A lifestyle medicine program designed in New South Wales to combat the dramatic weight gain and metabolic decline associated with anti-psychotic drug use has recently been adapted in the United Kingdom. It has been offered as an implementation resource to accompany the UK’s National Institute for Health and Clinical Excellence (NICE) guidelines for management of children and young people with psychosis.
The NICE clinical guidelines were issued in late January 2013 and mandate screening and intervention for metabolic health. People with psychosis have a 20-year shortfall in life expectancy, usually due to premature heart disease and diabetes complications.
The NSW program “positive cardiometabolic health” focuses on physical assessment and intervention, and was designed in 2011 in a collaboration between Professor Katherine Samaras, Clinical Researcher at the Garvan Institute of Medical Research and endocrinologist at St Vincent’s Hospital, and psychiatrist Dr Jackie Curtis from the Bondi Early Psychosis Program, Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District.
In January 2012, the team published a description of their work in the journal Early Intervention in Psychiatry. They also received a $375,000 grant from NSW Health Mental Health, Drug and Alcohol Office in August 2012 to evaluate their program.
The funding enables employment of a dietician and exercise physiologist to work with the early intervention mental health team at The Bondi Centre, which treats young people aged 15 to 25 who have experienced their first psychotic illness.
Dr David Shiers, a member of the NICE clinical guidance group, who is visiting Sydney for an upcoming conference on Linking Body and Mind in psychosis, said: “The NSW Health Resource has had a big impact on our thinking about what needs to be done to help young people with psychosis face physical health issues, but also how to act to protect the health they have”.
Professor Samaras and Dr Curtis follow patients from the time they start anti-psychotic medication, to see whether the additional practical advice, skills training and support prevents dramatic weight gain.
Professor Samaras said the current funding for the project will enable the project team to see the impact of an investment in nurses, dieticians, and exercise physiologists to train young people in minimising or preventing weight while taking these medications.
“We are heartened by the recent highlighting of our physical treatment pathway in the NICE guidelines. It clearly demonstrates that the problem we are facing locally is global and is being taken seriously by international authorities.
“As a matter of social justice and equity, we must address the factors that lead to the shorter life expectancy of people with severe mental illness,” Professor Samaras said.
Dr Jackie Curits said early intervention to prevent obesity will prevent the ‘seeding’ of cardiovascular and diabetes risk that destroys future health.
“Essentially, we want people with severe mental illness to enjoy the same health as their young peers and not experience a double disability of mental illness and obesity,” Dr Curtis said.
ABOUT THE BONDI CENTRE, EASTERN SUBURBS MENTAL HEALTH PROGRAM SOUTH EASTERN SYDNEY LOCAL HEALTH DISTRICT
The Bondi Centre, Early Psychosis Program, is part of the Eastern Suburbs Mental Health Program, South Eastern Sydney Local Health District, which operates from a large house in Sydney’s Bondi Junction and treats young people, aged15 to 25, who have experienced their first episode of psychosis. Comprised of a multidisciplinary team of psychiatric nurses, psychologist, psychiatrist, family therapist, dietician and occupational therapist, the Program performs a full mental health assessment on each client and manages the psychiatric, lifestyle and vocational recovery of its clients. The Program also conducts a two-year comprehensive multi-disciplinary recovery program- the RaDiCaL Group Program (Recovery and Discovery in Community and Lifestyle) to improve general physical health and promote a healthy lifestyle. Clients of the Program are also assisted by exercise physiologists and dieticians through the development of a healthy lifestyle plan and individualised exercises through the "Keeping the Body In Mind” program and use of the onsite gym at the Bondi Centre.