Informed, engaged communities for health

Filter by Categories
#PHAAThinkTank2023
Aged care
Budgets
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
Climate and health
National Health and Climate Strategy
#HealthyCOP28
Climate emergency
Heatwaves
Healthcare sustainability
#CoveringClimateNow
#HealthyCOP27
#HealthyCOP26
COVID collection
Long COVID
COVID-19
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
#GreenHealthForum23
#hpsymposium2023
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
Choosing Wisely National Meeting 2022
Equally Well 2022 Symposium
GiantSteps22
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
#PHAAThinkTank 2022
Summer reading 2022-2023
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Discrimination
Racism
Justice and policing
Poverty
Newstart/JobSeeker
Education
Housing
Internet access
Justice Reinvestment
Social policy
Commercial determinants of health
fossil fuels
Alcohol
Digital platforms
Food and beverages
Sugar tax
Tobacco
Vaping
Plain packaging
Gambling
Pharmaceutical industry
Arms industry
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Uluru Statement
The Voice
Community controlled sector
Cultural determinants of health
Cultural safety
Social and emotional wellbeing
Indigenous education
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Consumer health matters
Cancer
Cardiovascular disease
Chronic conditions
Non communicable diseases
Diabetes
Oral health
Disabilities
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
Medical marijuana
Mental health
Suicide
Trauma
LGBTQIA+
HIV/AIDS
Women's health
HRT
Abortion
Men's health
Youth health
Child health
Pregnancy and childbirth
Organ transplants
Pain
Sexual health
Infectious diseases
Influenza
Mpox
Swine flu
Death and dying
Euthanasia
Global health matters
Global health
WHO
Conflict and war
Asylum seeker and refugee health
#WorldInTurmoil
Ebola
NHS
Health policy and systems
MyMedicare
Health reform
Workforce matters
Health financing and costs
Health regulation
Strengthening Medicare Taskforce 2022
Co-design
TGA
Royal Commissions
National Commission of Audit 2014
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Healthcare
Primary healthcare
cohealth
Social prescribing
Rural and remote health
General practice
International medical graduates
Primary Health Networks
NDIS
Nursing and midwifery
Australian Medical Association
Allied healthcare
Pharmacy
Paramedics
Pathology
Naturopathy
Hospitals
Emergency departments and care
Palliative care
Safety and quality of healthcare
Adverse events
Choosing Wisely
Co-payments
Out of pocket costs
Complementary medicines
Conflicts of interest
Health ethics
Digital technology
Telehealth
E-health
Equally Well
Health Care Homes
Medicare Locals
MyHospitals website
Screening
Surgery
Tests
Media and health
Media-related issues
Public interest journalism
Misinformation and disinformation
Social media and healthcare
Health & medical marketing
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Artificial intelligence
Public health
Prevention
Health inequalities
Human rights
Health in All Policies
Health impact assessment
Legal issues
Australian Centre for Disease Control
VicHealth
Health literacy
Health communications
Vaccination
Air pollution
Physical activity
Sport
Obesity
Road safety
Transport
Gun control
Illicit drugs
Injuries
Marriage equality
Occupational health
Violence
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Government 2.0
Web 2.0
Nanny state
National Preventive Health Agency
Research matters
Health and medical research
#MRFFtransparency
Evidence-based issues
Cochrane Collaboration
Health and medical education
NHMRC
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2021
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2019
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010
Support non-profit public interest journalism
Filter by Categories
#PHAAThinkTank2023
Aged care
Budgets
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
Climate and health
National Health and Climate Strategy
#HealthyCOP28
Climate emergency
Heatwaves
Healthcare sustainability
#CoveringClimateNow
#HealthyCOP27
#HealthyCOP26
COVID collection
Long COVID
COVID-19
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
#GreenHealthForum23
#hpsymposium2023
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
Choosing Wisely National Meeting 2022
Equally Well 2022 Symposium
GiantSteps22
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
#PHAAThinkTank 2022
Summer reading 2022-2023
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Discrimination
Racism
Justice and policing
Poverty
Newstart/JobSeeker
Education
Housing
Internet access
Justice Reinvestment
Social policy
Commercial determinants of health
fossil fuels
Alcohol
Digital platforms
Food and beverages
Sugar tax
Tobacco
Vaping
Plain packaging
Gambling
Pharmaceutical industry
Arms industry
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Uluru Statement
The Voice
Community controlled sector
Cultural determinants of health
Cultural safety
Social and emotional wellbeing
Indigenous education
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Consumer health matters
Cancer
Cardiovascular disease
Chronic conditions
Non communicable diseases
Diabetes
Oral health
Disabilities
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
Medical marijuana
Mental health
Suicide
Trauma
LGBTQIA+
HIV/AIDS
Women's health
HRT
Abortion
Men's health
Youth health
Child health
Pregnancy and childbirth
Organ transplants
Pain
Sexual health
Infectious diseases
Influenza
Mpox
Swine flu
Death and dying
Euthanasia
Global health matters
Global health
WHO
Conflict and war
Asylum seeker and refugee health
#WorldInTurmoil
Ebola
NHS
Health policy and systems
MyMedicare
Health reform
Workforce matters
Health financing and costs
Health regulation
Strengthening Medicare Taskforce 2022
Co-design
TGA
Royal Commissions
National Commission of Audit 2014
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Healthcare
Primary healthcare
cohealth
Social prescribing
Rural and remote health
General practice
International medical graduates
Primary Health Networks
NDIS
Nursing and midwifery
Australian Medical Association
Allied healthcare
Pharmacy
Paramedics
Pathology
Naturopathy
Hospitals
Emergency departments and care
Palliative care
Safety and quality of healthcare
Adverse events
Choosing Wisely
Co-payments
Out of pocket costs
Complementary medicines
Conflicts of interest
Health ethics
Digital technology
Telehealth
E-health
Equally Well
Health Care Homes
Medicare Locals
MyHospitals website
Screening
Surgery
Tests
Media and health
Media-related issues
Public interest journalism
Misinformation and disinformation
Social media and healthcare
Health & medical marketing
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Artificial intelligence
Public health
Prevention
Health inequalities
Human rights
Health in All Policies
Health impact assessment
Legal issues
Australian Centre for Disease Control
VicHealth
Health literacy
Health communications
Vaccination
Air pollution
Physical activity
Sport
Obesity
Road safety
Transport
Gun control
Illicit drugs
Injuries
Marriage equality
Occupational health
Violence
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Government 2.0
Web 2.0
Nanny state
National Preventive Health Agency
Research matters
Health and medical research
#MRFFtransparency
Evidence-based issues
Cochrane Collaboration
Health and medical education
NHMRC
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2021
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2019
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010

Profiling diverse efforts to improve the physical health of people with mental illness

Eighty key health agencies and organisations have signed the Equally Well Consensus Statement, formally pledging to improve inequalities that lead to poor physical health outcomes for people with mental illness.

These supporters include all jurisdictional health departments, state mental health commissions, medical and nursing colleges, carer and consumer organisations, Primary Health Networks (PHNs), peak bodies and community managed organisations.

The recent #EquallyWellAust symposium in Melbourne sought to highlight efforts to put those commitments into action and find ways to build momentum.

Marie McInerney, who covered #EquallyWellAust for the Croakey Conference News Service, reports below.


Marie McInerney writes:

Around Australia, strong efforts are being made to improve the physical health of people with mental illness, through changes in clinical practice, policy and education.

A number were showcased at the recent #EquallyWellAust symposium in Melbourne, the first time that agencies and organisations signed up to the 2017 Equally Well Consensus Statement have come together to discuss that commitment.

The event brought together policy makers, academics, clinicians, service practitioners and people with lived experience of mental illness to showcase success and look to identify and address barriers to implementation of Equally Well priorities.

Together they highlighted the need to break down silos between physical and mental health care, to address the stigma that many health professionals still have about mental illness, and to tackle ‘diagnostic overshadowing’, where health professionals see physical health issues only through a mental health lens.

The forum also heard that targeted lifestyle interventions can work for mental health clients and staff, but that a focus on weight alone does not work and is also not fair for so many people with mental illness whose medications promote significant weight gain.

In an interview at the end of the event, Dave Peters, consumer representative and co-chair of the Equally Well Implementation Committee, told Croakey that the forum was an important step in itself, in providing a platform to “normalise” the issue.

But acting on those concerns raised was the critical next step, especially given that Equally Well has just a few paid support staff and is led by people with other day jobs.

“Everyone is really enthusiastic about the need for change but actually making it happen in a deliverable timeframe is the next challenge,” he said.

Metabolic and medication reviews

In just six months, a project in regional New South Wales has dramatically increased the numbers of people in community mental health settings who are having regular metabolic and medication reviews. The proportion of patients having these reviews, which check for adverse reactions to medications and treatment, jumped from less than 10 percent to nearly 70 percent.

The project was part of a multidisciplinary effort by the Western NSW Local Health District in Orange to better manage the physical health of patients in the community and avoid acute hospital admissions through better integration of care.

Steven David, the area’s Senior Clinical Pharmacist Mental Health – one of a handful of specialist mental health pharmacists in NSW – said the project arose from growing concern at the significant side effects of antipsychotic medications, notably obesity, diabetes and increased risk of cardiovascular disease.

“We’re treating all these patients for their illnesses by reducing the psychotic symptoms but we’re also killing them slowly through this emergence of these cardiovascular risk factors and diseases,” David told Croakey at the symposium.

Baseline studies found that less than eight percent of community mental health clients had an accurate medication history and less than five percent were documented to have recently had cardiometabolic screening, to look for a cluster of risk factors associated with development of cardiovascular disease, including diabetes, raised cholesterol and high blood pressure.

That was despite strong evidence that people with psychosis face a reduction in life expectancy of up to 20 years compared with the general population.

David told the symposium that the project, Integrative multidisciplinary services: key towards improvement in mental health delivery, brought him together with nurses, social workers, GPs, dietitians, and psychiatrists to try to address gaps in medication and metabolic reviews and between hospital, community mental health and local GP services.

For the 80 clients involved over the six-month project, metabolic and medication reviews rose to 67 per cent, and the project identified 13 medication-related errors and six incidents of adverse drug reactions.

David told of one patient who was being managed on a mood stabiliser and reported in multiple health interactions that she was experiencing worsening myopia.

She had changed her prescription glasses about six times in two years but nothing had been done to investigate why she needed so many replacements – until the project team reviewed her care, highlighted the problem, and gave her different medication “and better quality of life”.

David told Croakey that pharmacists could play a critical role in improving the physical health care of people with mental illness, given their frontline role in taking a history of medications and previous adverse events.

But he said most community pharmacists need more training to be able to identify issues and to address stigma that made many uncomfortable or fearful dealing with people with mental illness.

Watch this interview with Steve David

Psychiatrists as advocates

Psychiatrist Dr Kym Jenkins told the symposium she had received a personal and powerful lesson some years ago on the risks of ‘diagnostic overshadowing’ – where a person with a mental illness receives inadequate or delayed treatment for physical health issues because a health professional attributes their physical symptoms to their mental illness.

Jenkins, president of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), said her mother experienced various mental health issues throughout her life. She said:

Shortly after my father died her moods seemed to be very flat. She wasn’t able to enjoy anything, she wasn’t smiling when the rest of the family were laughing.

We put it all down to grief and her dipping back down into another episode of depression, until I took her to a GP who, as soon as we walked into the room, said, ’But your mum’s got Parkinson’s disease!’”

It was, Jenkins said, a huge wake up call.

Here am I, as a psychiatrist, seeing it through my lens of depression and mental illness, completely missing the fact that my own mum had Parkinson’s Disease.

What a huge bit of diagnostic overshadowing that was.”

Jenkins said the RANZCP realised about five years ago that it needed to play a much larger role in mental health advocacy and one of its first campaigns was about the physical health of people with serious mental illness.

It sought to draw the attention of governments and policy makers to the reduced life expectancy of most people with serious mental health issues, and to work with its own committee and members to drive change in practice, she said.

“I think we have a really important role in addressing stigma, monitoring side-effects of all medications, not just antipsychotics, advocating and helping patients in lifestyle interventions,” she said.

“We need integration and communication with other health practitioners. I can’t underscore that enough, and we need to advocate for systemic change.”

To that end, the college published four reports that documented the issues and economic cost of serious mental illness in physical health terms.

It has also published an expert consensus statement for the treatment, management and monitoring of people with serious mental health illness, and included physical health in new clinical practice guidelines and at Your Health In Mind.

But she agreed with audience members that there was continuing need for system change, including where most public hospital psychiatric appointments last for only 15 minutes.

Similar time and funding pressures and a relative lack of evidence base meant that important ‘talk therapy’, like cognitive behaviour therapy, also did not get prescribed as easily as medication, she said.

Speaking later to Croakey, Jenkins acknowledged grave concerns expressed at the symposium by people with lived experience of mental illness about the impact of mental health medications and treatments on their physical health, and stressed the importance of supported decision-making. She said:

Whenever considering medication it’s got to be as far as possible a joint decision.

With any intervention in medicine, particularly medication, the patient needs to be fully informed and aware of the pros and cons and benefits and side effects and balancing up the right thing for that person at the right time. And (of) being given options and choices.”

See our interview below with Jenkins

Recruiting nurses to the cause

Australia’s 410,000 nurses and midwives should be a priority focus in improving the physical health of people with serious mental health issues, according to Adjunct Associate Professor Kim Ryan, CEO of the Australian College of Mental Health Nurses (ACMHN).

Kim Ryan

Ryan told the Equally Well symposium nurses and midwives are often the first point of contact for many people with mental health concerns in the health system but are not necessarily alert or skilled to help manage mental health issues.

Ryan is hopeful the current review of registered nurse accreditation standards will strengthen the mental health component of undergraduate studies “so we’ll have all nurses coming out of uni with a better understanding of mental health and the intersection (with physical health for people with serious mental health issues)”.

The ACMHN has also developed a mental health scope of practice for general practice nurses, and introduced five online modules, starting with ‘mental health first aid 1.01’, to help them be more alert to the issues.

“For example, we do know that men over 45 who have a heart attack are going to have an increased risk of suicide that stays high for 12 months,” she said.

“If their GP and practice nurses who are checking their blood pressure don’t know to ask about depression, that’s going to get missed, so it’s really important we get general practice nurses to know about the incidences and be confident to ask the questions and do something with it.”

Since the modules were introduced in July 2018, they have been viewed by more than 4,100 people, enrolled in by 2,000 people and completed by 1500. The College has also developed a physical health care check reminder card to go with the ACMHN’s popular Mental Status Examination (MSE) cards that are attached to ID lanyards and used by mental health nurses, primary care nurses, student nurses and others in their daily practice. More than 5,000 cards have been distributed since October 2018.

Lifestyle interventions

The symposium also heard about a lifestyle intervention program run by the South Eastern Sydney Local Health District (SESLHD) that has reported significant and long-term physical health gains.

Andrew Watkins, co-developer and clinical lead of the Keeping the Body in Mind (KBIM) program, said it emerged out of concern among staff that young people with early psychosis experienced significant weight gain after beginning treatment.

“We were seeing their body shapes changing in a matter of weeks or months,” he said.

Watkins’ first response was to bring in a soccer ball from home and to go down to the local park for a kick with some of the young people, but the program grew. It added first a cooking club, converted a room into a gym, and then developed into a 12-week KBIM program run by a team of four – a clinical nurse consultant, exercise physiologist, dietitian and a peer support worker – which built in evaluation and achieved impressive results.

Where the average weight gain in the first two years of mental health treatment for young people with early psychosis is 12 kilograms, young people in the KBIM program were “weight neutral”, or had no change to their waist circumference, after two years – exceeding the expectations of the team.

“Instead of setting up people at the start of mental health treatment for a lifetime of physical poor health we were actually setting them up for lifetime of healthy living,” Watkins said, noting that the first three months of treatment was the critical time.

Watkins said his hope is that mental health services around the world will sign up to the Healthy Active Lives (HeAL) international declaration, aiming for health care professionals and their organisations to work together to protect and maintain the physical health of young people experiencing psychosis.

But while there is growing evidence of the benefits of programs like KBIM, which is now run by four teams and for adults at the SESLHD, Watkins said traditional “silo” thinking between physical and mental health practice remains a barrier for many services.

To address that, the KBIM team did a staff intervention, called Keeping Our Staff in Mind (KOSIM). It delivered a mini five-week version of the intervention, to try to shift the culture among staff, to give them the confidence to know they could and should intervene on some physical health issues – like a patient drinking two litres of Coke a day – without leaving it to a dietitian or other specialist.

Watkins said staff members’ health improved, and they gained confidence and knowledge about clients’ physical health issues. He said:

Most important was these staff members now feel this is an important area (of their work).

Culture change is perhaps the hardest part of service delivery. Staff are working in a system where they already feel burdened, so to come in and say ‘we want you to do physical health care as well’ is a massive challenge.”


From Twitter


Bookmark this link to follow Croakey’s #EquallyWellAust stories.