Home-based Recovery and Wellness in Mental Health Conference. June 9th 2010 Marion Nulty Physical Health & Well Bei

1. Home-based Recovery and Wellness in Mental Health Conference.June 9th 2010Marion Nulty Physical Health & Well Being Practitioner(Advanced Practitioner)

2. Topics for discussion. • Physical Health & Well Being Role. • Physical Healthcare Policy. • National Drivers and Policies underpinning current Physical Healthcare Agenda. • The Barriers & Challenges. • Health Promotion in an Acute Mental Health setting.

4. Physical Health & Well Being Advanced Practitioner….. My Purpose….My Role....... To improve lives by providing the best quality Physical Health & Well Being care for our service users . To raise awareness and implement the GMW Physical Healthcare Policy : Campbell et al(2009). Complete the MSc in Advance Practice. Be an autonomous practitioner within the Inpatient setting. 4

5. PHYSICAL HEALTHCARE POLICY STANDARDS Standard 1: Physical Healthcare standards for the Directorates Each Directorate will have a designated Lead to oversee the provision for physical healthcare for the Directorate. It will be the responsibility of the Lead for physical healthcare to ensure high standards of physical healthcare within the Directorate. Appropriate medical equipment must be available, readily accessible and maintained at all trust sites in accordance with local Medical Devices Policy . Emergency resuscitation equipment must be available, maintained and readily accessibleon all inpatient sites. 5

6. Standard 2: Physical Health Examination/Assessment on admission to inpatient unit All inpatients will have a comprehensive physical assessment within 24 hours of admission. The admitting clinician (Junior Doctor) is responsible for the completion of the physical examination. Any factors preventing a physical assessment i.e. patient refusal should be clearly recorded on ICIS. Clinicians should record basic observable physicalsigns and a full physical examination should be undertaken as soon as possible . 6

7. Standard 3: Physical healthcare for individuals on inpatient units, including long-stay patients and rehabilitation units Re-assessment of physical health care should be undertaken as required during the period of admission. For patients with identified chronic physical health conditions, care plans should include management of physical healthcare. Patients requiring transfer to Acute Trusts must be accompanied by an up to date care plan, prescription card and medication (if necessary). Patients who have an extended admission (greater than six months) should have a full Annual Physical Health Check/Assessment. 7

8. Standard 3: Physical healthcare for individuals on inpatient units, including long-stay patients and rehabilitation units ..continued….. All Inpatients should have access to health promotion. Focusing on smoking cessation & support. Healthy eating, diet and nutrition. Physical Activity & Exercise. Alcohol intake . Sexual health. Weight management, Body mass index (BMI). All Patients should , and will have easy access to appropriate written health promotion information. 8

9. At All Times…………………. • Service users should expect to be treated in a manner that preserves their rights and their dignity. • Whatever their age, background, gender, disability, sexual orientation, history of service use or use of illicit substances. • Service users have a fundamental right to receive services in the least restrictive manner conducive to their safety and the safety of their families and their communities.

10. National Drivers and Policies underpinning current Physical Healthcare Agenda. National Service Framework for, Mental Health (1999) Standard 1: Sets promotion of mental health within social inclusion agenda. Standard 2 & 3 : Focuses' on Primary care & Access to services. • SMI registers. Development of Shared care protocols. • National Institute for Health & Clinical Excellence : http://www.nice.org.uk/ • Quality and Outcomes Framework (QOF) http://www.nice.org.uk/media/E2C/82/ConsultationQOFAdvisoryCommJune2010.pdf • Care Quality Commission (CQC) http://www.cqc.org.uk/ the • Commissioning for Quality and Innovation (CQUIN) payment framework(2009) http://www.iocp.co.uk/downloads/iocp_20090106.pdf 10

11. Royal College of Psychiatrists 2009 “ Mental and Physical health are inextricably linked, and we do need to develop a ‘whole person’ approach to integrate rather than separate them.” Physical Health in Mental Health: Final report of a scoping group. Occasional paper.OP66:Jan2009. http://www.rcpsych.ac.uk/files/pdversion/OP67.pdf. DH (2007) Mental Health :New ways of working for everyone. Developing and sustaining a capable and flexible workforce. http://www.newwaysofworking.org.uk

12. Sainsbury Centre for Mental Health. “Not all in the mind: The Physical Health of Mental Health service users.” Linda Seymour (2003) Sainsbury Centre for mental health. http://www.scmh.org.uk/pdfs/not+all+in+the+mind+.pdf

13. The Chief Nursing Review of Mental Health Nursing (2006): “From Values to Action” • MHNs will have the skills & opportunity to improve the physical wellbeing of people with mental health problems. • It suggests that MHNs need to develop physical healthcare assessment skills & most importantly actively engage in Health promotion strategies with service users. • MHNs will work in partnership with service users of all ages, their carers and other professionals to improve the service users experience and outcomes of care.

14. DH 2004: Choosing Health: Making Healthy Choices easier. • DH 2006 : Choosing Health: Supporting Physical Health Needs of people with Severe Mental Illness. (Commissioning Framework) • DH 2008: Lord Darzi – High Quality care for all. NHS Next stage review final report: Sets out a vision for an NHS with Quality at its heart.

15. The NHS Health and Well-being Review :The Boorman Review The NHS Review of the Health & Wellbeing of the NHS Workforce was commissioned as part of the Government’s response to Dame Carol Black’s Review, “Working for a Healthier Tomorrow”. Dr Steve Boorman -Interim Report August 2009, sets out emerging findings and initial recommendations on NHS staff health and well-being. Final Report has been ratified and its recommendations accepted by the DOH. http://www.nhshealthandwellbeing.org

16. The Health of the Health Professional: Dept of Health 2010.. • “Invisible Patients” specifically focuses on the health issues facing regulated health professionals and identifies some priorities for addressing them. • It looks at how ill health in health professionals may affect their professional practice, the difficulties they face in seeking help and the role of the health profession regulatory bodies. • http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113540

17. “The staff of the National Health Service make up the largest single group of patients it serves, but it ignores this fact so often that ill health in health professionals may effectively become invisible. The consequence of that is profound: ranging from loss of resources to the Service – current levels of sickness absence in the NHS mean that more than 10 million working days are lost every year, equivalent to 4.5% of the entire workforce and at a direct cost of £1.7 billion every year – to rare but very public tragedy.”

18. Physical healthcare monitoring for people with Serious Mental Illness (Review- Cochrane Collaboration) Tosh G, Clifton A, Mala S, Bachner M (2010) http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008298/pdf_fs.html

19. Physical healthcare needs and mentally ill patients – what we know Life expectancy may be shorter. Quality of life is poorer. Smoking rates, obesity rates, alcohol consumption, and drug taking rates are all higher. 19

20. What we do know…………. People with mental health problems are much less likely to be offered blood pressure, cholesterol, urine or weight checks. or Be offered opportunistic advice on smoking cessation, alcohol, exercise, diet, or sexual health. 20

21. Converting National Strategies into action –The Barriers • Understanding of Mental Health. • Understand the importance of physical health care monitoring. • Organisational boundaries – lack of care pathways. • Not seeing the patient as a ‘whole patient’.

22. The challenges • Communication - Working across primary and secondary care - this links to effective shared care. • Effective assessments - Ensuring good and effective assessments which factor in physical health care. • On-going monitoring - of physical health care needs, in all service settings.

23. Physical Health, Wellbeing & Health Improvement in a Mental Health Setting. Three Questions to ask…before we start... • Is it Important ? • Is it practical or doable ? • Is it being done now?

24. PHYSICAL HEALTH & WELL BEING IN A MENTAL HEALTH UNIT. • The UK has a population of about 60 million people (2009). • In 2005, the DH estimated that as many as 17.5 million people in the UK may be living with a long-term chronic illness or condition. • Smoking kills about 87,000 every year. It is also a major cause of illness and disability. Many of the patients who attend hospital are smokers and many of them are suffering ill health as a direct result of smoking. • Alcohol currently kills about 9000 people a year and is one of the fastest growing causes of avoidable ill-health and hospital admissions. • Employer: Greater Manchester West Mental Health NHS Foundation Trust. Which provides integrated Mental Health & Social Care Services to approximately 700,000 people living within 3 Directorates and across 52 sites. • The Directorate I work in with has an estimated population of 265,000, it is suggested by Spencer (2007), that parts of the area, are amongst the most deprived in the UK.

25. Health Promotion in Hospital : The Context. • GMW’s physical healthcare policy (Campbell 2009) outlines minimum standards to be achieved and maintained during a patient’s journey within our organisation with regard to their physical health care and needs. • Haynes & Cook (2007) suggest that current UK public health requires all hospitals should aim to deliver health promotion for healthy lifestyles to patients. • Risk factors such as smoking, alcohol misuse, poor diets, lack of physical exercise and obesity, these as we know are unilaterally deemed to be ‘modifiable ‘or ‘risk factors’ which can contribute to ill health, premature death. • Thus a reduction in these ‘risk factors’ has been attributed to decreases in mortality from chronic disease.

26. Health Promotion Assessment Project Pilot: within an Acute Mental Health Setting. Serious Mental Illness is a barrier to effective physical medical care, 15 to 30 year shorter lifetime of those with a Serious Mental Illness, compared with the general population. (Saravane et al 2009.) We wanted to use opportunistic and non invasive approach with regard to Health Promotion as endorsed by the DH &WHO (1992) within an Acute Mental Health unit. Using a format suggested by West (2002) using ‘brief interventions’, gaining information on an individual’s health status and assessing an individual’s personal motivation towards achieving positive lifestyle change. “How important is your Physical Health to you on a scale of 1 to 10?”

27. Health Promotion Assessment Project Pilot: within an Acute Mental Health Setting. WHY ?Having a Serious Mental Illness remains a barrier to effective Medical care, and Mainstream Health Improvement Information. BECAUSE ? This represents a major health problem, with a 15 to 30 year shorter lifetime of those with a Serious Mental Illness, compared with the general population. (Saravane et al 2009.) WHAT ? We wanted to take an opportunistic and non invasive approach with regard to Health Promotion as endorsed by the DH &WHO (1992) within an Acute Mental Health unit. HOW ? Using a format suggested by West (2002) in a brief intervention, capturing important data on an individual’s health status and personal motivation towards positive lifestyle change. “How important is your Physical Health to you on a scale of 1 to 10?”

28. PROS Key to the concept of Health Improvement/Promotion is "empowerment“ of individuals, social groups and communities. Health Promotion Promotes Recovery & Social Inclusion. Give choice to people with Serious Mental Illness (SMI) in regard to Health & Lifestyle Improvement Programmes. Users of Mental Health Services should have access to the same quality of physical healthcare as the general population. It enables Mental Health Staff to become familiar with current health issues, thus giving them more confidence in offering help and advice to their patients to enable positive lifestyle change. (Boorman report 2009) Hospitals are good places for patients to receive Health Education. Risk factors such as Smoking, Alcohol misuse, etc; we know are deemed to be ‘Modifiable Risk Factors’’ thus a reduction in these ‘Risk factors’ has been attributed to decreases in mortality from chronic disease. CONS BARRIERS : Mental Health Services have failed to address this major health inequality because of a lack of consensus about the type and frequency of Health promotion and interventions suitable for those with SMI. CHALLENGES: Lack of knowledge and skills in the Mental Health Workforce. Mental Health should expand their skills with regard to physical Health & Well Being. BARRIERS: Mental Health Staff do not prioritise Physical health care and Health promotion in their practice. CHALLENGES : Mental Health Staff are in a unique position to positively affect the physical health of people with SMI but need to develop new competencies to enable them to do this. BARRIERS : Are Mainstream Public Health Improvement programmes up to meeting the needs of those with a Mental Illness?. We need robust and sustainable referral pathways. Commissioners & Provider services Engaging in Shared Care service planning. The Future of Health Promotion Assessment in an Acute Mental Health Setting: Organisational Change: Imbedding and Sustaining Practice.

29. Health Promotion Assessment Tool is an Electronic Assessment tool. Available in GMW’s Integrated Computer Information System.(ICIS) • Project was developed in collaboration with NHS Bolton. • Current work to raise awareness of the importance of health promotion . • Development of a training package for all Mental Health Staff • For further details and information contact…. Marion.nulty@rbh.nhs.uk Room 65 Bolton Mental Health Directorate Rivington Unit. Royal Bolton Hospital Bolton BL4 0JR Tel : 01204 390 975.

30. The Challenge for the Future • Think Differently about our Practice. • Be Engaged with the Physical Healthcare Agenda. • Be optimistic about the future......using Irish County Football as a metaphor for an aspiration to succeed I take inspiration in the following......

31. Be optimistic about the future......... References/Further information. “Thank you for listening” • http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008298/pdf_fs.html • http://www.mentalhealthshop.org/products/rethink_publications/100_ways_to_support.html

32. Health Promoting Activities in Bolton Mental Health Directorate Inpatient unit. • Gardening Project @ Hawthorn House every Wednesday 13.00 -15.00. Part of the “Grow your Own. Eat your Own” project. • Podiatry Drop in Clinic every Tuesday (alongside the Clozaril Clinic) in ECT Recovery room 10.30-12.30 pm. • Food Access Bolton (FAB) van attends every Tuesday 09.30am outside the K Block entrance. (FAB van may be visiting Firwood & Paragon in near future.) • Farmers/Mini Market selling fresh fruit & vegetable at Wholesale price between 12.00 -14.00 in main restaurant, check RBH intranet for dates. • Exercise room on K3, see your ward physiotherapist for more details. • Health promotion week in Bolton Mental Health Directorate & Royal Bolton Hospital week commencing 27 th September 2010.

33. Health Promoting Activities in Bolton Mental Health Directorate Inpatient unit • Healthy walks around the hospital, pick up a leaflet, take part in your lunch break. • Use the Garden on Rivington corridor , protected time for staff to use at lunch. Key at Rivington reception. • Artwork walking trail around the RBH site looking for the 10 stone art pieces sculpted by patients, carers and staff in April 2009. (Leaflet under development.) • Football project with Community resources. • Healthy Heads Project focussing on Staff, Service users and Carers well being, • Public Health initiatives for staff and patients, i.e. showcasing Chlamydia screening, Condom Promotion & Sexual Health, Bowel cancer and other Health checks (Bolton Big Health Check) being run throughout the year on site and at key locations on RBH.

34. Health Promoting Activities in Bolton Mental Health Directorate Inpatient unit. • Monthly Interprofessional Educational forum, next one is Vascular assessment on 20th May 2010 13.00-14.30 pm i.e. Podiatry awareness, AWARM, “Food for thought". Management of Pain; Delirium, “End of Life” amongst many other topics. • Working closely with STR workers, Patients Council , Occupational Therapists, Physiotherapy and Psychology dept to showcase each others work, and together to improve the Health & Well being of our service users. • Bi-Monthly Physical Healthcare meeting held locally in Bolton. • Physical Health /Health promotion linkson each ward.