1. Parity of Esteem
People with mental health conditions will receive the same quality of physical healthcare as their peers.
Marie Band Physical Health lead
Christopher Burton Physical health coordinator
Introductions what we do What aims are background setting the scene

2. Disparity
Despite the multitude of physical and mental health benefits of physical activity, many of us struggle to meet the recommended targets of 150 min a week.
If you have a diagnosis of a SMI you are 50 % less likely to meet these recommendations than your peers of same age and gender.
If you have SMI more likely to die younger than your peers without a diagnosis, with a reduced life expectancy of 20 years due to increased risk of CVD/ diabetes.
Weight gain is an unpopular side effect of treatment making weight loss extremely difficult.
Dilemma faced is poor physical health through side effects of medication or onset of illness.
IF have SMI already at disadvantage as well as social and economic factors / anxiety /

3. Essential actions
We require practical ways to improve physical health for people with SMI.
There is no room for complacency, we need to make a difference now.
Medical Royal colleges, general practitioners, nursing, pathologists, physicians, Royal pharmaceutical society, Public Health England. (2016)

4. Our Mission
To improve the overall assessment and quality of the physical health monitoring of our patients.
To provide interventions to reduce / prevent future risk of metabolic syndrome in patients.
To improve health and well being of patients
To provide staff support and training to feel more confident in undertaking screening of physical health.
To provide effective interventions to sustain positive health outcomes.
To ensure needs are communicated re future risk
Promote self efficacy / responsibility
What we have done so far history
NICE guidelines support delivery and improvement
CQUINS drives targets ensures we meet recommendations - writing programme evidence based targeted at population SMI
Increase staff confidence / push barriers/ evaluate

5. Metabolic Syndrome Pre Diabetes
So – our patients present with an already raised BMI and
poor self care.
If the waist circumference is over 90 cm ( central obesity ) Plus one of the following –
Raised triglycerides (type of fat found in blood which increases risk of heart disease - equals low HDL (GOOD CHOLESTEROL)
High blood pressure
High glucose levels or raised HbA1C
= Metabolic syndrome and increased risk CVD & Diabetes
The challenge ! Plus smoking/ alcohol/ sedentary lifestyle/ negative symptoms co morbidity

6. What we know Lack of activity (a lot less) Poorer quality of diet
Higher prevalence of smoking (85%)
Every risk factor is increased
Evidence of clinical practice shows us this and highlights the need for holistic assessment and regular monitoring.
Not enough of the intervention!
Don't just screen, intervene!
As well as ! Ref LESTER tool

7. Question
How much weight would you expect a patient to gain within the first 3 months of treatment ?

8. Alvarez-Jimenez et al; CNS Drugs, 2008 22: 547-562
Antipsychotic-Induced Weight Gain in Chronic and First-Episode Psychotic Disorders: a Systematic Critical Reappraisal 20
Established Psychosis
RCTs
Established psychosis RCTs
3 kg 15
4 kg kg 10
12 kg
Within 7 weeks can gain 7 kg 5
First episode of psychosis RCTs 12 24 36 48
Months
Alvarez-Jimenez et al; CNS Drugs, :

9. Shape referral process / criteria
Physical Health Check complete
1st episode – Schizophrenia/Psychosis and/or Cluster 10+ SMI & LTC
Refer for lifestyle interventions identified
Refer to SHAPE
Review referral
*1 to 1
Group
Signposting
Review Baseline physiological measures
REFERRAL PATHWAY identify risk following screening – Brief intervention – refer – monitor – review
12 week review of measures
Update GP
Intervention/Signpost
Monitor in services
Pharma interventions GP

10. Challenge Culture Training Networks Internal Process Collabora- tions
Physical Health
Training for
staff and patients
Other teams:
NHS, CVS etc.
Challenge
Culture
Training
Networks
Policies/systems
Research
Internal
Process
Collabora-
tions
CQUIN/KPI’s
Students
Quality aims
Peer Support
Social
Prescribing
In-patient
Marketing
Social media
Interventions
Signpost
1 to 1
Internet/Intranet
Literature
Quality
Improvement!!
Groups

11. SHAPE 12 week outcomes (n=26)
Mean weight, BMI and waist circumference for group held constant (typically would expect these to increase without intervention)
12 maintained baseline weight
7 decreased weight (2-7 kg)
7 increased weight (2-9 kg)
Only 1/7 exceeded weight gain guidelines of <7 kg in 12 wk
Results compare favourably with only published study of a similar intervention programme in Australia (Curtis et al., 2015)
OUTCOMES after INTEVRENTION 12 weeks 12 months what we need to do stop increase and preventative care only one out of those increased more than expected trajectory

12. SHAPE 12 Month Outcomes (n=16)
Mean weight, BMI, waist circumference and other risk indicators held constant (typically would expect these to increase without intervention)
2 increased weight > 5 kg
Positive impact on healthy lifestyle behaviours:
7 reported eating healthier (eating 5 fruits and vegetables per day)
2 ceased substance use
2 ceased alcohol use
4 ceased smoking
5 were less sedentary (>90 minutes per week)
2 increased weight but less than 7 kg exercise – moved more increased routine

13. What does good quality look like
improve and sustain Physical health monitoring and provide access to targeted timely interventions.
Patient feedback and involvement
Using Multidisciplinary skills/ Expertise
Sharing good practice with other areas / Shared learning – meeting standards
4 points
Staff competencies training more expectations
Define shared care discharge pathway – LESTER tool

14. Participant Feedback
“ …I quite liked how it structured my day, because before, I would not do anything, so you feel like you’ve accomplished after coming and that’s good for my self-esteem”.
“…because of the nutrition side of things, I’m trying to concentrate more on healthy eating and things.”
“…once I’ve done the exercise, I feel loads better, like a weight has been lifted, it enables me to carry on for the day, for the rest of the week. It really motivates me, just by the fact that it lifts me. “
WHAT IS SHAPE HOW TO REFER EXAMPLE OF PARTICIPANT STORY

15. Participant Feedback
The following audio clip is a participant of SHAPE answering a number questions to support their quantitative outcomes.
Example participants perspective of impact of mental health on physical health.

16. Future Plans/ Spread improvement
supports health care teams to deliver the SHAPE programme in local areas.
Staff training sessions to other NHS organisations who wish to adopt the SHAPE programme.
Roll out 12 week programme county wide WHACT.
Develop 1:1 support pathways
In patient access to interventions
Standardise process
Communicate to GP s – shared care / exit
WHAT WE DO AND FUTRE HOPES

17. Conclusions
At a time of shrinking resources, we need to recruit service users as partners in their own recovery in order to maintain reasonable services.
Peer support champions
Innovative use of skills and resources
Be innovative look to wider community promote self efficacy early on in treatment INTRODUCE CHRIS

18. Healthy Active Lives (HeAL) international consensus statement
Resources
Lester Positive Cardio metabolic Health Resource or
Healthy Active Lives (HeAL) international consensus statement
REF