Integrating mind and body: combining physical and mental health
Project title: Translation of preventive care guidelines into community mental health service delivery
Start date: February 2016
End date: June 2018
What is the issue?
People with a mental illness have significantly poorer physical health and shorter life expectancy than the general population, primarily due to chronic diseases. A greater prevalence of modifiable health risk behaviours such as poor nutrition, inadequate physical activity, overweight and smoking contribute substantially to these health inequalities.
Evidence-based guidelines recommend that mental health services routinely assess and manage chronic disease health risks, including modifiable health risk behaviours. Despite these guidelines, mental health services are not adequately addressing chronic disease in people with mental illness.
The research team’s own research in community mental health services demonstrates low rates of assessment for dietary risk, physical activity and smoking. When clients are identified as being at risk of chronic disease, few are referred to services such as telephone support services.
The long tradition of separating mental and physical healthcare impedes the ability of mental health services to best address clients’ physical health. The need to integrate physical and mental healthcare is acknowledged as a priority in Australia and internationally.
Three pilot studies have demonstrated the potential of allocating a specific practitioner to deliver preventive care, but this model has not been rigorously evaluated and there has been little exploration of how such a practitioner could be feasibly and acceptably positioned in a mental health service.
How did the project address the issue?
This project explored the feasibility, acceptability and effectiveness of a locating a designated preventive care practitioner in a mental health service to address clients’ chronic disease risks.
It involved a study conducted in a community mental health service in a Hunter New England Local Health District with around 500 clients.
Clients attending the service over a six-month period were randomly allocated to receive usual care, or usual care plus an appointment with the preventive care practitioner (the intervention group).
Intervention group clients had a 40-minute consultation with a preventive care practitioner before their appointment with the community mental health service. The practitioner assessed, advised and connected at-risk clients to the NSW Get Healthy Service and the NSW Quitline and refer them to a GP if needed.
Clients in the usual-care group saw a mental health clinician for a routine consultation in accordance with the current policy of the health district – risk assessment, brief advice and referral to the Get Healthy Service and Quitline.
The primary outcome measured was the number of clients in each group who took up referrals to the Get Healthy Service and Quitline. The researchers explored clients’ reasons for taking up such referrals, or not, as well as their satisfaction with services if they did take up a referral. The project also asked mental health clinicians for their views about the impact of locating the preventive care practitioner within the service.
Relevance for practice
International, national and state-level policy and practice reviews all identify an urgent need to develop and evaluate integrated models of physical health care in mental health services. However, there has been little research to evaluate such models, so the findings of this study will make an immediate contribution to this evidence gap.
The findings will inform policy makers and practitioners about whether this model of care is effective and feasible, as well as inform the development of policies that focus on addressing the physical health and overall wellbeing of people with a mental illness, and on strategies for implementation in mental health services.
What are the expected outcomes?
If shown to be effective, the designated preventive care practitioner model of care will provide a mechanism for mental health care services nationally and internationally to increase the delivery of care to address chronic disease risks among their clients.
The project will also provide information around the feasibility of this model of care and its acceptability for mental health clients and clinicians.
Associate Professor Jenny Bowman, University of Newcastle
- Dr Kate Bartlem, University of Newcastle
- Ms Caitlin Fehily, University of Newcastle
- Rhonda Patrick, Healthy lifestyle clinician
- Lauren Gibson, Research assistant
- Natalie Hancox
- Ellen Browning
The project is also well supported by the expertise of both Prevention Centre investigators (Professor Andrew Wilson, Professor Chris Rissel and Professor John Wiggers) and other researchers and clinicians with significant experience and expertise in this field (Professor David Castle, Dr Paula Wye and Mr Richard Clancy).
We acknowledge the invaluable input into this project of our colleague, mentor, and above-all friend, Associate Professor Sonia Wutzke (1970–2017). The public health community is richer for having had you as one of its most passionate advocates.
This project was funded by the NHMRC, Australian Government Department of Health, NSW Ministry of Health, ACT Health and the HCF Research Foundation.
- Individual interviews are planned to be undertaken with community mental health clinicians to understand the solutions that they think would make preventive health care provision feasible in community mental health settings
- Final data collection has been completed (6 month follow-up)
- Fehily CM, Bartlem KM, Wiggers JH, Wye PM, Clancy RV, et al. Effectiveness of embedding a specialist preventive care clinician in a community mental health service in increasing preventive care provision: A randomised controlled trial. Aust N Z J Psychiatry. 2020 May 14:4867420914741. doi: 10.1177/0004867420914741. [Epub ahead of print].
- Fehily C, Ling R, Searles A, Bartlem K, Wiggers J, et al. An economic evaluation of a specialist preventive care clinician in a community mental health service: a randomised controlled trial. BMC Health Serv Res. 2020;20(1):405. doi: 10.1186/s12913-020-05204-7.
- Fehily CM, Bartlem KM, Wiggers JH, Hodder RK, Gibson LK, et al. Uptake of a preventive care consultation offered to clients of a community mental health service. Prev Med Rep. 2020;18. doi: 10.1016/j.pmedr.2020.101076
- Fehily C, Bartlem K, Wiggers J, Wye P, Clancy R, Castle D, Wutzke S, Rissel C, Wilson A, McCombie P, Murphy F, Bowman J. Evaluating the effectiveness of a healthy lifestyle clinician in addressing the chronic disease risk behaviours of community mental health clients: study protocol for a randomised controlled trial. Trials. 2017; 18:276. doi: 10.1186/s13063-017-2017-1
- Bowman J. Actions to embed smoking care in mental health services: Oceania Tobacco Control Conference, Hobart, October 2017
- Bartlem K, Fehily C, Wye P, Clancy R, Wiggers J, Bowman J. Models for implementing physical activity and nutrition care into mental health services. Poster presentation: International Society of Behavioral Nutrition and Physical Activity 16th Annual Meeting, Victoria, Canada, June 2017.
- Fehily C*, Bartlem K, Wiggers J, Wye P, Clancy R, Castle D, Wutzke S, Rissel C, Wilson A, Bowman J. Embedding a healthy lifestyle clinician in a community mental health service. Poster presentation: International Congress on Behavioral Medicine, Melbourne, December 2016.