Come on! Let’s do something about this! – Sarah O’Connor

On the 23rd of February this year my colleague and I went to a summer school course at the University of Otago medical school in Wellington. The University’s Public Health Summer School ran this course. It was called “The physical health of tangata wahiora/mental health service users” and came about through the Equally Well project. It brought together a range of people from around the country from different sectors who were all wanting to find out more about how we can collectively address the physical health disparities faced by tangata whai ora. There were many people in the room including service users, research fellows, peer support workers, service user academics, mental health nurses, policy advisors, general practitioners, psychiatrists and epidemiologists.

This group of people were at summer school because of this reason:

Persons diagnosed with mental health “disorders” die 10-25 years earlier than the general population.

The first time I read that statistic several years ago it took my breath away. It still does. There are quite a few things you can do when you find out things like this. Sweep it under the carpet, bury your head in the sand, pretend it’s not happening or throw your hands up in the air and say it’s too hard! Or, like this group of people in the room at summer school, you can collectively agree, this is appalling, so what we can do?

The physical health of tangata wahiora/mental health service users
Dr Ruth Cunningham an epidemiologist and public health physician at University of Otago, Wellington proposed the idea to hold a summer school course on this topic. It was met with a lot of interest by the people mentioned earlier. Ruth’s main area of research is the physical health of people with experience of mental health conditions in New Zealand. As one of the first speakers, Ruth illustrated that the causes of premature death of mental health service users primarily include physical health conditions such as cancer, cardiovascular disease, as well as suicide and other natural causes.

IMG_1772.jpg

In this powerpoint slide, that comes from Ruth’s researched published in NZMJ 2014 127:1394, there is a pie chart that shows the top three causes of premature death for women using mental health services are cancer, suicide and other natural causes, and a pie chart showing for men the top three causes are cardiovascular disease, suicide and other natural causes.

It Takes Time
At the course, Carolyn Swanson, Service User Lead at Te Pou o te Whakaaro Nui (Te Pou), made the point that it’s really important to take time to look at a person’s health as a whole. That means not to rush things and to investigate all physical and mental health needs thoroughly so that a person can get their best quality of life.

A discussion that arose from the presentation of Professor Tony Dowell, of Otago University at Wellington, who is also a general practitioner, was that time spent in GP consultations could be longer. Professor Dowell also made the point that this time also needs to be effective and useful for the person who comes to see their GP; longer consults don’t always mean better consults.

Time Well Spent
An example of time well spent was a recent research project led by Dr Anthony O’Brien, Senior Lecturer, School of Nursing at the University of Auckland, and nurse specialist in liaison psychiatry. The project came from the question of how to develop a screening instrument to measure metabolic syndrome in people who are prescribed neuroleptic/antipsychotic drugs. Psychotropic medications, in particular neuroleptics/antipsychotics, can cause metabolic syndrome, typically including central obesity, dylipidaemia (overproduction or deficiency in cholesterol), insulin resistance and hypertension (high blood pressure). These conditions can increase the risks of mental health service users developing diabetes and cardiovascular disease.

Many people are aware that taking neuroleptic/antipsychotic medication can put people at risk of developing metabolic syndrome and Tony’s project checked out what policies each of our DHBs have for monitoring it. What he discovered was that the DHBs across the country all had different metabolic screening policies, and some DHBs didn’t come back with any policy at all. The policies that do exist tend to be complex. Sometimes there were separate policies for different types of these medications and there was no one policy around how to address the issue when metabolic syndrome was identified.

Recommendations
Through the work on this project, Tony has come up with some great recommendations. Tony recommends that all DHBs have a one page policy for screening metabolic syndrome including:

  • Factors to include when measuring metabolic syndrome
  • Frequency of when screening is to be done
  • Key interventions if metabolic syndrome is identified
  • Identification of the clinician responsible for ensuring that monitoring is done

In addition, DHBs should have a metabolic screening register shared by primary and secondary services. This initiative would be nurse-led, and not just by mental health nurses.

At the Equally Well evaluation symposium held at Otago University the next day this idea was further developed into a proposal that empowers mental health service users to engage with metabolic monitoring as part of their relationship with the health workers they regularly see.

A key part of this draft evaluation plan was consideration of the various groups involved. At the centre of this plan is the service user who is prescribed neuroleptic/antipsychotic medication and the health practitioner who prescribed them. Professional groups who can prescribe psychiatric medications include general practitioners, nurse practitioners, mental health pharmacists and psychiatrists, though some of these groups need people to get extra registrations before they are able to do so. The way our mental health system works is that the prescribers are also the people that a service user is likely to spend the least amount of time with.

That’s why making metabolic monitoring a nurse led practice makes sense. While the prescriber has the responsibility of checking that the monitoring has been done before they sign off on the next prescription, it is nurses who get to spend more time with a person, and who can support the relationship between the service user and the prescriber.

The Ministry of Health also needs to be involved in this plan, as this all requires a national shared electronic health record. At a practical level, if a service user’s records sit in a paper file at the DHB, it is of no use to them if they get their physical health care provided by a nurse at their GP’s medical centre. Also, people move across DHB boundaries, particularly in larger centres like Auckland where there are many DHBs in operation.

I think the work Tony and his colleagues have done ticks a lot of boxes. It’s a practical intiative, it’s straight forward, effective and best of all it looks easy to engage with. I look forward to seeing this implemented.

In case you need reminding…

Persons diagnosed with mental health “disorders” die 10-25 years earlier than the general population.

 We have to do something about it. It’s about time.

Equally Well
Equally Well is a collective movement that has Te Pou as the leading partner. It is a group of over one hundred organisations that have committed to improving the physical health outcomes of people who experience mental health conditions and/or addictions. Equally Well is about taking the initiative and working together for change. Those involved span the health, mental health and social sectors, and include community organisations, mental health and addiction NGOs, primary care, district health boards, medical colleges and education providers. Mental health and addiction service users are important partners in this work.

If you want to find out more about Equally Well you can visit http://www.tepou.co.nz/initiatives/equally-well-physical-health/37 Here you will find information about the Equally Well initiative, resources, the team behind it, current research, information about the organisations who endorse Equally Well and how to join. Through the on-line forum Loomio, organisations and individuals can share what is happening in the Equally Well space. It’s a great platform for a wide range of people with the interest and the ability to co-create change in this area.

Special thanks to one of the Equally Well leaders, Helen Lockett, who tirelessly works in this area.

 

 

2 thoughts on “Come on! Let’s do something about this! – Sarah O’Connor

  1. Good to see some recognition of issues caused by psych drugs. Perhaps next somebody could look at the increased risk of suicide for a person either taking psych drugs or trying attempting to stop taking them.

  2. Many thanks for the write-up Sarah. I was really disappointed not to be able to attend (I was in Auckland for a meeting) and your post at least gives me a taste for what I missed! Your post is also so clear and useful, and manages to present some pretty complicated stuff in a very readable and understandable way. Such an important topic, and Equally Well are so lucky to have a firecracker like Helen leading work in this area. And advocates like you involved!

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