How to use this Adobe document as a power point

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1 How to use this Adobe document as a power point Now that you have opened the file: 1. Click the View tag in the top left hand corner of the screen. 2. Scroll down to Full Screen in the dialogue box 3. Click on Full Screen 4. Begin the presentation as you would a power point. 5. At the end of the show press the escape button on the key board, it will take you back to the normal pdf format. 6. You can then close the document. 1

2 Physical Health Workshop Improving the physical health of people living with mental illness: A workshop for health care professionals By Dr Sue Jackson MB BS, FRACGP And Vivien Kemp BA(Hons) 2 HealthRight and Hills Community support Group ht

3 Overview The physical health of people living with mental illness. Why focus on physical health? Core risk factors. How physical health can effect mental health. Barriers to good health care Recommended checks Summary. 3

4 Before we start.. Everybody, Somebody, Anybody, And Nobody 1 This is a little story about four people named Everybody, Somebody, Anybody, and Nobody. There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody's job. Everybody thought that Anybody could do it, but Nobody realised that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done. 4

5 World Health Organisation Health is a state t of complete physical, mental and social well being not merely the absence of disease or infirmity. 2 5

6 WHO global l strategy t for prevention and control of non-communicable diseases We know that lifestyle changes reduce the incidence of non-communicable chronic diseases 3 WHO has an Action Plan to avert millions of premature deaths and help promote a better quality of life for millions more. 3:piii 6

7 7 Disease Mortality in Australia 4

8 Some disturbing facts: 90% of ALL deaths in the calendar year 2002 in Australia were due to chronic diseases. 4 At least 80% of premature heart disease, stroke and type 2 diabetes and 40% of all cancer could be prevented by healthy diet, regular physical activity and avoidance of tobacco products. 4 8

9 More disturbing facts In 2005, 74% of men and 69% of women over 30 years old were overweight or obese 4. By 2015 this is expected to rise to 80% of men and 75% of women 4. 9

10 Facts about the physical health of people p living with mental illness Regardless of the type of mental illness a person lives with, their physical health will be poorer than people in the general population 5 The life expectancy of people living with mental illness can be up to 25 yrs shorter than people in the general population 6. People living with mental illness are 2.5 times more likely to die from preventable and treatable diseases than people in the general population 7 Diseases are either not diagnosed, not treated properly, or diagnosed and treated at much later stages of the disease process in people living with mental illness 7 10

11 Small Group Discussion: Turn to the people sitting next to you and discuss: Why do you think people living with mental illness have such poor physical health? 11

12 Why focus on physical health? Lack of clarity about who is responsible for attending to the physical health of people 89 8,9 People living with mental illness seek primary care as often as those in the general population, p but outcomes are worse 10,11 Fractured nature of health delivery systems 5 People living with severe mental illness may not spontaneously report problems with physical health, or only report pain when it becomes severe 12,13 12

13 Why focus on physical health? Frequently physical health problems are dismissed as symptoms of mental illness 14. Physical conditions that cause or exacerbate mental health problems are not uncommon 15 Many psychiatric medications contribute to poor physical health 16 33% of people who live with schizophrenia have 3 or more co-morbid health problems 17 13

14 In our work with consumers we have found that: They are more likely to attend to their physical health with support. They are aware of health promotion campaigns but lack the knowledge of how to go about making lifestyle changes. Financial cost and accessibility are big issues. They may feel so overwhelmed by their mental health problems that physical health issues are ignored/overlooked/ endured. When people do complain about a physical health problem it is often ignored or dismissed. 14

15 Core risk factors As part of a broader plan for chronic disease risk management in this group we have focused on core risk factors: 15

16 Chronic disease risk factors 4 : Heart Disease Poor diet Smoking Strokes R I S K S Obesity Physical inactivity Chronic Respiratory Diseases 16 Type 2 Diabetes Alcohol and other drug use

17 Weight.. Many psychiatric medications predispose people to weight gain 9. People with chronic mental health problems often have limited finances. Most dietary information is presented in a form that is not useful for this population 5. 17

18 Exercise.. Social isolation Negative symptoms of mental illness Finances 18

19 Smoking 20% of the general population smoke. 46% of people with mental health problems smoke. Up to 90% of people with schizophrenia smoke. 19

20 Nicotine - May help relaxation May increase alertness Antidepressant affect Reduce symptoms such as hearing voices 20

21 Smoking Smoking cessation has been shown to be the biggest individual factor in the improvement of life expectancy. Smoking cessation increases the effectiveness of antipsychotic medication. Smoking cessation significantly improves financial health. 21

22 How does physical health affect mental health? Physical health problems can present as symptoms of mental illness. Improvement of physical health will often lead to improved mental health. 22

23 How physical health can impact on mental health 18 Endocrine dysfunction Metabolic dysfunction Mental Health Hematologic abnormalities Vascular disease 23 All are associated with thinking and functional disturbances that may mimic functional psychoses 18 p109)

24 How physical health can impact on mental health It is therefore essential that every individual diagnosed with a mental health illness has an initial iti thorough h physical health check and ongoing monitoring of their physical health. 24

25 Barriers to receiving i effective healthcare Ability to identify health concerns. Beliefs of health care provider. Ability to access health care. Not wanting to know. 25

26 Barriers to receiving i effective healthcare Patients may assume psychiatrists will check both physical and mental health. Or they may not want anyone at a MHS to talk about their physical health Lack of understanding of the importance of screening. 26

27 Recommended d Health Checks CANCER screening - Bowel Cervical Skin Breast Testicular 27

28 Recommended Health checks Heart disease and stroke Eye checks including glaucoma Type 2 diabetes Dental health

29 Other recommended routine health checks Blood pressure Blood sugar Lipids Weight 29

30 Turn to the people next to you and discuss: Given the demands and limitations of your work place, what small steps can you take to start to address the physical health needs of the people p you work with? 30

31 So which type of person are you? Everybody hoping that Somebody will do what Anybody could do, but generally Nobody does? Who will start t to take care of the physical health of clients if you don t? 31

32 Summary The physical health of people living with mental illness is poor. Many of them die prematurely from preventable and treatable diseases. There are many barriers to getting good health care in this group of people. 32

33 References Everybody, Somebody, Anybody, And Nobody: Poem. Available from: 2. World Health Organization, (2003) Investing in mental health. Investing in Mental Health, WHO, p7. Retrieved on 27/11/2008 from: 3. World Health Organization, (2008) Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases. Geneva: WHO Press 4. World Health Organization (n.d). Facing the Facts: The impact of chronic disease in Australia. Available from: report/australia pdf3 5. Mackin P, Bishop DR, Watkinson HMO. A prospective study of monitoring practices for metabolic disease in antipsychotic-treated community psychiatric patients. BMC Psychiatry. 2007;7(28): Retreived 5/9/2007 from 6. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. Morbidity and Mortality in People with Serious Mental Illness. The thirteenth in a series of technical reports. Alexandria, VA: Retrieved 24/05/2007, from Lawrence D, Holman D, Jablensky A. (2001).Duty to Care: Preventable Physical Illness in People with Mental Illness. Perth: The University of Western Australia. 8. Carney CP, Jones LR, Woolson RF. Medical comorbidity in women and men with schizophrenia: A population-based controlled study. Journal of General Internal Medicine. 2006;21(11): Osborn DP. (2001) The poor physical health of people with mental illness. Western Journal of Medicine. 175 (5):329-32

34 References 10.Leucht S, Fountoulakis K. Improvement of the physical health of people with mental illness. Current Opinion in Psychiatry. 2006;19: Samele CC, Patel CM, Boydell CJ, Leese CM, Wessely CS, Murray CR. Physical illness and lifestyle risk factors in people with their first presentation of psychosis. Social Psychiatry and Psychiatric Epidemiology. 2007;42(2): Howard PB, El-Mallakh P, Rayens MK, Clark JJ. Comorbid mental illnesses and perceived general health among adult receipients of Medicaid Mental Health Services. Issues in Mental Health Nursing. 2007;28: Beecroft N, Becker T, Briffiths G, Leese M, Slade M, Thornicroft G. Physical health care for people with severe mental illness: The role of the general practitioner. Journal of Mental Health. 2001;10(1): l Koran LM, Sheline Y, Imai K, Kelsey TG, Freedland KE, Mathews J, et al. Medical Disorders Among Patients Admitted to a Public-Sector Psychiatric Inpatient Unit. Psychiatr Serv December 1, 2002;53(12): Carney CP, Jones LR, Woolson RF. Medical comorbidity in women and men with schizophrenia: A population- based controlled study. Journal of General Internal Medicine. 2006;21(11): Lieberman AA, Coburn AF. The health of the chronically mentally ill: A review of the literature. Community Mental Health Journal. 1986;22(2):

35 Contact Details Vivien Kemp Senior Research Officer HealthRight Community, Culture and Mental Health Unit School of Psychiatry and Clinical Neurosciences University of Western Australia W Block, L6, 1 Alma Street Fremantle, WA 6160 Ph: Fax: vivien.kemp@uwa.edu.au g Dr Sue Jackson MoblieGP Mob: suejackson@westnet.com.au 35