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This article was first published on Tuesday, March 29, 2022
The Equally Well 2022 Symposium will showcase initiatives to improve the physical health of people with mental illness, as well as identifying barriers to improved care.
Croakey editor and journalist Cate Carrigan is covering the event for the Croakey Conference News Service, and previews the #EquallyWellAu22 discussions below.
(It’s not too late to register to join the symposium, whether virtually or in person at the Gold Coast campus of Griffith University.)
Cate Carrigan writes:
Every day in Australia, many more people with mental illness die from often preventable physical illness than as a result of suicide, yet most are still not asked about their physical health when they seek healthcare.
That’s a key finding of a soon-to-be-released report from Lived Experience Australia (LEA), which found those with mental illness are missing out on basic health checks, leading to a delay in diagnosis and effective treatment for chronic illness, cancer and other conditions.
Professor Sharon Lawn, Chair and Executive Director of LEA, and a former Mental Health Commissioner for South Australia, will launch the report at the second Equally Well Symposium, which will be held in April as a virtual event as well as in person at the Gold Coast Campus of Griffith University.
She told Croakey of her own experience with clinicians overlooking the physical health of those with mental illness.
Lawn’s husband (who helped prepare her talk for the symposium), a former professional Rugby League player, has lived with schizophrenia for decades, for many years undiagnosed and untreated.
Her husband grew up amidst family violence, poverty, racism, sexual and physical abuse, but also with a culture of strong and fierce commitment to family and football.
While his eventual diagnosis of schizophrenia and treatment with anti-psychotic drugs helped address his mental health, the treatments have also led to much poorer physical health.
The metabolic impact on his weight – he gained 30 kilos in the month following his first admission to hospital – and overall health has been significant.
“Those things chase each other and cause other things. You become more inactive and are likely to put on more weight – it’s quite a vicious cycle,” Lawn explained.
“He was homeless when we met 20 years ago and the impact of that time living in deprived situations has also left him with other insidious and continuing physical health problems.”
Now in his 50s, her husband has had several periods of hospitalisation for mental illness, many medications, and accumulating diagnoses for his physical health.
Taking time
Lawn, a Professor in the College of Medicine and Public Health at Flinders University in Adelaide, wants clinicians to know that it is not just a matter of telling someone to ‘be healthy, eat better and move more’ – it’s about trying to walk in their shoes.
“It’s very hard when you’re struggling with trauma and problems with motivation and, like my husband, have trouble initiating, planning and thinking about what to do most days,” she said.
Many days are spent rising late or staying in bed, resulting in loss of muscle tone and bone strength, and – like many with schizophrenia – smoking (people with schizophrenia are five times more likely to smoke than the general population).
“Add that to the mix and you have a real problem with the person’s ability to walk as far as they used to, be motivated and not spend their day just sitting, smoking and sleeping – losing connection with people and self-esteem,” she said.
Lawn wants clinicians to see the whole man – not just the schizophrenia – and tap into her husband’s past, what happened in his childhood and his success with Rugby, to help him find motivation.
“It’s like they are just standing by and watching things move in a particular direction and feel powerless to change anything.”
Lawn believes clinicians could be more up-to-date with evidence-based treatments, such as effective smoking cessation programs, and also tap into what gives her husband self-esteem.
She wants consistency and follow-up to ensure there is feedback and motivation to keep going, rather than every contact being an isolated incident.
The impacts of her husband’s mental and physical health are there every day and are felt by the whole family, but particularly her husband.
Yet family members are often left out of the discussion. “We’re the magic fairy navigator who sits in the waiting room but often doesn’t get included,” she said.
The message to the conference from her husband will be for clinicians to ‘be hopeful’ and ‘take an interest in more than just compliance with medications’, ask more about the patient as a person, and find what motivates them.
He also wants clinicians to work on boosting his self-esteem and make a living plan to measure small steps and progress, using scales and other tools regularly to monitor weight and breathing, and work with the family, rather than leaving them in the waiting room.
Lawn echoes her husband’s comments, saying family members are often in the background doing the prompting, supporting and encouraging.
Tackling barriers
The National Director of Equally Well Australia, Professor Russell Roberts, said a key focus of the 12-13 April symposium would be tackle barriers such as those outlined by Professor Sharon Lawn, as well as sharing success stories.
With the theme: ‘Equally Well: Action and collaboration for hope and health’, the gathering will bring together experts from the United Kingdom, New Zealand and Australia to share innovative practice and developments aimed at improving the physical health and wellbeing of people living with mental illness.
It’s a chance for signatories to the Equally Well Consensus Statement initiated by the National Mental Health Commission in 2017 to touch base, check progress and reset.
Roberts said most people with mental illness were still not asked about their mental health by clinicians, showing there is still a long way to go.
This is happening even though the risk of premature death from chronic physical diseases is “far, far higher than the risk of death by suicide”, he told Croakey.
“We’re talking about over 70 people a day with mental illness dying early from mainly preventable chronic health conditions and still they are not being asked about things like vaccination, smoking, cholesterol, blood sugar and cancer screenings in consultations,” said Roberts.
“This is a no brainer – basic health checks, such as cancer screening, can result in early detection and effective treatment, yet too few people with mental illness are being encouraged or supported to access it.”
Vaccination rates – for COVID-19 and other infectious diseases – are also much lower for those with mental illness, with vaccine-preventable deaths five times higher and vaccine-preventable hospitalisations seven times higher for those with mental illness than the general population.
The fact that people living with mental illness are not getting basic, inexpensive health-preserving and life-saving vaccinations shows how far away we still are from achieving equity of access and health outcomes, he said.
But Roberts also pointed to many successful initiatives in recent years, with Equally Well goals now on the national agenda, and clinicians, services and advocacy bodies implementing hundreds of initiatives to address the physical health of those with mental illness.
Our motto is for people and organisations to do ‘what they can, where they can, when they can’, whether that be employing someone to focus on physical health or a state government implementing a comprehensive Equally Well strategy, he said.
Clinicians had told EWA of people living with undiagnosed chronic illness for decades who had been successfully treated simply because the mental health team started a program to also focus the physical health of those with mental illness, not just their psychiatric diagnosis.
Gym power
One initiative successfully boosting physical health for people with mental illness is an innovative gym and swim program at an aquatic centre at Marrickville in Sydney’s inner west.
Barriers stopping people with mental illness from accessing gyms and pools can be financial and emotional, with body image linked to medicine-induced weight gain, and lack of confidence being some of the hurdles.
“I know with my lived experience being able to go to the gym with people who look like me, and have similar experiences to me, made me feel more comfortable in the gym,” Katie Thorburn, a lived experience peer support worker with Marrickville CORE Mental Health Team in inner west Sydney, told Croakey.
Thorburn, who will present her team’s findings at the EW symposium, is part of a team from the Sydney Local Health District (SLHD), which put together a program that made going to the gym a fun and safe experience for people with mental illness, and, most importantly, built a community.
The Gym and Swim Program (GSP), an initiative of the Living Well Living Longer team at SLHD, boosted confidence and fitness levels, with many participants going on to sign up for regular gym sessions.
Based at the Annette Kellerman Aquatic Centre, the program has exercise physiologists working alongside peer support workers to provide personalised programming for participants, all within a low-cost, flexible membership environment.
It’s one of many initiatives to address the dramatic life expectancy gap between people living with a mental illness – 80 percent of whom also have a serious physical health condition – and the general population. For those with severe mental illness life can be shortened 14-23 years.
Thorburn said the supportive environment was key to the program’s success, with participants waiting for each other, walking in together, and urging each other on while using the equipment.
“It’s great to be doing exercises with other people who might have similar mobility …. with people who understand the struggles with medication and related health issues.”
Thorburn backs wider use of programs such as the Gym and Swim, featuring collaboration between local organisations, exercise physiologists and – most importantly – lived experience peer workers to ensure the needs of consumers are understood.
Since it began in 2018, the program’s 106 participants have completed 1,323 exercise sessions, with 25 attending more than 10 sessions and others transitioning to general community exercise services, something Thorburn views as a mark of the program’s success.
One participant – nicknamed the ‘godfather’ – had gone on to win a six-week general fitness challenge at the centre, and others had started doing their own gym sessions.
Thorburn said the GSP broke down the barriers to using a gym by creating a supportive community, with participants ringing each other to see who was going and how they were feeling
“It became an organic thing – not just a program that relies on the facilitators but something that becomes self-sustaining,” said Thorburn.
Peer support
Conference participants will also hear about research on a physical activity intervention program for emergency service workers, which found peers crucial in engaging and motivating participants.
A workforce regularly exposed to trauma – and even more so through the last two years of bushfires, COVID-19 and devastating floods – emergency service workers such as police, paramedics, fire fighters and State Emergency Service volunteers, are at a heightened risk of poor mental and physical health.
In Australia, one emergency service worker takes their life every six weeks and emergency service workers are twice as likely to experience suicidal thoughts as the general population. In addition, one in 10 develop post-traumatic stress disorder (PTSD).
Dr Grace McKeon from the School of Psychiatry at the University of NSW, who will deliver the paper on behalf of the multi-university research team, told Croakey that despite the mental health risks, there are significant barriers to emergency workers getting the healthcare they need.
These included a workplace culture built around being ‘tough’.
To address this, McKeon’s team recruited peer facilitators – mainly former emergency service workers who had been diagnosed with PTSD – to work with exercise physiologists in delivering an online physical activity intervention program to current and ex-emergency service workers.
“We know that emergency service workers with PTSD are not only experiencing high rates of mental health issues but high rates of diabetes and cardio-vascular disease and that’s what drove us to deliver this intervention.”
To help recruit participants, the research team enlisted the ex-service community organisation, ‘Behind the Seen’, founded by a former fire fighter – who left the service with PTSD – and his partner, a social worker.
Delivered online to ensure access for those in remote and regional settings, participants were given Fitbits to monitor their activity, and encouraged to engage in any physical activity they enjoyed – be that lifting weights, walking, riding a bike or other forms of exercise.
McKeon said the program significantly eased levels of psychological distress but one of the most rewarding outcomes was seeing strong friendships forged.
The peer facilitators, with their credibility and knowledge, were critical in understanding how the participants were feeling – if they didn’t feel like exercising on a particular day and normalising those ups and downs, she said.
In feedback, the peer facilitators, many of whom had lost part of their identity due to PSTD-related job loss, said they found participation rewarding, boosting their own mental and physical health.
Keynote speakers
The symposium aims to prioritise First Nations people, LGBTQI+ people, and those from culturally diverse backgrounds, and to focus on consumer and carer co-design in the planning and rollout of programs.
Keynote speakers include:
- Professor David Castle, Scientific Director of the Centre for Complex Interventions (CCI) at the Centre for Addictions and Mental Health (CAMH), Toronto, Canada, on a workforce to help consumers
- Assistant Minister to the Prime Minister for Mental Health and Suicide, David Coleman
- Cardiologist and Associate Professor David Colquhoun from the National Heart Foundation and
- Caro Swanson from Equally Well NZ with a consumer perspective
- Andy Bell from the Centre for Mental Health UK.
Concurrent sessions will cover primary care, partnerships, prevention, co-design, models for online care, chronic care, physical activity and diet, care coordination and lifestyle.
More details
To register for the symposium follow this link.
On Twitter follow: #EquallyWellAu22
Also follow this Twitter list of participants.
Bookmark this link to track the Croakey Conference News Service coverage of the conference, with Cate Carrigan reporting. Also see our coverage of the 2019 event.
