Practitioner’s Corner Assessment of Response to Providing Health-related Information in a Community Psychiatry Outpatient Setting The objective of this study was to assess the subjective responses of patient and staff to the provision of health-related information in an outpatient psychiatric clinic. Simple educational information on healthy eating, exercising, and smoking cessation was provided in the waiting area of a clinic over the course of a year. This information took the form of educational handouts, educational DVDs, and monthly “special events” such as a poster competition for smoking cessation. In addition, patients were given an opportunity to attend free nutritional counseling sessions. Also, when needed, staff assisted patients in making appointments with primary care physicians. At the end of the year, a survey was distributed to patients and staff to assess the perceived benefits of the initiative. The majority of the 79 patients who completed the survey (n=60, 76%) had used the information provided, 95% of whom (n=57) had made some behavioral change, with 13% of the total survey respondents indicating that they had quit smoking. Ninety percent of the surveyed providers (18/20) felt that the initiative had had a positive impact on their patients. These results suggest that simple, low cost health and wellness initiatives in conjunction with an enthusiastic expenditure of a relatively small amount of staff time have the potential to have a positive impact on individuals attending an outpatient psychiatric clinic. (Journal of Psychiatric Practice 2016;22;344– 347) KEY WORDS: health education, healthy eating, exercise, smoking cessation, community psychiatry
DEEPA PAWAR, MD, MPH RAMIN MOJTABAI, MB, MPH AVIVA GOLDMAN, MD, MPH DONNA BATKIS, LCSW-C KATHLEEN MALLOY, LCPC BERNADETTE CULLEN, MB, BCh, BAO, MRCPsych
compared with the general population of the United States, individuals with SMI experience excess mortality and greater years of potential life lost.2–6 Although the most common causes of death (heart disease, cerebrovascular disease, cancer, chronic respiratory diseases, diabetes mellitus) are similar to those in the general population,3 individuals with SMI experience excess mortality related to these chronic diseases.2,7,8 The cause of this excess mortality in individuals with SMI is multifactorial, with socioeconomic factors, life stressors, poor quality of care, mental illness, medical illness, and negative health behaviors all playing a role.2,7,8 Frequently, the excess mortality is related to modifiable risk factors and preventable conditions.6 Individuals with mental illness are more likely to have negative health behaviors, such as sedentary lifestyles, poor diet and nutrition, and tobacco use.4,6,9 Thus, to prevent chronic diseases and related morbidity and mortality, these modifiable health behaviors are a critical target for lifestyle interventions. Although lifestyle interventions for patients with mental illness can be beneficial,10–12 variations in existing studies make it challenging to establish which particular interventions are most effective.11,13–15 Bartels and Desilets16 systematically reviewed exercise PAWAR: Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, and General Preventive Medicine Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; MOJTABAI and CULLEN: Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry and Behavioral Science, Johns Hopkins University, Baltimore, MD; GOLDMAN: Department of Psychiatry and Behavioral Science, Johns Hopkins University, Baltimore, MD; BATKIS and MALLOY: Community Psychiatry Program, The Johns Hopkins Hospital, Baltimore, MD Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
In 2008, the United States Substance Abuse and Mental Health Services Administration (SAMHSA) proposed the Pledge for Wellness, which sought to reduce mortality rates among individuals with serious mental illness (SMI) over a 10-year period.1 This initiative was driven by evidence that,
344
July 2016
Please send correspondence to: Bernadette Cullen, MB, BCh, BAO, MRCPsych, Meyer 144, The Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287 (e-mail: bcullen@ jhmi.edu). The authors declare no conflicts of interest. DOI: 10.1097/PRA.0000000000000168
Journal of Psychiatric Practice Vol. 22, No. 4
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
HEALTH INFORMATION IN A COMMUNITY PSYCHIATRY SETTING FIGURE 1. Behavior change by health topic. 100 90 80 Percent (+/- 95% CI)
and nutritional programs and concluded that combined educational and activity-based interventions of at least 3 months duration could be beneficial. However, more research is needed to find financially viable models that encompass these interventions and can be successfully implemented.16 In the meantime, clinicians need to address these issues with their patients in whatever way they can. The purpose of this pilot study was to understand the response of patients and providers to health information regarding nutrition, physical activity, and smoking cessation, provided in an outpatient community psychiatry setting using a self-report survey.
70 60 50 40 30 20 10 Healthy Eating Exercising Smoking Any Behavior (32/46 responses) (25/39 responses) Cessation Change (10/32 responses) (57/60 responses)
METHODS During 2013, a clinically driven, year-long health and wellness initiative was implemented in a community psychiatry outpatient program based in an academic institution. The goal of this initiative was to target 2 modifiable risk factors, obesity and smoking, by addressing 3 topics: healthy eating, exercise, and smoking cessation. Each topic was targeted on a monthly basis in a multipronged manner. Information on the topic was posted on a dedicated “Health and Wellness” bulletin board in the waiting room, copies of posted topic tip sheets were available to all patients in the waiting room, educational DVDs related to the topic were played in the waiting room, and there were quarterly “special events” related to each topic. In addition, nursing staff provided free nutritional assessments and therapists facilitated patients making appointments with primary care physicians when needed. Sources of the information provided included the American Heart Association, The Centers for Disease Control and Prevention, and the US Department of Agriculture. Examples of “special events” included a smoking cessation poster competition and distribution of healthy food samples. A multidisciplinary team of physicians, nurses, therapists, and support staff met monthly to select appropriate literature to display, organize quarterly events, and implement the initiative. At the end of the year, patients and staff were invited to complete an anonymous survey about the initiative. Over a week-long period, all Englishspeaking patients attending the clinic were requested by either their provider or reception staff
Journal of Psychiatric Practice Vol. 22, No. 4
Data reflect behavioral change after a year-long health and wellness initiative conducted in 2013.
to complete the survey and to return it to a box in the waiting room. The survey was distributed to providers at staff meeting and they were invited to complete it and return it to a designated mailbox. For most survey questions, respondents could select >1 answer. Given the nature of the data being collected, the IRB waived the need for written consent and no incentive was offered for participation.
RESULTS The Community Psychiatry Program serves approximately 1100 patients with severe mental illness. The majority of the patients are female (64%), African American (74%), and the mean age is 42 years. Approximately 60% of the patients have affective disorders, 30% have psychotic disorders, and 10% have adjustment or anxiety disorders. Just over 40% have a comorbid substance use disorder. During the week of the survey, the demographic and diagnostic profiles of those attending the clinic were: 69% female, 80% African American, mean age 37 years, 66% affective disorders, 27% psychotic disorders, 8% anxiety disorders, and 50% comorbid substance use disorders. During the selected week, 79 (65%) of the 121 patients seen in the clinic completed the patient Health and Wellness Initiative survey. Of those surveyed, 60 (76%) reported using any of the health information; 46 of the 79 patients surveyed (58%)
July 2016
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
345
HEALTH INFORMATION IN A COMMUNITY PSYCHIATRY SETTING used information on healthy eating, 39 (49%) used information on exercising, and 32 (41%) used information on smoking cessation. Of the 60 patients who reported using any health information, 57 (95%) reported making a behavior change. The specific behavior changes reported by total survey respondents are outlined in Figure 1. Of those who used information on healthy eating, 69.6% (32/46) reported changing their behavior; for exercising, this was 64% (25/39); and for those who reported taking information on smoking cessation, 31% (10/32) reported that they had stopped smoking. For smoking cessation, the percent who reported stopping out of the total group surveyed was 13% (10/79). Of the 25 health care providers in the clinic, 20 (80%) completed the provider survey concerning their perception of the impact of the Health and Wellness initiative on patients. Ninety percent of the providers who completed the survey (n=18) felt that the initiative had a positive impact on the patients. Of these 18 providers, 14 (78%) reported that patients brought up one of the health topics; 8 (44%) reported that patients were more receptive to discussing one of the health topics; and 3 (17%) reported that patients changed their behavior related to one of the health topics. Regarding preferred modes of communication of health information, 35 (44%) of the 79 patients surveyed endorsed DVDs, 34 (43%) endorsed flyers/ brochures, 29 (37%) endorsed one-on-one counseling, 17 (22%) endorsed special giveaways, and 12 (15%) endorsed poster presentations. Among the 20 providers who completed the survey, 14 (70%) believed that one-on-one counseling was a useful teaching tool, followed by special giveaways (n=9, 45%), flyers/brochures (n=7, 35%), posters (n=5, 25%), and DVDs (n=4, 20%).
DISCUSSION It is essential to promote health and wellness among individuals with SMI because these individuals continue to have a significantly reduced life expectancy2–6 due, in large part, to modifiable risk factors. Although multiple interventions targeting health and wellness have been investigated,10–15 and information is available on what can work,16 the development of programs that integrate these interventions in a practical, cost-effective way is
346
July 2016
still in its infancy.16 Such programs are clearly warranted and it is important to strive to develop and implement them. However, while awaiting the arrival of these programs, there is an onus on providers to attempt to address these issues. Although other studies have found that education alone does not promote behavioral change,16 the results of this pilot study suggest that providing information about modifiable risk factors in a setting where staff are actively engaged in and enthusiastic about the program could have an impact on an individual’s health behavior. Of the patients who reported availing themselves of any of the information that was provided, 95% reported a behavior change. Of the providers who were surveyed, 90% of providers reported that they believed the information had had a positive impact on their patients. The results pertaining to smoking cessation were particularly interesting. Thirteen percent of the 79 patient respondents reported that they had quit smoking; when we looked at those who reported taking information on smoking cessation, this percentage increased to approximately 30%. This compares favorably with the 42% quit rate found among 50 individuals with schizophrenia who received 7 weeks of smoking cessation group therapy.17 This approach to health and wellness is low cost and low intensity and provides individuals with tools they can use to improve their health while awaiting the introduction of more comprehensive programs. These pilot results may be relevant to the development of integrated health programs. At its core, the goal of the movement toward integrated care is to improve the overall health of the individual. While implementing such a system requires much planning and organization, simple measures that could be beneficial, such as those outlined in this pilot study, can be overlooked. Often the key to improving care is heightening awareness of the issues among patients and staff and facilitating and implementing simple measures to address them. This study had several limitations. The 65% response rate in the sample was low, although it exceeded the 31% response rate achieved in another recent survey in the same clinic and in another community psychiatry clinic in Baltimore.18 In addition, the patient sample who completed the survey may have been a selective sample of those who found the information beneficial. There may also have been a desirability bias in both the patient
Journal of Psychiatric Practice Vol. 22, No. 4
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
HEALTH INFORMATION IN A COMMUNITY PSYCHIATRY SETTING and provider survey results. We also do not know how relevant the specific information that was used was to the individual patient respondent, which could have had an impact on the reported behavioral changes. Furthermore, the sample size is small and the data on behavior change are based on self-report. Finally, we have no information on other factors, such as motivation, that may account for reported behavior changes. Nonetheless, the relatively low cost and minimal resources needed to implement the program, along with its potential value to those with SMI, suggests that providing health promotion information about modifiable risk factors is worthwhile. These preliminary data support the feasibility and acceptability of such programs, and a larger more formal prospective study of this pilot program is planned. The management of modifiable risk factors among those with SMI is essential and initiatives are needed that address these risk factors in the outpatient psychiatry setting. While awaiting the development and implementation of comprehensive, cost-effective, practical programs to address this need, these results indicate that simple, inexpensive health promotion initiatives supported and implemented by motivated and enthusiastic staff could have a positive impact for at least some individuals in the population with SMI.
5.
6.
7. 8. 9.
10.
11. 12. 13.
14. 15.
REFERENCES 1. 2. 3.
4.
Manderscheid RW. Aiming for a healthier population by 2020. Behav Healthc. 2009;29:51–52. Berren MR, Hill KR, Merikle E, et al. Serious mental illness and mortality rates. Hosp Community Psychiatry. 1994;45:604–605. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis. 2006;3:A42. Druss BG, Walker ER. Mental disorders and medical comorbidity. Synth Proj Res Synth Rep. 2011;21:1–26.
Journal of Psychiatric Practice Vol. 22, No. 4
16.
17. 18.
Druss BG, Zhao L, Von Esenwein S, et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011;49:599–604. Parks J, Svendsen D, Singer P, et al. Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council; 2006. Available at:*** http://www.nasmhpd.org/sites /default/files/Mortality%20and%20Morbidity%20Final% 20Report%208.18.08.pdf. Accessed May 24, 2016. Daumit GL, Anthony CB, Ford DE, et al. Pattern of mortality in a sample of Maryland residents with severe mental illness. Psychiatry Res. 2010;176:242–245. Miller BJ, Paschall CB III, Svendsen DP. Mortality and medical comorbidity among patients with serious mental illness. Psychiatr Serv. 2006;57:1482–1487. Cabassa LJ, Ezell JM, Lewis-Fernandez R. Lifestyle interventions for adults with serious mental illness: a systematic literature review. Psychiatr Serv. 2010;61: 774–782. Chacón F, Mora F, Gervás-Ríos A, et al. Efficacy of lifestyle interventions in physical health management of patients with severe mental illness. Ann Gen Psychiatry. 2011;10:22. Tosh G, Clifton AV, Xia J, et al. General physical health advice for people with serious mental illness. Cochrane Database Syst Rev. 2014;3:CD008567. Daumit GL, Dickerson FB, Wang NY, et al. A behavioral weight-loss intervention in persons with serious mental illness. N Engl J Med. 2013;368:1594–1602. Tranter S, Irvine F, Collins E. Innovations aimed at improving the physical health of the seriously mentally ill: an integrative review. J Clin Nurs. 2012;21: 1199–1214. Stanley S, Laugharne J. The impact of lifestyle factors on the physical health of people with a mental illness: a brief review. Int J Behav Med. 2014;21:275–281. Gierisch JM, Nieuwsma JA, Bradford DW, et al. Pharmacologic and behavioral interventions to improve cardiovascular risk factors in adults with serious mental illness: a systematic review and meta-analysis. J Clin Psychiatry. 2014;75:e424–e440. Bartels S, Desilets R. Health Promotion Programs for People with Serious Mental Illness. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions; 2012. Addington J, el-Guebaly N, Campbell W, et al. Smoking cessation treatment for patients with schizophrenia. Am J Psychiatry. 1998;155:974–975. Mojtabai R, Cullen B, Everett A, et al. Reasons for not seeking general medical care among individuals with serious mental illness. Psychiatr Serv. 2014;65: 818–821.
July 2016
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
347
DEEPA PAWAR, MD, MPH RAMIN MOJTABAI, MB, MPH AVIVA GOLDMAN, MD, MPH DONNA BATKIS, LCSW-C KATHLEEN MALLOY, LCPC BERNADETTE CULLEN, MB, BCh, BAO, MRCPsych
compared with the general population of the United States, individuals with SMI experience excess mortality and greater years of potential life lost.2–6 Although the most common causes of death (heart disease, cerebrovascular disease, cancer, chronic respiratory diseases, diabetes mellitus) are similar to those in the general population,3 individuals with SMI experience excess mortality related to these chronic diseases.2,7,8 The cause of this excess mortality in individuals with SMI is multifactorial, with socioeconomic factors, life stressors, poor quality of care, mental illness, medical illness, and negative health behaviors all playing a role.2,7,8 Frequently, the excess mortality is related to modifiable risk factors and preventable conditions.6 Individuals with mental illness are more likely to have negative health behaviors, such as sedentary lifestyles, poor diet and nutrition, and tobacco use.4,6,9 Thus, to prevent chronic diseases and related morbidity and mortality, these modifiable health behaviors are a critical target for lifestyle interventions. Although lifestyle interventions for patients with mental illness can be beneficial,10–12 variations in existing studies make it challenging to establish which particular interventions are most effective.11,13–15 Bartels and Desilets16 systematically reviewed exercise PAWAR: Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, and General Preventive Medicine Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; MOJTABAI and CULLEN: Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry and Behavioral Science, Johns Hopkins University, Baltimore, MD; GOLDMAN: Department of Psychiatry and Behavioral Science, Johns Hopkins University, Baltimore, MD; BATKIS and MALLOY: Community Psychiatry Program, The Johns Hopkins Hospital, Baltimore, MD Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
In 2008, the United States Substance Abuse and Mental Health Services Administration (SAMHSA) proposed the Pledge for Wellness, which sought to reduce mortality rates among individuals with serious mental illness (SMI) over a 10-year period.1 This initiative was driven by evidence that,
344
July 2016
Please send correspondence to: Bernadette Cullen, MB, BCh, BAO, MRCPsych, Meyer 144, The Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287 (e-mail: bcullen@ jhmi.edu). The authors declare no conflicts of interest. DOI: 10.1097/PRA.0000000000000168
Journal of Psychiatric Practice Vol. 22, No. 4
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
HEALTH INFORMATION IN A COMMUNITY PSYCHIATRY SETTING FIGURE 1. Behavior change by health topic. 100 90 80 Percent (+/- 95% CI)
and nutritional programs and concluded that combined educational and activity-based interventions of at least 3 months duration could be beneficial. However, more research is needed to find financially viable models that encompass these interventions and can be successfully implemented.16 In the meantime, clinicians need to address these issues with their patients in whatever way they can. The purpose of this pilot study was to understand the response of patients and providers to health information regarding nutrition, physical activity, and smoking cessation, provided in an outpatient community psychiatry setting using a self-report survey.
70 60 50 40 30 20 10 Healthy Eating Exercising Smoking Any Behavior (32/46 responses) (25/39 responses) Cessation Change (10/32 responses) (57/60 responses)
METHODS During 2013, a clinically driven, year-long health and wellness initiative was implemented in a community psychiatry outpatient program based in an academic institution. The goal of this initiative was to target 2 modifiable risk factors, obesity and smoking, by addressing 3 topics: healthy eating, exercise, and smoking cessation. Each topic was targeted on a monthly basis in a multipronged manner. Information on the topic was posted on a dedicated “Health and Wellness” bulletin board in the waiting room, copies of posted topic tip sheets were available to all patients in the waiting room, educational DVDs related to the topic were played in the waiting room, and there were quarterly “special events” related to each topic. In addition, nursing staff provided free nutritional assessments and therapists facilitated patients making appointments with primary care physicians when needed. Sources of the information provided included the American Heart Association, The Centers for Disease Control and Prevention, and the US Department of Agriculture. Examples of “special events” included a smoking cessation poster competition and distribution of healthy food samples. A multidisciplinary team of physicians, nurses, therapists, and support staff met monthly to select appropriate literature to display, organize quarterly events, and implement the initiative. At the end of the year, patients and staff were invited to complete an anonymous survey about the initiative. Over a week-long period, all Englishspeaking patients attending the clinic were requested by either their provider or reception staff
Journal of Psychiatric Practice Vol. 22, No. 4
Data reflect behavioral change after a year-long health and wellness initiative conducted in 2013.
to complete the survey and to return it to a box in the waiting room. The survey was distributed to providers at staff meeting and they were invited to complete it and return it to a designated mailbox. For most survey questions, respondents could select >1 answer. Given the nature of the data being collected, the IRB waived the need for written consent and no incentive was offered for participation.
RESULTS The Community Psychiatry Program serves approximately 1100 patients with severe mental illness. The majority of the patients are female (64%), African American (74%), and the mean age is 42 years. Approximately 60% of the patients have affective disorders, 30% have psychotic disorders, and 10% have adjustment or anxiety disorders. Just over 40% have a comorbid substance use disorder. During the week of the survey, the demographic and diagnostic profiles of those attending the clinic were: 69% female, 80% African American, mean age 37 years, 66% affective disorders, 27% psychotic disorders, 8% anxiety disorders, and 50% comorbid substance use disorders. During the selected week, 79 (65%) of the 121 patients seen in the clinic completed the patient Health and Wellness Initiative survey. Of those surveyed, 60 (76%) reported using any of the health information; 46 of the 79 patients surveyed (58%)
July 2016
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
345
HEALTH INFORMATION IN A COMMUNITY PSYCHIATRY SETTING used information on healthy eating, 39 (49%) used information on exercising, and 32 (41%) used information on smoking cessation. Of the 60 patients who reported using any health information, 57 (95%) reported making a behavior change. The specific behavior changes reported by total survey respondents are outlined in Figure 1. Of those who used information on healthy eating, 69.6% (32/46) reported changing their behavior; for exercising, this was 64% (25/39); and for those who reported taking information on smoking cessation, 31% (10/32) reported that they had stopped smoking. For smoking cessation, the percent who reported stopping out of the total group surveyed was 13% (10/79). Of the 25 health care providers in the clinic, 20 (80%) completed the provider survey concerning their perception of the impact of the Health and Wellness initiative on patients. Ninety percent of the providers who completed the survey (n=18) felt that the initiative had a positive impact on the patients. Of these 18 providers, 14 (78%) reported that patients brought up one of the health topics; 8 (44%) reported that patients were more receptive to discussing one of the health topics; and 3 (17%) reported that patients changed their behavior related to one of the health topics. Regarding preferred modes of communication of health information, 35 (44%) of the 79 patients surveyed endorsed DVDs, 34 (43%) endorsed flyers/ brochures, 29 (37%) endorsed one-on-one counseling, 17 (22%) endorsed special giveaways, and 12 (15%) endorsed poster presentations. Among the 20 providers who completed the survey, 14 (70%) believed that one-on-one counseling was a useful teaching tool, followed by special giveaways (n=9, 45%), flyers/brochures (n=7, 35%), posters (n=5, 25%), and DVDs (n=4, 20%).
DISCUSSION It is essential to promote health and wellness among individuals with SMI because these individuals continue to have a significantly reduced life expectancy2–6 due, in large part, to modifiable risk factors. Although multiple interventions targeting health and wellness have been investigated,10–15 and information is available on what can work,16 the development of programs that integrate these interventions in a practical, cost-effective way is
346
July 2016
still in its infancy.16 Such programs are clearly warranted and it is important to strive to develop and implement them. However, while awaiting the arrival of these programs, there is an onus on providers to attempt to address these issues. Although other studies have found that education alone does not promote behavioral change,16 the results of this pilot study suggest that providing information about modifiable risk factors in a setting where staff are actively engaged in and enthusiastic about the program could have an impact on an individual’s health behavior. Of the patients who reported availing themselves of any of the information that was provided, 95% reported a behavior change. Of the providers who were surveyed, 90% of providers reported that they believed the information had had a positive impact on their patients. The results pertaining to smoking cessation were particularly interesting. Thirteen percent of the 79 patient respondents reported that they had quit smoking; when we looked at those who reported taking information on smoking cessation, this percentage increased to approximately 30%. This compares favorably with the 42% quit rate found among 50 individuals with schizophrenia who received 7 weeks of smoking cessation group therapy.17 This approach to health and wellness is low cost and low intensity and provides individuals with tools they can use to improve their health while awaiting the introduction of more comprehensive programs. These pilot results may be relevant to the development of integrated health programs. At its core, the goal of the movement toward integrated care is to improve the overall health of the individual. While implementing such a system requires much planning and organization, simple measures that could be beneficial, such as those outlined in this pilot study, can be overlooked. Often the key to improving care is heightening awareness of the issues among patients and staff and facilitating and implementing simple measures to address them. This study had several limitations. The 65% response rate in the sample was low, although it exceeded the 31% response rate achieved in another recent survey in the same clinic and in another community psychiatry clinic in Baltimore.18 In addition, the patient sample who completed the survey may have been a selective sample of those who found the information beneficial. There may also have been a desirability bias in both the patient
Journal of Psychiatric Practice Vol. 22, No. 4
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
HEALTH INFORMATION IN A COMMUNITY PSYCHIATRY SETTING and provider survey results. We also do not know how relevant the specific information that was used was to the individual patient respondent, which could have had an impact on the reported behavioral changes. Furthermore, the sample size is small and the data on behavior change are based on self-report. Finally, we have no information on other factors, such as motivation, that may account for reported behavior changes. Nonetheless, the relatively low cost and minimal resources needed to implement the program, along with its potential value to those with SMI, suggests that providing health promotion information about modifiable risk factors is worthwhile. These preliminary data support the feasibility and acceptability of such programs, and a larger more formal prospective study of this pilot program is planned. The management of modifiable risk factors among those with SMI is essential and initiatives are needed that address these risk factors in the outpatient psychiatry setting. While awaiting the development and implementation of comprehensive, cost-effective, practical programs to address this need, these results indicate that simple, inexpensive health promotion initiatives supported and implemented by motivated and enthusiastic staff could have a positive impact for at least some individuals in the population with SMI.
5.
6.
7. 8. 9.
10.
11. 12. 13.
14. 15.
REFERENCES 1. 2. 3.
4.
Manderscheid RW. Aiming for a healthier population by 2020. Behav Healthc. 2009;29:51–52. Berren MR, Hill KR, Merikle E, et al. Serious mental illness and mortality rates. Hosp Community Psychiatry. 1994;45:604–605. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis. 2006;3:A42. Druss BG, Walker ER. Mental disorders and medical comorbidity. Synth Proj Res Synth Rep. 2011;21:1–26.
Journal of Psychiatric Practice Vol. 22, No. 4
16.
17. 18.
Druss BG, Zhao L, Von Esenwein S, et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011;49:599–604. Parks J, Svendsen D, Singer P, et al. Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council; 2006. Available at:*** http://www.nasmhpd.org/sites /default/files/Mortality%20and%20Morbidity%20Final% 20Report%208.18.08.pdf. Accessed May 24, 2016. Daumit GL, Anthony CB, Ford DE, et al. Pattern of mortality in a sample of Maryland residents with severe mental illness. Psychiatry Res. 2010;176:242–245. Miller BJ, Paschall CB III, Svendsen DP. Mortality and medical comorbidity among patients with serious mental illness. Psychiatr Serv. 2006;57:1482–1487. Cabassa LJ, Ezell JM, Lewis-Fernandez R. Lifestyle interventions for adults with serious mental illness: a systematic literature review. Psychiatr Serv. 2010;61: 774–782. Chacón F, Mora F, Gervás-Ríos A, et al. Efficacy of lifestyle interventions in physical health management of patients with severe mental illness. Ann Gen Psychiatry. 2011;10:22. Tosh G, Clifton AV, Xia J, et al. General physical health advice for people with serious mental illness. Cochrane Database Syst Rev. 2014;3:CD008567. Daumit GL, Dickerson FB, Wang NY, et al. A behavioral weight-loss intervention in persons with serious mental illness. N Engl J Med. 2013;368:1594–1602. Tranter S, Irvine F, Collins E. Innovations aimed at improving the physical health of the seriously mentally ill: an integrative review. J Clin Nurs. 2012;21: 1199–1214. Stanley S, Laugharne J. The impact of lifestyle factors on the physical health of people with a mental illness: a brief review. Int J Behav Med. 2014;21:275–281. Gierisch JM, Nieuwsma JA, Bradford DW, et al. Pharmacologic and behavioral interventions to improve cardiovascular risk factors in adults with serious mental illness: a systematic review and meta-analysis. J Clin Psychiatry. 2014;75:e424–e440. Bartels S, Desilets R. Health Promotion Programs for People with Serious Mental Illness. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions; 2012. Addington J, el-Guebaly N, Campbell W, et al. Smoking cessation treatment for patients with schizophrenia. Am J Psychiatry. 1998;155:974–975. Mojtabai R, Cullen B, Everett A, et al. Reasons for not seeking general medical care among individuals with serious mental illness. Psychiatr Serv. 2014;65: 818–821.
July 2016
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
347
