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My Story: Jane, caring for a son with schizophrenia
In our series of videos for Mental Health Month watch this engaging interview with Jane, who cares for her son, diagnosed with schizophrenia.
Living Well, Living Longer (LWLL) is a district-wide program to improve the health and well-being of people living with severe mental illness, who have a reduced life expectancy of 14-23 years compared to the general population. This is due mainly to low rates of treatment for coexisting physical health conditions, leading to cardiovascular disease, respiratory disease and cancer which together account for around two thirds of the premature mortality. The LWLL program therefore aims to guide community mental health consumers through the four stages of screening, detection, initiation of treatment and ongoing management for these coexisting conditions.
SLHD is committed to ensuring that people with severe mental illness have equitable access to the same high quality health care as the general population. This includes access to primary and secondary care and highly specialised health care.
The LWLL strategy includes targeted activities and initiatives to improve health and well-being, as well as ensuring that all mental health consumers are offered screening for metabolic syndrome. Metabolic syndrome is cluster of dangerous cardiovascular risk factors including abdominal obesity, raised plasma glucose, raised cholesterol, and elevated blood pressure.
Screening for cardiovascular risk factors must be followed by review, interpretation of data and formulation of an appropriate multidisciplinary intervention plan of treatment. Regular monitoring and follow up is crucial to ensure that interventions are implemented and that their effect is quantified. The LWLL initiatives are a driving force to improving the understanding of cardiometabolic risk factors amongst mental health clinicians and consumers alike. The breaking down of barriers and changing the culture to address the physical health of our consumers is imperative.
ccCHiP Cardiometabolic Health Clinics
Cardiometabolic disorders are the fastest growing chronic health issue in the world, and they disproportionately affect people living with a severe mental illness. The Collaborative Centre for Cardiometabolic Health in Psychosis (ccCHiP) is a multidisciplinary clinic that includes psychiatry, cardiology, endocrinology, dentistry, dietetics, exercise physiology, sleep, smoking cessation and nursing. The ccCHiP clinic provides a consultative service to our consumers, focussing on cardiovascular risks. The clinic is an integrated service for screening, detection, management and follow up of cardiometabolic disorders among patients with severe mental illness.
The ccCHiP clinic places consumers at the core of the business and aims towards providing an accurate and efficient service to all who are referred. In order to deliver this, it is essential that as much accurate information is provided efficiently and with ease. ccCHiP is working with the community care coordinators and GPs to provide an electronic referral pathway when referring to the clinic. This electronic referral pathway will provide ease of referral and automate important information such as patient demographics and pathology results to not only increase referral efficiency, but also increase data accuracy and minimise transcription errors.
Mental Health Shared Care
Mental Health Shared Care involves improved integration of physical and mental health care, with collaboration between the mental health consumer, their preferred GP and the mental health service. The roles and responsibilities in Mental Health Shared Care are guided by a shared care checklist, which is the standardised Mental Health Shared Care plan used across the district. Mental Health Shared Care is facilitated by specialist shared care liaison CNCs who foster working relationships with local GPs to ensure the increased participation of mental health care coordinators in establishing Mental Health Shared Care plans.
Mental Health Shared Care ensures updated information about physical and mental health reviews and prescribed medication are communicated and shared within a comprehensive annual cycle of care. It is supported by peer support workers who work with consumers to achieve healthy lifestyles and to access medical care.
The Mental Health Shared Care program is a partnership between SLHD and Central and Eastern Sydney Primary Health Network.
Healthy Lifestyle Clinicians
Since 2015, LWLL has been delivering dietitian and exercise physiology services directly to the consumers of the SLHD community mental health service. This continues to include groups, individual sessions and home visits as well as integration with ccCHiP and collaboration with the many and varied mental health teams across the district.
The exercise physiologists and peer support workers co-facilitate two weekly 'gym & swim' groups at the Annette Kellerman Aquatic Centre. This has been successful in giving consumers the skills, knowledge and confidence to attend the gym & pool independently.
The aim of the healthy lifestyle clinicians is to work with consumers to develop individualised achievable and relevant health behaviour change goals and support the practical strategies required to achieve these.
Stopping smoking not only improves physical health but mental health as well. Some people confuse withdrawal symptoms with worsening mental health; however quitting smoking is not harmful to mental health recovery. In fact, quitting smoking usually reduces anxiety, depression and stress levels and improves overall quality of life.
LWLL has appointed smoking cessation officer who, in collaboration with drug health services, can provide community based interventions for consumers receiving care coordination across the district. Additionally, some care coordinators within the mental health care coordination teams have been accredited to provide smoking cessation interventions and dispense Nicotine Replacement Therapy (NRT).
Peer Support Workers
Drawing on their lived experience of mental health challenges and recovery, peer support workers are integral members of the team. They play a pivotal role in addressing the physical health care requirements of consumers by re-iterating the importance of physical health check-ups. They play a supporting role by attending medical appointments with the consumer and work within the multidisciplinary team to ensure that recommendations and tests are followed up. Some peer workers are involved in hosting physical activity groups like walking groups, smoking cessation groups or yoga. Peer support workers assist others to gain their own sense of confidence and hope about their journey of recovery.
The oral health of people with a mental illness is often poor and their dental needs can be complex. There is a strong link between poor dental hygiene and an increased risk of cardiometabolic health issues. Regular oral health checks are an important mechanism for identifying early signs of dental decay, or addressing more complex dental issues that have been untreated. Dental appointments also provide an opportunity for education about oral hygiene, and maintenance of good oral health.
Dental appointments can be stressful for everyone, let alone for those suffering with severe mental illness who are sometimes incorrectly considered as a low priority. Assisting consumers to attend dental appointments through the use of a peer support worker or accompaniment by a care coordinator can assist in alleviating anxiety and reduce incidents of consumers failing to attend appointments.
The LWLL program has arranged for two free oral health assessments per week at both Croydon and Marrickville health centres, with free dental treatment provided subsequently as required. All consumers of the service are eligible via care coordinator referral. Those who have received an oral health review at ccCHiP should not require an initial assessment appointment but are still eligible for free treatment.
Community Health Projects
There are a number of locally developed community based strategies and projects that fall under the umbrella of LWLL due to their shared objective of improving the health and well-being of consumers living with severe mental illness. Many of these groups are facilitated by peer support workers or care coordinators locally, within the community mental health teams.
Education and Training
Our workforce is being trained and supported to improve their knowledge, skills and confidence in identifying, treating and managing the health needs of mental health consumers.
Continuing Professional Development events for GPs, practice nurses and allied health are held across the district, in collaboration with Central and Eastern Sydney Primary Health Network. These focus on the complex physical health needs of mental health consumers.
The Collaborative Centre for Cardiometabolic Health (ccCHiP) clinic has developed a continually evolving training framework delivered by all disciplines within ccCHiP. Presentations have been delivered both within Sydney Local Health District as well as additional presentations to interested external stakeholders.