SOCIAL ENHANCEMENT

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Improving the physical health of people living
with mental illness A workshop for consumers who
are living well with mental illnessPart 1
Medical Issues
Physical Health Workshop

• by Vivien Kemp BA (Hons)
• And Dr Sue Jackson MB BS, FRACGP
• HealthRight and Hills Community Support Group
• www.healthright.org.au

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Overview

• Introduction The physical health of people
  living with mental illness.
• How physical health can effect mental health.
• Barriers to good health care.
• Getting the most out of GP visits.
• Health checks for men and women.
• Summary.

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World Health Organisation

• Health is a state of complete physical, mental
  and social well being not merely the absence of
  disease or infirmity 1

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Facts about the physical health of people
living with mental illness

• The 2001 Duty to Care2 report found that
• People living with a mental illness were 2 ½
  times more likely to die of preventable and
  treatable diseases than people in the general
  population.
• Diseases affecting people living with mental
  illness are either not diagnosed, not treated
  properly or diagnosed and treated at a much later
  stage of the disease process.
• The most common cause of death was heart disease.
• About 8 of the population have a diagnosed
  mental illness, and half of these smoke.

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Small Group Discussion

• Get into groups of 3 or 4
• Why do you think people living with mental
  illness have such poor physical health?

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How does physical health affect mental health?

• Quite often physical health problems can be
  mistaken as a symptom of mental illness.
• Improvement of physical health will often improve
  mental health.

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Example Under active thyroid

• Constipation
• Weight gain
• Slowing of mental function
• Depression

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Example Overactive thyroid

• Weight loss
• Anxiety/agitation
• Pressure of speech
• Sleep problems

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Prescribed medications

• May lead to raised cholesterol, raised blood
  sugar, raised blood pressure and unwanted weight
  gain.
• May make diabetes more likely.

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Barriers to receiving effective healthcare
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Barriers to receiving effective healthcare

• Ability to identify health concerns.
• Beliefs of health care provider.
• Ability to access health care.
• Wanting to keep mental and physical health
  separate.
• Not wanting to know.

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Brainstorm

• Think of the last time you went to a GP
• What did you like/dislike?

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GP visits

• Choose your GP carefully.
• Book a longer consultation.
• Plan your visit.
• Take someone with you.

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GP visits

• Request a full medical.
• Keep a personal health record detailing BP,
  weight, pap smears, lipid and sugar measurements
  and when they are next due.
• Take this record with you whenever you go to a
  GP, psychiatrist, chemist etc.

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Recommended Health Checks for Everyone

•  A NOTE ON MEDICATIONS
• People who take psychiatric medications maybe at
  increased risk of physical health problems.
• Tell your doctor which psychiatric medications
  you take and ask him/her if there are any tests
  you should have, and how often you should have
  them.

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Recommended Health Checks for Everyone

• CANCER Many types of cancer are now treatable
  with good outcomes, especially if detected and
  treated early. Some common cancers are
• BOWEL CANCER
• If you have a family history of bowel cancer ask
  your doctor about screening options and how often
  you should be checked. People
• over 50 are advised to get checked every 2
  years.
• Whatever your age, if you experience any symptoms
  such as bleeding from the anus, change in bowel
  habit or abdominal pain talk to
• your doctor about it as soon as you notice the
  change.

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Recommended Health Checks for Everyone

• SKIN CANCER
• Everybody is advised to do a skin
  self-examination every 3 months.
• If you have many moles that change in shape or
  colour or an area of skin that looks unusual, and
  seems to have changed recently, ask a doctor to
  examine your skin as soon as you notice it.
• If you have had skin cancers before, ask your
• doctor to examine your skin regularly.

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Recommended Health Checks for Everyone

• DENTAL HEALTH
• Everyone should have regular dental check- ups.
  Your dentist will advise you on the timing of
  dental examinations.

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Recommended Health Checks for Everyone

• HEART DISEASE AND STROKE
• It is recommended that everyone over the age of
  45 is tested every 5 years.
• It is a good idea to be tested more regularly if
  you are at risk due to family history, smoking,
  obesity, high cholesterol, high blood pressure or
  inactivity.

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Recommended Health Checks for Everyone

• WEIGHT GAIN  
• Everyone should be aware of their weight.
• People who take some types of psychiatric
  medication are advised to have their weight
  checked every year.
• Increased waist measurement raises the risk of
  heart disease and diabetes.

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Recommended Health Checks for Everyone

• OPTICAL HEALTH (Eye checks are free under
  Medicare every 2 years.)
• GLAUCOMA
• People usually have the first eye check for
  glaucoma at age 40, and then regularly after
  that.
• For people who may be at risk of glaucoma due to
  family history of glaucoma, diabetes, short
  sightedness, eye injuries or if you have ever
  taken cortisone, it is suggested that you have
  the first eye check at age 35 for glaucoma and
  then regularly after that.

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Recommended Health Checks for Everyone

• EYE CHECKS
• Your optometrist can advise you about how often
  you need an eye check if you already wear
  glasses.
• People who are aged 50 or over are advised to
  have an eye test every 5 years, or earlier if
  their vision starts to deteriorate. People over
  65 are advised to have an eye test every 12
  months.
•  

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Recommended Health Checks for Everyone

• TYPE 2 DIABETES
• People with impaired glucose tolerance, people
  over 45 or who have a family history of diabetes
  are advised to be tested once a year.
• People who are overweight, have high blood
  pressure or have had a heart attack, angina or
  stroke, should ask their doctor about how often
  they need to be tested.

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Extra checks for men

• TESTICULAR CANCER
• It is a good idea to become familiar with how
  your testes normally feel. If you notice any
  unusual lumps, talk to your doctor about it.
• Men should do regular checks for lumps or
  swellings if they have a family history of
  testicular cancer, or if they have undescended or
  absent testicles. If you notice any unusual lumps
  or swelling, talk to your doctor about it.
•  

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Extra checks for women

• BREAST CANCER
• All women should be familiar with the normal look
  and feel of their breasts. See a doctor
  immediately if you notice any unusual breast
  changes.
• You can have free access to breast screening for
  a mammogram if you are over 40. Mammograms are
  recommended every 2 years if you are aged between
  50 69.
• Talk to your doctor about how often you need to
  be screened if you have a family history of
  breast cancer.

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Extra checks for women

• CERVICAL CANCER
• Pap Smears are recommended every 2 years for any
  woman who has ever had sex and not had a
  hysterectomy. Your doctor may recommend that you
  to have more frequent screening if you are at an
  increased risk of cervical cancer.

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Part 1 summary

• For a number of reasons living with a mental
  illness usually means a person has poor physical
  health.
• It is very important to find a GP you are
  comfortable with and ask for regular physical
  health checks.
• Use the tips we have given you about GPs and
  health checks to make sure you get good health
  care.

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Break
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Improving the physical health of people living
well with mental illnessPart 2 Lifestyle Issues
Physical Health Workshop

• by Vivien Kemp BA (Hons)
• And Dr Sue Jackson MB BS FRACGP
• HealthRight and Hills Community Support Group

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Overview

• Alcohol and other drugs
• Alcohol guidelines
• Smoking and mental illness
• Dietary guidelines
• Physical activity guidelines

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Alcohol
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Alcohol and other drugs

• May have significant effects on both physical and
  mental health.
• Have effects on well being and
• social functioning.

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Alcohol and other drugs

• May themselves induce psychosis.
• May make it harder to separate drug-induced
  problems from mental health problems.

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What is a standard drink?

• Health authorities use the idea of a STANDARD
  DRINK to help people keep track of the amount of
  alcohol they drink.
• Different kinds of alcoholic drinks have
  different amounts of alcohol in them.
• A standard drink and a standard glass size
• are not the same thing.
• Look on the bottle, can or cask to see how
• many standard drinks it contains.

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What does a standard drink look like?
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Alcohol guidelines
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Tips for reducing alcohol intake

• ? Dont drink on an empty stomach.
• ? Space your drinks make each drink
• last an hour.
• ? Alternate with non-alcoholic drinks.
• ? Choose low alcohol alternatives.
• ? Make sure you have some alcohol free days every
  week.

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Are you comfortable about the amount you drink?
If not

• Think about the situations where you are most
  likely to drink.
• What part does alcohol play in your life?
• What can you do to reduce possible harm?

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Smoking
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Smoking

• Smoking cessation has been shown to be the
  biggest single factor in the improving life
  expectancy.
• Smoking cessation increases the effectiveness of
  antipsychotic medication.
• Smoking cessation significantly improves
  finances!!

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Smoking

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

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Why smoke ??

• To relieve boredom and provide framework for the
  day.
• Smoking can improve social interaction.

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Nicotine -

• May help relaxation.
• May increase alertness.
• Antidepressant effect.
• Reduce symptoms such as hearing voices.

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Stopping smoking

• Various pharmacological agents available.
• Courses and information.
• Be aware of specific difficulties individuals
  with mental health problems may face.

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Group brainstorm How can I eat more healthy
foods?
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Good news! Before you feel overwhelmed

• Small changes now can lead to long term benefits
  down the track.

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Small changes that over time make a BIG
difference

• For Example
• Buy low fat instead of full cream milk
• (Hi-Lo, Skim, No Fat etc).
• Buy whole grain or wholemeal breads and pastas,
  
• Basmati rice.
• Dont add salt to your cooking.
• Look for mono-saturated or poly-unsaturated
  butter, margarine and oils.

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Small changes that over time make a BIG
difference

• Cut down of the amount of sugar in your diet
• Reduce the amount of sugar in tea and coffee by
  1/4 of a teaspoon a week until you add no sugar
  at all.
• Switch to diet soft drinks and cordials instead
  of regular soft drinks and cordials.
• Drink unsweetened fruit juice.
• Buy canned fruits in natural juice not
• syrup.

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Small changes that over time make a BIG
difference

• Water Try to drink 6-8 glasses of water a day
• For every kind of drink you have in a day, drink
  one glass of water first.
• If you dont like the taste of water try adding
  squeeze of lemon juice.
• Drink it hot from the kettle or cold from the
  fridge.

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Lets get physical!
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Physical activity guidelines

• Try to do 30 minutes of moderate physical
  activity most days of the week, everyday if you
  can.
• Moderate activity means increasing your heart
  rate, but not making you breathless i.e. a brisk
  walk.
• You dont have to do it all at once 3 sessions
  of 10 mins each is fine.

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Physical activity guidelines

• If you tend to be an inactive person PLEASE see a
  GP for a thorough physical health check BEFORE
  you start any exercise program.
• This is VERY important.

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Physical activity

• When you are active you
• Have better long term health.
• Have more energy.
• Reduce your risk of getting heart disease type 2
  diabetes and some cancers.
• Reduce blood pressure and bad cholesterol.
• Feel more confident and happy.
• Sleep better.

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Physical activity guidelines

• If you have been inactive for a while
• Start slowly e.g. walk down your street
• Gradually build up the amount of time being
  active
• Find an activity you enjoy.
• Make it part of your daily routine.

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Brainstorm..

• How can you be more active everyday without
  killing yourself?

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A take home message

• Has anything you have heard today made you think
  about changing what you do?
• If so what and why?

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Summary, Part 2

• Be aware of the risks associated with alcohol use
  and smoking.
• Look for low fat, sugar and salt foods when
  shopping.
• Try to be more active every day.

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Conclusion

• Physical and mental health are linked together.
• It is important to have regular physical health
  checks.
• By making small changes in your daily eating and
  activity habits you can reduce your risk of
  getting metabolic syndrome, heart disease and
  type 2 diabetes.

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References

1. World Health Organization, (2003) Investing in
   mental health. Investing in Mental Health, WHO,
   p7. Retried on 27/11/2008 from
   http//www.who.int/mental_health/en/investing_in_m
   nh_final.pdf
2. Lawrence D, Holman D, Jablensky A. (2001).Duty to
   Care Preventable Physical Illness in People with
   Mental Illness. Perth The University of Western
   Australia.
3. Lieberman AA, Coburn AF. The health of the
   chronically mentally ill A review of the
   literature. Community Mental Health Journal.
   198622(2)104-16.
4. Brown S, Birtwistle J, Roe L, Thompson C. The
   unhealthy lifestyle of people with schizophrenia.
   Psychological Medicine. 199929697-701.
5. Davidson S, Judd F, Jolley D, Hocking B, Thompson
   S, Hyland B. Cardiovascular risk factors for
   people with mental illness. Australian and New
   Zealand Journal of Psychiatry. 2001a35196-202.

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References Web sites

1. http//www.alcohol.gov.au/internet/alcohol/publish
   ing.nsf/Content/standard
2. http//www.iccwa.org.au/Youth20Alcohol20Project/
   YAP/web20site/HP5979-standard20drink.pdf
3. The Fagerstrom test may be used to assess
   nicotine dependence ( See website)
   http//www.way2quit.com/Quit_Place_Dependency.aspx
   
4. http//www.nutritionaustralia.org/Food_Facts/Fact_
   Sheets/about20_the_healthy_eating_pyramid.asp
5. Find Thirty everyday findthirtyeveryday.com.au

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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 StreetFremantle, WA 6160 Ph 9431
  3438Fax [phone]
• vivien.kemp_at_uwa.edu.au
• http//www.healthright.org.au

• Sue Jackson
• MobileGP
• Ph 0417 984 210
• suejackson_at_westnet.com.au