Access to Health Improvement Opportunities

1
Access to Health Improvement Opportunities

• Shamin Malik Manchester Public Health
• Pete Walton OT Edale Unit
• Lara Chourbaji ALFA project

2

• Manchester Strategy for improving the physical
  health of people with mental health problems
• Practical examples of work
• Peter Walton, In-patient Occupational Therapist
  Team Leader, Edale House
• Lara Chourbaji, ALFA (Active Life For All)
  Co-ordinator
• Other developments

3
Manchester Strategy

• Based on the evidence of health inequalities
• Is broad in its remit
• Concerns people with severe mental illness and
  common mental health problems
• Developing links between physical health and
  mental health
• Need to support social inclusion

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Vision

• Promote access to health improvement initiatives
  in the community and develop stepping stones to
  make this access easier
• Embed the provision of health promotion within
  specialist mental health services
• Integrate the needs of this group within
• Primary care and general practice
• Non NHS agencies who deliver health related
  initiatives

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Vision

• Develop links and support between different
  providers
• Develop the capacity of staff/volunteers so that
  they are able to deliver effectively to target
  group, within both NHS and non NHS.

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Key elements

• Provides an overview of the practical areas that
  need attention
• What different sectors can do, including physical
  health screening
• Development of links between secondary care and
• primary care
• Action to reduce the negative impact of
  medication
• Integration within all health improvement policy
  and
• practice
• Voluntary sector
• Carers
• Sites some examples of current work

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Some key areas to implement strategy

• Will require partnership working with all key
  sectors
• Quality and Outcomes Framework indicators

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Next steps

• Need for strategy to be owned and adopted
• Comments have been invited

9
In-patient access to physical activity at Edale
House

• Background
• In line with
• Social Inclusion Agenda
• Choosing Health 2004
• Action on Mental Health
• We were been tasked to extend opportunities for
  people to choose healthier lifestyles.

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Physical health of service users

• Can be adversely effected by
• The sedentary life style of inpatients that are
  on sections of the mental health act
• Social isolation as a result of severe enduring
  mental illness
• The side effects of medication
• Negative symptoms of mental illness impacting
  upon motivation.

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What are the aims of the initiative?

• To introduce regular activity to people whom
  previously may not have considered it.
• To provide a graded step to engagement in
  socially inclusive community based activity.
• To improve the physical health of clients.
• To offer structured exercise to clients with
  restricted access including PICU patients.
• To sign post clients to community activities.

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The Initial Proposal for Group session

• Staff A member of mainstream sports and leisure
  staff supported by Occupational Therapy staff.
• Venue Edale gym.
• Activity Dictated by attendees in collaboration
  with the instructor, may include
• Circuit training
• Weights
• Running
• Sports

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EXERCISE GROUP PATHWAY
ADMISSION
OCCUPATIONAL THERAPISTS PROMOTE/MOTIVATE/EDUCATE
O.TS AND NURSES SCREEN RISK ASSESSMENT
ATTEND EXERCISE GROUP
O.TS CLOSE MONITORING/SUPPORT
SIGNPOSTING/ENCOURAGE TO ATTEND
O.TS REFER TO ALFA
ASSESS NEED FOR SUPPORT TO ATTEND ALFA DISCHARGE
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Collaboration

• Who
• Ward staff
• Occupational therapy service
• Exercise instructor
• ALFA Co-ordinator
• Why
• Risk assessment
• Encourage new participants
• Trust/ rapport/ communication

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Benefits

• Approx 5 people a week attended
• On average over a year 250 sessions of exercise
  that would not have taken place otherwise
• Promote physical health
• Promote engagement
• Sign posting

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Highlighted need

• Some service users have difficulty with groups
• Not pushed hard enough
• Pushed too hard
• Embarrassed in front of opposite sex
• Being in this group socially considered
  unacceptable

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Proposal for One to one sessions

• Pilot 11 sessions for 10 weeks
• Staff
• Exercise instructor and an OT/TI
• Venue
• Edale House client rooms/PICU/gym
• Activity
• Tailored to the individual clients need. From
  bed side low key interventions to high impact
  weight training.

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Patients comments

• Gave me a chance to chill out
• It is very important for people in mental health
  because of side effects of medication. It is
  important people are able to go to gym and
  exercise.
• Grading was good because I got to go to ALFA
• Havent been to the gym for ages it was great
• Not worth doing
• Very good idea
• Directing their mind away from daily problems
• Also good because of fitness
• Help patients to get fit
• Friendly atmosphere due to good organisation
• Statements made 9.05.07

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The future

• Need to expand initiative across three sites
• Need to find funding for more equipment
  resources
• Begun to complete robust audit of group using
  standardised measuring tools
• Need to find funding to recommence 11 pilot
  initiative

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Issues and future of health improvement activity
delivered through pilots

• Physical activity pilots have been useful
  stepping stones onto mainstream activity and
  engaging clients generally in activity
• Health promotion within an in-patient setting is
  important
• Need for on-going targeted sessions in the
  community
• Use of experienced non-mental health exercise
  tutors input can motivate clients and normalise
  their experience
• Close working relationship between support staff
  and tutor improves outcomes for client

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Future of health improvement activity delivered
through pilots

• Gender needs
• Recruitment of new clients
• Exploration of other ways to enable people to
  move onto mainstream services, such as use of
  health trainers
• Long term solutions are needed to embed physical
  activity provision within mental health services
  and Trust need to explore options for this

22
Developing links between exercise on referral
schemes and specialist mental health services

• Reasons for this development
• Mental health training for exercise on referral
  teams
• Networking meetings
• Increasing familiarity with mental health
  services, e.g., through visits
• Consolidation of referral process

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Exercise on referral schemes

• Physical Activity Services
• ALFA (Central)
• PACE (North)
• SMILE (South)
• Referrals for people who need to do physical
  activity/ exercise for health reasons
• 11 Advice and support.
• Community Activities

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Referral process mechanisms

• Development of a more detailed referral form for
  referrals from mental health services
• Differences in capacity/ working in North, South
  and Central
• Current activity

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Some successes

• ALFA and Edale House Partnership
• Progression from Ruby Ushers session
• OT support with initial consultation
• Support for clients to attend the activities
• ALFA supervised sessions

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Contact Details

• Lara Chourbaji
• ALFA Co-ordinator
• Unit 8, Cornbrook Enterprise Centre
• 70 Quenby Street
• Hulme
• Manchester, M15 4HW
• 0161 833 4434
• lara.chourbaji_at_manchester.nhs.uk

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Other Developments

• Increasing health promotion skills and access to
  heath promotion information and resources for
  mental health staff
• Access to training on offer through Public
  Health Development Service
• Need to explore access via Trust induction
  training
• Need to explore access to information via the
  Trust web site

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Other Developments

• Building capacity of non-mental health staff to
  work with people with mental health problems
• Food Futures strategy
• More targeted access to health trainers
• Self help guides and pull up banners on
• Physical activity and mood
• Food and mood

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Useful Contacts

• Manchester Public Health Development Service
  Resource and Information Centres
• Victoria Mill, Lower Vickers St, Miles Platting
• 0161 861 2900
• Old Withington Hospital, Road access from
  Cavendish Road, Nell Lane, West Didsbury
• 0161 611 3642
• Shamin Malik
• Tel [phone]
• shamin.malik_at_manchester.nhs.uk
• Reports and strategy
• www.manchesterpublichealthdevelopment.org