Addressing The Physical Health Of People With Mental Illness
Mental health and physical health are fundamentally connected. A proportion of individuals experiencing mental illness will also experience poor physical health, and poor physical health can in turn be associated with poor mental health.
Given the well-known relationship between physical and mental health, an increased focus on holistic multidisciplinary treatment can enhance quality of life, and improve the physical and mental health outcomes for individuals living with a mental health disorder. The high rates of physical illness including diabetes, respiratory illness, cardiovascular disease and cancer among people with serious mental illness are well documented. For example, people with serious mental illness are two to three times more likely to suffer from diabetes and the rate of cardiovascular disease is almost four times that of the general population1, 2.
Depression is considered an independent risk factor for coronary heart disease, but can also affect the recovery of people with coronary heart disease and increase their risk of further heart problems3. Thus, people with chronic health conditions are themselves more likely to experience a mental illness4. The high level of comorbidity with chronic disease contributes to poor quality of life and is acknowledged as one of the major reasons for the high mortality and morbidity rates among people with serious mental illness. For example, the relative risk of death is estimated to be 2.2 times higher in people with mental disorders compared to the general population5, and this is primarily due to chronic physical rather than mental illness6.
The poor physical health of many people living with mental illness is due, in part, to the side effects of medication, a range of lifestyle factors, and inadequate management of chronic disease. Importantly, lifestyle factors such as poor diet, low levels of physical activity, smoking, and substance misuse are modifiable and offer a way for health professionals to assist people living with mental illness. The provision of multi-disciplinary care to address modifiable lifestyle factors is therefore an important component of holistic care for many people with mental illness and can improve both their physical and mental health outcomes.
Healthy eating behaviours, regular physical activity, moderate alcohol consumption, and smoking cessation can help decrease the burden of chronic disease7. When incorporated with evidence-based psychological and medical treatment, dietary and exercise interventions can provide a range of physical, social and mental health benefits for people living with a mental illness.
The Dietitians Association of Australia, Exercise & Sports Science Australia and the Australian Psychological Society endorse:
• Increased access to dietary and exercise interventions in addition to evidence-based psychological and medical treatment for individuals experiencing mental illness.
• Regular screening and ongoing monitoring of both physical and mental health for people experiencing mental illness.
• Where indicated, referral to appropriately qualified allied health professionals to address lifestyle issues and physical health needs.
• Strengthening referral networks and collaboration between core professionals in the mental health treatment team.
The Management of Mental Illness: The Role of Dietitians, Exercise Physiologists and Psychologists
Accredited Practising Dietitians
Poor dietary habits are well documented among people living with mental illness. When compared to the general population, people with schizophrenia consume more energy (kilojoules) and saturated fat and eat less fruit, vegetables and dietary fibre8. A significant association has also been found between depressive symptoms and a reduced likelihood of eating a healthy diet9. Poor dietary patterns account for, in part, the higher rates of obesity, diabetes and cardiovascular disease within this population. Accredited Practising Dietitians are experts in food and medical nutrition therapy with skills to translate scientific nutrition information into personalised, practical dietary advice.
They are skilled in coaching strategies to improve diet quality through lifestyle change, so as to:
• Improve concurrent and comorbid conditions (e.g. diabetes, cardiovascular disease, obesity, metabolic syndrome) and reduce all-cause mortality risk 10-13.
• Mitigate weight gain commonly seen in patients taking psychotropic medications13-15.
• Reduce the risk and progression of common mental disorders (e.g. depression and anxiety)9, 16-20.
• Identify and improve disordered eating patterns and eating behaviours21.
• Enhance food security (i.e. food access, supply and utilisation) through improved meal planning, budgeting, shopping, food preparation and cooking skills22.
To find an Accredited Practising Dietitian go to: www.daa.asn.au/find-an-apd/
Accredited Exercise Physiologists
Exercise is an efficacious adjunct intervention for improving both physical and mental health outcomes23. However, it can be more difficult for people experiencing mental illness to initiate and maintain exercise programs because of the complex nature of mental illness. Accredited Exercise Physiologists are trained to provide evidence-based exercise interventions to individuals at high risk of developing, or with existing, chronic and complex medical conditions and injuries.
In populations with mental illness regular physical activity prescribed by an Accredited Exercise Physiologist has been shown to:
• Improve cardiorespiratory fitness and reduce all-cause mortality risk24, 25.
• Improve psychosocial functioning (i.e. activities of daily living, social and occupational functioning)23.
• Mitigate weight gain induced by psychotropic medications26.
• Improve chronic disease outcomes (especially type 2 diabetes and cardiovascular disease)27.
• Decrease symptoms of depression and anxiety28-30.
• Improve sleep qualityand increase self-esteem32.
To find an Accredited Exercise Physiologist go to: www.essa.org.au/find-aep/
Psychologists are trained to provide evidence-based psychological treatment for mental health problems. These treatments are effective for a large number of mental health difficulties including anxiety33, depression34, and eating disorders35, as well as sleep problems36 and drug and alcohol difficulties37. Psychologists play a major role in the provision of interventions for mental illness but they also have a key role in addressing the lifestyle factors associated with poor physical health in people living with mental illness.
For example, Psychologists can deliver:
• Motivational interviewing to facilitate lifestyle behaviour change38 (e.g. smoking, substance use, weight loss).
• Behavioural strategies to support lifestyle change (e.g. eating habits39, sleep36).
• Cognitive approaches to overcome barriers to improving quality of life40.
• Strategies to assist individuals to adjust to new lifestyles and maintain the changes40.
To find a psychologist go to: www.psychology.org.au/FindAPsychologist/
Existng Referral and Funding Pathways
In addition to traditional fee-for-service and the Medicare Better Access items for the delivery of psychological services for diagnosed mental illness, there are a number of existing referral and funding pathways to support access to Accredited Practising Dietitians, Accredited Exercise Physiologists and Psychologists:
• Medicare Benefits Schedule
Individuals with chronic medical conditions (likely to be present for 6 months or longer), can be managed by their general practitioner (GP) under a GP Management Plan (item 721) and Team Care Arrangement (item 723) that facilitates Medicare rebates for allied health services on referral from the GP.
• Department of Veterans’ Affairs
The Department of Veterans’ Affairs (DVA) funds all health services necessary to meet a clinical need for Gold Card holders. For White Card holders, the DVA will fund those services required because of their accepted war-caused or service-related condition(s).
• Personal Injury Schemes
Allied health services make a significant contribution to improving health and return to work outcomes for injured workers, including those with mental illness. Personal Injury Schemes can pay the reasonable costs of healthcare services up to a maximum amount as detailed in the relevant fee schedule.
• Private Health Insurance
Some individuals with mental illness may be eligible for private health insurance rebates for services delivered by Accredited Practising Dietitians, Accredited Exercise Physiologists and Psychologists.
• Primary Health Networks (PHNS)
PHNs commission primary mental health services across Australia. In addition to Psychologists, PHNs may provide access to a range of allied health services for individuals with mental illness. Contact your local PHN to ascertain if they provide access to Accredited Exercise Physiologists and Accredited Practising Dietitians for this cohort.
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