Dr Rod McKay PHYSICAL HEALTH CARE OF MENTAL HEALTH CONSUMERS

Transcription

1 Dr Rod McKay PHYSICAL HEALTH CARE OF MENTAL HEALTH CONSUMERS

2 Introduction Linking physical and mental health...it makes sense initiative launched May 2009 n Broad goals: Recognise important link between physical and mental health Support holistic approach to health care Encourage greater collaboration between stakeholders n Specific aim: improve physical health of people with a mental illness

3 n Guidelines and Policy Directive released to: Clarify and promote responsibility of services to provide holistic care Acknowledge importance of working collaboratively with other health care providers n This training is based on these documents

4 Mental health & physical health care n Evidence confirms people with a mental illness: Have poor physical health. Have reduced life expectancy. Have reduced access to healthcare. May receive insufficient medical assessment and treatment.

5 A Collaborative Approach Regular Health Checks IMPROVED HEALTH OUTCOMES Understanding Priority Components of Care Service Improvements

6 Principles of Care n Quality, evidence-based care and treatment n Respectful, non-judgemental and culturally sensitive practice n Consider physical health in care and planning for mental health interventions n Collaborate with other health providers, particularly GPs n Include access to health promotion, screening and preventative activities n Be response to consumer preferences, gender, ethnicity, English proficiency and age

7 Importance of regular health checks Reduced misdiagnosis Early treatment Tailored medication Access to preventative interventions

8 Priority health issues for consumers Obesity Diabetes Hypertension Smoking Lack of regular exercise Hyperlipidaemia Other cardiac risk factors, such as DENTAL DISEASE & METABOLIC SYNDROME

9 DENTAL DISEASE DENTAL DISEASE... n Risk factor for atherosclerosis n Generally recognised as high prevalence in people with a mental illness due to Level of motivation or self esteem Lack of knowledge about dental services Unable to access services due to poverty, transport issues or fear Damaging oral side effects of medication eg Xerostomia (dry mouth)

10 CENTRAL (ABDOMINAL) OBESITY METABOLIC SYNDROME... Elevated trigs Reduced HDL Elevated BP Elevated fasting glucose PLUS ANY 2 >1.7 mmol/l <1.03 (male); <1.29 (female) mmol/l >130 systolic, or >85 diastolic mm Hg >5.6 mmol/l or previous treatment for this condition or previous treatment for this condition or has been previously diagnosed with this condition or has been previously diagnosed with this condition

11 Other important components of care Optical Hearing Cancer Side effects of treatment Asthma Healthy Lifestyle Preventative health management

12 Observations Weight & waist hip/waist INITIAL PHYSICAL EXAM Height Exam of respiratory, cardio & gastro systems Exam of neurological system

13 Investigations that may be appropriate for new admissions EUC FBC Serum levels of relevant psychotropic drugs Urinary Drug Screen ECG Urinalysis ESR or CRP Adults BSL Lipid profile (within 6 months) Beta HCG if adult female and potentially sexually active Adults <65yo Adults >45yo, or if clinical indications Adults > 45yo, or if clinical indications Adults > 65yo Adults Adults In community, if considering commencing new medications

14 Conducting an examination for movement disorders 1.Check if anything in mouth 2.Assess condition of teeth 3.Assess movement in mouth, face, hands & feet 4.Observe while sitting 5.Observe hands & other body areas 6.Observe tongue at rest in mouth

15 Conducting an examination for movement disorders cont d 7.Observe abnormalities of tongue movement 8.Observe facial & leg movements while tapping 9.Note any rigidity of flexed arms 10.Observe standing body in profile 11.Observe trunk, legs & mouth with arms extended 12.Observe hands & gait when pacing

16 Ongoing physical health care LIST A Smoking cessation Weight control Regular exercise BP monitoring Dental reviews LIST B Sexual safety advice Vision and hearing evaluations Self exam for cancers Flu vaccines Education on alcohol and drug risks

17 Actions at discharge/transfer of care Consult with consumer and GP Complete MH Clinical Doc Provide info re health issues / medication DISCHARGE/TRANSFER OF CARE

18 Minimum requirements IN ALL SETTINGS Clear criteria to respond to emergencies Improve partnership s with GPs Include activities in rehab and recovery programs Clear protocols for consumers receiving ongoing care Ensure care plans address physical health needs Document & record exams

19 IN AN INPATIENT SETTING Access to equipment to conduct exam Physical exam within 24 hours of admission Discuss necessary interventions if admission >3 mths Physical exam for non-acute consumers, inc for movement disorders, every 12 months

20 IN A COMMUNITY SETTING Clear mechanism for accessing equipment for physical exam Physical assessment & exam within 1 month of admission Physical exam, inc for movement disorders, at least every 12 months Discuss necessary interventions if admission >3 mths & include carers with consent

21 Building Better Partnerships Private practitioner Mental health service GP NGO Consumer GOOD HEALTH CARE Carer/ family

22 Between mental health services & GPs Communication Confidentiality MHS GP Networks Key personnel

23 MEDICARE REBATED ASSESSMENTS UNDERTAKEN BY GPs MEDICARE REBATED CARE PLANS DEVELOPED OR REVIEWED BY GPs

24 Between mental health services & consumers Provide info about n Physical health diagnosis n Treatment options n Interactions with medication n Treatment plan n Follow up care Offer support to n Make health appointments n Link consumer with GP n Organise transport n Communicate with health professionals

25 Between mental health service & other key stakeholders. Carers & families NGOs Private specialists & allied health providers Role formally recognised in MH Act 2007 Provide range of complementary interventions Relationships are key strategic alliances Uniquely placed to provide support Can have important knowledge about consumers health Requires formalisation of procedures Need info about consumer s health issues, with consent Can help to engage carers and families Can support MHS to identify & treat health issues

26 Summary n Guidelines and Policy: Help specialist mental health services to recognise their role in physical health care of consumers. Clarify appropriate linkages with other health care providers. Encourage stronger partnerships with key stakeholders. Establish minimum expectations and a program to improve standards. Improve the physical health of mental health consumers.

27 Thank You