Physical Health

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Introduction
Publications
Research and Practice
Videos and Presentations
Organisations
Links


Introduction

"The evidence is now clear – weight gain, cardiovascular risk and metabolic disturbance commonly appear early in the course of emerging psychosis and are potentially modifiable. As clinicians, if we dismiss these disturbances as being of secondary concern to controlling their psychiatric symptoms, we may be inadvertently condoning a first critical step on a path towards physical health inequalities for these young people. This vulnerable group urgently need a far more holistic and preventive approach." Dr David Shiers, co-author of HeAL and IMHCN Special Advisor

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Publications (date ordered)

Healthy Active Lives (HeAL): tackling premature death in young people with psychosis: The Statement

The Healthy Active Lives (HeAL) international consensus statement aims to reverse the trend of people with severe mental illness dying early by tackling risks for future physical illnesses pro-actively and much earlier.  Compared to their peers who have not experienced psychosis, young people with psychosis face a number of preventable health inequalities:

  • Young people with psychosis can expect to die 15-20 years younger than people without psychosis
  • Young people with psychosis can expect to die 15-20 years younger than people without psychosis
  • A lifespan shortened by about 15-20 years
  • 2-3 times the likelihood of developing cardiovascular disease making it the single most common cause of premature death (more so than suicide)
  • 2-3 times the likelihood of developing type 2 diabetes
  • 3-4 times the likelihood of being a smoker

The HeAL statement reflects international consensus on a set of key principles, processes and standards. It aims to combat the stigma, discrimination and prejudice that prevent young people experiencing psychosis from leading healthy active lives, and confront the perception that poor physical health is inevitable.

Targets

A group of clinicians, service users, family members and researchers from eleven countries have joined forces to develop an international consensus statement on improving the physical health of young people with psychosis.

The statement, called Healthy Active Lives (HeAL), aims to reverse the trend of people with severe mental illness dying early by tackling risks for future physical illnesses pro-actively and much earlier.

The HeAL group have set themselves ambitious targets. Within the next five years, they want to see that:
Preventing weight gain is one of the key objectives of the HeAL initiative
Preventing weight gain and the associated complications is one of the key objectives of the HeAL initiative
90% of young people experiencing a first episode of psychosis and their families or supporters are satisfied that they made treatment choices informed by an understanding of their risks for future obesity, cardiovascular disease and diabetes
Within a month of starting treatment, 90% have a documented assessment which includes risks for future obesity, cardiovascular disease and diabetes
All young people receive a regular review of their medication to minimise the development of complications of obesity, cardiovascular disease and treatment

  • 75% gain no more than 7% of their pre-illness weight two years after starting antipsychotic treatment
  • 75% maintain blood glucose, lipid profile and blood pressure within the normal range two years after initiating antipsychotic treatment

2 years after the onset of psychosis:

  • 90% receive health promotion advice on healthy eating, tobacco and substance use, dental care and sexual health
  • Fewer than 30% smoke tobacco
  • More than 50% engage in appropriate physical activity.

    Professor Sue Bailey, President of the Royal College of Psychiatrists, said:

    A person’s physical and mental health influence one another: deficiency in the care of one can lead to serious problems with the other. Having worked with vulnerable children and families for more than 30 years, I’m delighted to see the HeAL initiative tackling the physical health problems experienced by young people with psychosis, and ensuring both their mental and physical health are given equal attention.

    Rights

    The HeAL statement says that young people experiencing a first episode of psychosis have a number of rights:

    Young people with psychosis deserve better

    • I should not lose the physical health I possess, as a consequence of my mental illness, or my care and treatment
    • I have a right to a healthy active life
    • I have similar expectations of good physical health and health care as my peers who have not experienced psychosis
    • I, my family and my supporters, are respected, informed and helped to take responsibility for treatment medications where appropriate
    • I am not discriminated against or disadvantaged in my physical health care because of my mental health difficulties
    • I expect positive physical and mental health outcomes of my care to be equally valued and supported
    • From the start of my treatment and as a fundamental component of my health care, I am helped to minimize my risks of developing obesity, cardiovascular disease and diabetes

    The Statement is endorsed by
    International Early Psychosis Association
    International Early Psychosis Association (IEPA)
    International Mental Health Collaborating Network
    European Psychiatric Association
    European Psychiatric Association (EPA)
    WHO Collaborating Center in Mental Health (Dipartimento di Salute Mentale Trieste)
    NZ Early Intervention in Psychosis Society
    New Zealand Early Intervention in Psychosis Society (NZEIPS) Inc.
    Associazione Italiana Interventi Precoci nelle Psicosi
    Associazione Italiana Interventi Precoci nelle Psicosi (AIPP)
    Japanese Society of Prevention and Early Intervention in Psychiatry (JSEIP)
    Japanese Society of Prevention and Early Intervention in Psychiatry (JSEIP)

    You can download the full statement in pdf format Here

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    Research and Practice

    HETI Positive Cardiometabolic Health algorithm Lester Adaptation: Positive Cardiometabolic Health Resource
    An early intervention framework people on psychotropic medications (Curtis, Newall & Samaras, 2011)

    You can read the pdf version by clicking on title Psychiatry Positive Cardio Metabolic Algorithm 2011


    A UK version of the HETI algorithm adapted for use in the UK 

    You can read the pdf version by clicking on title Positive Cardiometabolic Health chart- website

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    Videos and Presentations

    'Being Bothered About Billy - The RCGP James Mackenzie Lecture 2012 with Professor Helen Lester

    Professor Helen Lester encouraged GPs to make people with serious mental illness their "core business" at the Royal College of General Practitioners' AGM in London recently (16/11/12) and to adopt a new mantra to improve their care: don't just screen, intervene - and from an early age. Professor Lester, GP, made the comments during her James Mackenzie Lecture which she entitled 'Being Bothered About Billy' from a poem by Simon Armitage. This is a recording of her lecture.

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    Organisations

    iphYs The iphYs collaboration commenced in 2010 at the IEPA conference in Amsterdam and then continued at several iphYs meetings including in Sydney in 2011 and 2013 as well as in San Francisco in October 2012, Leuven (2013) and Padua (2014). Visit their site here

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    Links

    Iris The Early Intervention in Psychosis IRIS Network supports the promotion of EI in psychosis. First formed to support the National EI Programme (2004-2010) this network brings together elected EI regional leads to share issues and solutions.  

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