Enlisting “health coaches” to see if they can boost physical health and teach self-management in those overwhelmed by mental health issues is the key part of a University of WA trial aimed at tackling alarming death and disease rates.
The Healthway-funded three-year trial is designed to harness a strong will among people with a mental illness to switch to a healthier lifestyle and addresses the life expectancy gap highlighted in the 2001 Duty to Care Report.
This revealed that for WA people with mental illness the mortality and morbidity from all major health conditions was two to three times the rate of those in the general population.
The life expectancy gap is reported to be as high as 16 years for male psychiatric patients and 12 years for females, with 78 per cent of excess deaths being due to physical health conditions including cardiovascular disease and cancer.
Known as HealthRight II, the trial will compare with a control group the health gains in 20 people with schizophrenia, severe anxiety or major depression who are backed up by a health coach. All are living in the community in the Perth and Wheatbelt regions.
“It is presumed that those with severe mental illness cannot make decisions regarding their health — that is not true at all,” senior research officer with the UWA school of psychiatry and clinical neurosciences Vivien Kemp said.
“They like making decisions in consultation with people they trust. We want to show that if people are given support, they can make lifestyle changes that are health protective.”
The appointed health coaches are support workers with community mental health organisations but have no medical background.
They will help with health motivation, problem solving, goal setting, planning and advocacy, using the South Australian Flinders Program of Chronic Condition Management which has already had great success with respiratory conditions, diabetes and problem gambling.
If successful locally, the health coach program could be used Statewide. The current trial follows UWA’s HealthRight I trial which focused on assisting people living with mental illness to access GPs, to attend to immediate physical health needs and reduce risk factors.
Goals already set by WA trial participants included giving up smoking, learning to cook, getting to the pool for a swim and walking more, Ms Kemp said.
Past barriers to healthy living included their short-term focus on finding immediate ways to boost mood and feel better, such as eating sweet treats in a cafe, and deferring their physical health to “worry about later”.
Other complicating factors had been the lack of co-ordination between health services, medication side effects increasing appetite and weight gain, aches and pains presumed to be related to mental illness rather than physical illness, and using cigarettes, alcohol and illicit drugs to attempt to counteract the side-effects of medication.
The program is overseen by UWA professor of psychiatry Mohan Isaac from the school of psychiatry and clinical neurosciences.
The support workers taking part are from Richmond Fellowship, Ruah Community Services, Uniting Care West and Mental Illness Fellowship WA
Success in giving up
The British Medical Journal recently highlighted the successes of the Flinders program with “difficult” cases.
It enabled a 45-year-old single, Australian man with chronic paranoid schizophrenia, complicated by longstanding drug abuse, to give up a 100-cigarettes-a-day habit within a week and remain off cigarettes for two years.
The man had been spending up to half of his government pension on cigarettes and going without food.
He quit after drawing up a health plan with his “health coach” and the local deli proprietor. He also built up a routine of walking his dog in the evenings and set up a care plan with his GP.
His psychiatrist was amazed by the progress, previously perceiving the patient as having little self-control.
For several years, the man had been on a treatment order due to not taking prescribed medication.