EHR525 Week 02 Preparing to Work With MH Consumers PDF

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WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice School of Allied Health, Exercise and Sports Sciences 1 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 1 EHR525 EXERCISE FOR NEUROLOGICAL & MENTAL HEALTH CONDITIONS Preparing to Work with Mental Health Consumers Presenter: Jack Cannon School of Allied Health, Exercise and Sports Sciences 2 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 2 What We Will Cover ■ Life expectancy of persons with mental health conditions. ■ Cardiometabolic disease risk in persons with mental health conditions. ■ Lifestyle factors contributing to poor health in persons with mental health conditions. ■ Effect of psychoactive medications on health status. ■ Reduced access to health care and prevention services. ■ Mental health care providers. ■ Positive communication. ■ De-escalation. School of Allied Health, Exercise and Sports Sciences 3 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 3 Introduction ■ Mental health conditions can significantly impact a person's physical health and well-being. ■ Relationship between mental and physical health is complex and interconnected involving: □ □ □ □ Increased chronic disease risk. Lifestyle factors. Medication side-effects. Reduced access to health care and preventative services. ■ Behaviour of people mental health conditions may change quickly and we need to be able to safely respond to situations. School of Allied Health, Exercise and Sports Sciences 4 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 4 LIFE EXPECTANCY ■ People with severe (schizophrenia, bipolar disorder, mod-severe depression) mental conditions experience a 10-25 year reduction in life expectancy (after accounting for suicide). ■ Increases to a 25-30 year reduction when combined with drug or alcohol misuse. ■ Addressing this health disparity has been a major focus of national governments over the past decade. School of Allied Health, Exercise and Sports Sciences 5 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 5 Mental Health Disease Burden ■ ABS (2018) burden of disease study reported mental health and substance misuse is the 4th largest contributor to total disease burden. ■ >98% is related to non-fatal burden (life years living with disability). ■ What does this mean? In addition to the large reduction in life expectancy, quality of life is poor and associated with substantial disability and loss of functioning. School of Allied Health, Exercise and Sports Sciences 6 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 6 Differences in Life Expectancy Between Different Population Groups ■ Strong social support networks are key correlates of mental health. ■ Setting social engagement and community participation goals and working with clients to help them achieve these goals School of Allied Health, Exercise and Sports Sciences Australian Bureau of Statistics. (2017). Mortality of people using mental health services and prescription medications. Retrieved from http://www.abs.gov.au/ausstats/[email protected]/mf/4329.0.00.006. 7 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 7 CARDIOMETABOLIC DISEASE RISK ■ Reduction in life expectancy and large non-fatal disease burden is due to a high prevalence of chronic physical health conditions: □ □ □ □ Hypertension. Diabetes. CVD. Metabolic syndrome. ■ Cardiovascular morbidity and mortality are increased ~2-3 fold overall in persons with mental health issues. ■ Cardiometabolic rates have slightly decreased over the last 20 years, but not for those with severe mental illnesses.. School of Allied Health, Exercise and Sports Sciences 8 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 8 Prevalence and Relative Risk of Cardiometabolic Risk Factors ■ Estimated prevalence and relative risk (RR) of modifiable risk factors for cardiovascular disease in schizophrenia and bipolar disorder compared to the general population. De Hert (2007) School of Allied Health, Exercise and Sports Sciences 9 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 9 Relationship Between Depression and CVD ■ Potential factors that could explain the relationship between CVD and depression. ■ The relationship between CVD and depression appears to be bidirectional. ■ Similar relationships likely exist for other secondary diseases. School of Allied Health, Exercise and Sports Sciences Miorelli, (2020) 10 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 10 LIFESTYLE FACTORS AND POOR HEALTH ■ Improving health status in persons with mental health conditions is complex and challenging. ■ Many lifestyle factors likely involved including: □ □ □ □ □ Poor sleep patterns. Inadequate physical activity/ high sedentary behaviour. Unhealthy eating habits. Smoking. Substance abuse. School of Allied Health, Exercise and Sports Sciences 11 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 11 Physical Activity/ Sedentary Behaviour ■ Adults with mental illness spend 2/3 of waking time sedentary with 1/3/ accumulated in prolonged bouts. ■ Less likely to adhere to exercise programs. ■ Sedentary behaviours associated with array of cardiometabolic complications. ■ Very few will regularly (if ever) participate in moderate to vigorous activity. School of Allied Health, Exercise and Sports Sciences 12 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 12 PSYCHOACTIVE MEDICATIONS AND HEALTH ■ Some psychoactive medications can contribute to cardiovascular disease risk by inducing weight gain. □ E.g. Clozapine (schizophrenia) and mirtazapine (anti-depressant). □ Up to 75% of patients may experience weight gain. □ Mechanisms involved not fully known (increases appetite and ?). ■ People receiving psychoactive medications have a higher prevalence of diabetes and metabolic syndrome. ■ Best predictor of long-term weight gain is weight change in the first 4-6 weeks of commencing medication. School of Allied Health, Exercise and Sports Sciences 13 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 13 Rate of Weight Change ■ Weight changes occur rapidly after commencing treatment. ■ Best predictor of long-term weight gain is weight change in the first 46 weeks of commencing medication. ■ Weight gain may continue for >4 years. School of Allied Health, Exercise and Sports Sciences Alvarez-Jimenez (2008) Preventing, reducing and/or managing medication-induced weightSCHOOL gainOF is essential 14 EXERCISE SCIENCE, SPORT & HEALTH 14 REDUCED ACCESS TO HEALTH CARE AND PREVENTATIVE SERVICES ■ Poor physical health in people with mental health condition may also be explained by reduced access to health care services. ■ Social stigma, discrimination, and social isolation may all contribute to inadequate physical health care and management. School of Allied Health, Exercise and Sports Sciences 15 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 15 Social Stigma and Discrimination ■ Society generally has a limited understanding of mental health and how it may present in different people. ■ Different cultures also have different perspective on mental health: □ □ □ □ □ People with mental health problems need to take ownership for their MH. Mental health problems are purely behavioural in nature. Mental health diagnosis are only for young adults. People with a mental illness are often locked up in hospitals. People with a mental illness are unpredictable and violent. Stigma and shame reduces the likelihood people with seek treatment School of Allied Health, Exercise and Sports Sciences 16 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 16 Violence and Mental Health ■ Mental disorders are neither necessary, nor a cause of violence. ■ Major determinants of violence are socio-demographic and socio-economic factors (e.g. young, male, and of lower SES status). ■ Substance abuse is also a major determinant of violence and this is true whether it occurs in the context of a concurrent mental illness or not. ■ Far more likely that people with a mental illness will be the victim of violence than a perpetrator (regardless of severity). School of Allied Health, Exercise and Sports Sciences 17 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 17 Stigma and Barriers to Disclosure ■ Fear of discrimination creates an environment where individuals feel hesitant to disclose their mental health conditions. ■ This may be due to concerns about potential negative consequences, such as loss of social standing, discrimination in employment, relationships, etc. ■ The fear of discrimination can lead to secrecy and avoidance of seeking mental health care or other preventative health services. School of Allied Health, Exercise and Sports Sciences 18 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 18 MENTAL HEALTH CARE SERVICES AND PROVIDERS ■ General practitioners: Most people access services through their GP (13% of all GP encounters; AIHW, 2014). □ Most common managed MH problem by a GP is depression (32% of MH encounters, AIHW, 2014). □ GPs may prescribe medications and provided referral to other practitioners (e.g. Psych, Dietician, or AEP) through Medicare funded treatment plans (e.g. GPMP, TCA, or Mental Health Care Plan). ■ Community mental health care facilities: Include various community and hospital-based outpatient care services. □ Provide an array of services, including housing, support groups, staffing, access to other medical services (see example here: https://www.youtube.com/watch?v=9DGDjdpQbZ0) School of Allied Health, Exercise and Sports Sciences 19 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 19 Mental Health Care Services and Providers ■ In-patient hospital care: People with mental health problems may require acute hospitalisation if they present harm to themselves or others. □ Specialised psychiatric care can be provided in a psychiatric hospital or in a psychiatric unit within a hospital. □ Involuntary admissions accounted for 29.5% of mental health-related hospital admissions requiring specialised psychiatric care (AIHW, 2014). ■ Residential care: Provide specialised mental health care on an overnight basis in a domestic-like environment. □ Access by 0.01% of person with mental illness. □ Principle diagnosis was schizophrenia (32%), depressive episode (12%), schizoaffective disorder (10%). □ Most common length of stay was 2 weeks or less (58%) with 3% of episodes admitted for >1 year (AIHW, 2014) School of Allied Health, Exercise and Sports Sciences 20 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 20 POSITIVE INTERACTION AND COMMUNICATION ■ Build relationships: □ Body language (non-verbal communication) □ Treat people with respect. □ Show genuine interest. ■ Communicate effectively: □ Focus on the person (not condition). □ Emphasise strengths and abilities. □ Ask, don’t assume, and check for understanding. ■ Include families and carers: □ Obtain consent. □ Actively involve in treatment planning and decision making. □ Involve them in the treatment plan delivery. School of Allied Health, Exercise and Sports Sciences 21 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 21 DE-ESCALATING STRATEGIES ■ Use the strategies below to de-escalate a situation: □ □ □ □ □ □ □ L: Listen to the issue and hear the person's concerns. O: Offer reflective comments to show you have heard their concerns. W: Wait until the person has expressed their frustration and explained their feelings. L: Look and maintain appropriate eye contact to connect with the person. I: Incline your head to show you are actively listening and provide a non-threating posture. N: Nod to confirm that you are listening and have understood. E: Express empathy and concern. ■ You cannot control a person’s emotions, but the steps above may help to make the person feel more calm. ■ Once they have de-escalated could can work with them to resolve their concerns. NSW Health (2023) School of Allied Health, Exercise and Sports Sciences 22 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 22 Summary ■ People with mental health conditions experience substantial reductions in physical health due to cardiometabolic factors that lead to large reductions in life expectancy. ■ Integrated healthcare approaches that address both mental and physical health are necessary to improve the wellbeing of individuals with mental health conditions. ■ Exercise physiologists are well positioned to provided support for increasing the physical health of people with mental health conditions. ■ Mental health stigma continues to be an issue and contributes to reduced health care access and provision of timely and appropriate health care. ■ Most mental health consumers will access treatment and support through their GP and make use of several different care plans to access additional treatment services. ■ When working with persons with mental health conditions, facilitating positive interaction and communication is critical to establishing effective client relations. ■ In circumstances where a client becomes aggressive or agitated, safety also comes first, then attempts at de-escalating may occur when appropriate. School of Allied Health, Exercise and Sports Sciences 23 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 23