watching you as that's why I don't use it” Patient identified barriers Social contact “I don't like doing things on my own” Time pressures “Fitting with full time job, Mentally exhausted” “Having more hours in the day”

Patient identified enablers to increasing physical activity Time Scheduling & having a weekly plan Physiotherapy / staff input Increased social contact Environmental – easier access

Qualitative results: staff Staff identified benefits of increasing physical activity Improved mental health Distraction from symptoms of mental illness Improved physical health More healthy weight Improved life expectancy Counteract the side effects of medication Justified by the scientific evidence base Personal experience

Staff identified barriers to increasing physical activity Lack of motivation (in patients) Finances Staff pessimism Local access Lack of relevant activities Side effects of medications Staffing numbers

Staff identified enablers to increasing physical activity Increase the physical activity input offered more relevant activities more walking groups Support and encouragement for patients Education for patients for staff Financial factors funding for services free gym membership financial incentives for patients

Discussion Lack of physical activity in patient sample – 12% Most patients and staff did recognise importance of physical activity Staff more pessimistic than patients about possibility of change Both patients and staff broadly identified the same benefits from increasing activity Strong theme of hopelessness regarding lack of activity Marked disparity between patient and staff identified barriers to activity Patients- physical health / pain / environmental factors / social factors Staff- motivation / finances Strongest enabler for patients is having time & activity scheduling

Ways forwa rd Contact with services is an opportunity Motivational Interviewing CBT style approaches for somatisation / pain Liaison psychiatry / pain management services Role for basic education Timetabling activity scheduling Social skills training More research on interventions- especially with focus groups / single patient interviews

Thanks to Linda Milne, Physiotherapist Dr Lisa Conway, ST6 Psychiatrist Maggie McKinnon & Colleagues, Quality Improvement Department Lynn Speed, Lead Physiotherapist Dr Colin Dewar, Consultant Psychiatrist Dr Beth McHugh, Consultant Psychiatrist Dr Mark Fulton, Associate Specialist In Psychiatry Shirley Hamilton, Senior Health Promotion Officer