MECC Training for Trainers

1. MECC Training for Trainers

2. What are we going to cover? • What MECC is and isn’t, why it is • important to your work and what • kind of impact we could have • 2. Putting MECC into Practice: • What is MECC to your Team • Tips to Ask, Advise and Assist • Opportunity to practice • 3. Review Barriers to MECC

3. Appreciate the importance and potential impact of raising lifestyle issues in your work Increase knowledge of what factors can impact on peoples’ ability to make lifestyle changes Develop skills for putting MECC into practice: -Plan for how and when to raise lifestyle issues -Increase knowledge of key messages in relation to lifestyle areas and tips for effective advice -Increase understanding of where to signpost -Practice raising and responding to lifestyle issues By the end of the session

4. Section 1 MECC Review

5. WHAT IS MECC? It IS about you helping people to know how they can improve their own health and wellbeing

6. Why is it important to raise lifestyle issues? MECC is particularly important for people with mental health issues or learning disability because: Data suggest that they may see worse physical health outcomes than the general population, for example: • People with depressive disorders are about twice as likely to develop coronary artery disease, twice as likely to have a stroke and four times as likely to have a myocardial infarction as people who are not depressed. • People with schizophrenia are more likely to get common cancers (breast and bowel) and to be diagnosed with coronary heart disease or have a stroke under age 55

7. Why is it important to raise lifestyle issues? MECC is particularly important for people with mental health issues or learning disability because: It can be difficult for people with mental illness or learning disability to access primary care services without prompting Improvements in lifestyle behaviourscan positively impact on mental health and wellbeing for example: • Alcohol is a depressant drug • Smoking (nicotine withdrawal) increases stress levels

8. What Impact Can MECC Have? In the past day, how many contacts have you had where you could have raised lifestyle issues? Every day staff have millions of contacts with people that could be used to offer appropriate information on staying healthy Over 288,000 staff in NHS Midlands & East. Very brief advice given 10 times a year by every member of staff = 2.88 million opportunities to change lifestyle behaviour • Less than an hours time a year per person

9. Barriers to Implementing MECC We all want to help improve peoples’ health: What barriers might stand in the way of us making contacts count?

10. Section 2 Putting MECC Into Practice:

11. MECC in Your Team/Department -What does MECC look like for your team/department? -What lifestyle areas do you see the most and where can you have the most impact?

12. MECC and Health Inequalities • Health is affected by a number factors i.e. wider determinants of health: • Examples: Factors we are born with – ethnicity, gender, age; Social and community factors – relationships with family and peers; Socioeconomic and environmental factors –un/employment, income, education, housing, literacy, geography, transportation, access to health services • Health inequalities are differences in health status or in the distribution of health determinants between different population groups. (WHO) • Example: People from deprived socio-economic areas within Herefordshire not only have considerably shorter lives compared to people from more affluent areas, but they also spend many more of their later years living with a chronic disease or disability

13. MECC and Health Inequalities What does this mean for how you will implement MECC? -How might the wider determinants of health contribute to peoples’ current lifestyle behaviours and make it difficult for them to change? -How might this impact on how you will deliver BOA?

14. Overview of the Process

15. Implementing MECC: Ask How to raise lifestyle issues? What to say and how to say it

16. Implementing MECC: Ask When to raise lifestyle issues? -What are the points of contact with people which provide opportunities to promote healthy lifestyles? -Are some points in the intervention pathway likely to be more effective than others to engage the person? receptionist initial assessment consultation treatment receptionist

17. Implementing MECC: Ask Dealing with resistance What if the person……. doesn’t want to talk? is defensive? is not fluent in English? is tearful? is in a hurry? is not telling you the truth?

18. Implementing MECC: Advise Tips for giving advice I’ve been told to move around more, lose weight, quit smoking and eat the carrot!

19. Implementing MECC: Advise Look interested Involve yourself by responding Stay focussed on information giving Test your understanding Evaluate what is not being said Neutralise your feelings.

20. Implementing MECC: Advise Self Efficacy • A person’s belief or confidence in his/her ability to succeed in a particular situation or achieve a desired outcome • Helping people believe that they can be successful at changing their behaviour and achieving their goals can move them towards making a change • To build self efficacy, you can provide words of encouragement and support, for example: • “I really think you are capable of succeeding” • “It sounds like when you’ve made up your mind you can get on and do things” • “You have the power to change yourself”

21. Implementing MECC: Advise Key Messages by Lifestyle Area

22. Implementing MECC: Advise: Smoking Quitting SMOKING

23. Implementing MECC: Advise: Smoking Why Quit? Quitting smoking is the single most powerful way of improving your health and living longer You will reduce the chances of your children getting bronchitis, pneumonia, asthma attacks, meningitis and ear infections. You will save money – around £250 a month for a typical 20 a day smoker. Youwill improve your breathing and general fitness. You will no longer smell of stale tobacco and your skin and teeth will look better.

24. Implementing MECC: Advise: Smoking • Suggestions you can make: • Offer support: • People are 4 times more likely to quit with support • With a stop smoking adviser you get free advice, support and encouragement to help you stop smoking for good. • Stop smoking providers are at GP surgeries, Halo Leisure centres and most pharmacies • Try nicotine replacement products or medication – range of products available • Avoid situations you associate with smoking • Gain support from friends and family • Set a date for stopping smoking a few weeks in the future. This gives you a day to aim for and time to prepare

25. Implementing MECC: Advise: Alcohol

26. Implementing MECC: Advise: Alcohol • Why Cut Down:

27. Implementing MECC: Advise: Alcohol • Suggestions you can make: • Find out how many units are in your usual drink • Try for 2 alcohol free days each week • If you tend to have a drink at a certain time of day, try to plan other activities and tasks at those times • Swap your usual drink for a drink with less alcohol content (ABV) • Try a smaller drink – a small glass of wine instead • Make a plan – before you start drinking, set a limit for how much you’re going to drink • Only take a fixed amount of money to spend on alcohol • Have your first drink after starting to eat • Quench your thirst with non-alcohol drinks before alcohol and alternate alcohol with water to keep hydrated

28. Implementing MECC: Advise: Physical Activity

29. Implementing MECC: Advise: Physical Activity Why Be Active: Regular physical activity can reduce your risk of major illnesses, such as heart disease, stroke, diabetes and cancer by up to 50% and lower your risk of early death by up to 30%. Almost 40% of deaths from coronary heart disease are down to inactivity Physical activity can reduce stress, help you feel happier and boost your self-esteem, energy levels and sleep quality.  It is an excellent way to be with friends, meet new people, enjoy yourself and have fun!

30. Implementing MECC: Advise: Physical Activity Suggestions you can make: Build up activity levels slowly and at your own pace Pick an activity you like that fits into your life Walk or cycle for all or part of your journey (get off the bus one stop early or park your car a few blocks away) Take the stairs instead of the lift or escalator Exercise at lunch time; walk or go to a gym Take up an active hobby such as cycling or walking Get active around the house e.g gardening or DIY Split it up – As long as you’re getting your heart rate up for 10 minutes or more it counts

31. Implementing MECC: Advise: Physical Activity Suggestions you can make: Build up activity levels slowly and at your own pace Pick an activity you like that fits into your life Walk or cycle for all or part of your journey (get off the bus one stop early or park your car a few blocks away) Take the stairs instead of the lift or escalator Exercise at lunch time; walk or go to a gym Take up an active hobby such as cycling or walking Get active around the house e.g gardening or DIY Split it up – As long as you’re getting your heart rate up for 10 minutes or more it counts

32. Implementing MECC: Advise: Healthy Eating and Weight Management

33. Implementing MECC: Advise: Healthy Eating/Weight Management Why? Eating the right foods in the right amounts helps to: • Maintain a healthy weight • Reduce blood pressure and cholesterol levels • Maintain strong bones and muscles • Improve resistance to infection • Keep up energy levels and improve mood

34. Implementing MECC: Advise: Weight Management Why? Losing just 5-10% of your weight (about 5-10kg or 11-22lbs) can help you: Feel less tired Increase your energy levels Move about more easily Reduce breathlessness Reduce back and joint pain Lower blood pressure and cholesterol Reduce the risk of diabetes and heart disease, stroke and some cancers

35. Implementing MECC: Advise: Healthy Eating/Weight Management Suggestions you can make: Use the eatwell plate to help you get the balance right One third of what you eat should be starchy foods like potatoes, cereal, pasta, rice and bread Aim for ‘five a day’ portions of fruit and vegetables. Try to have some fruit or vegetables with each meal to reach 5 a day – frozen and tinned count. Aim for less fat, sugar and salt. Check food labels for fat, sugar and salt contents to swap higher levels for lower levels Drink plenty of fluids – about 1.2 litres each day (6 to 8 glasses). All non-alcoholic drinks count, but water, milk and fruit juices are most healthy Eat regularly - try to eat 3 meals a day, including breakfast

36. Implementing MECC: Advise: Healthy Eating/Weight Management Suggestions you can make: • Aim for losing between 5-10% weight to make a big difference to your health • Aim for a gradual weight loss of between 1-2lbs or 0.5-1kg a week • Check your BMI regularly – (you can use the link to a BMI calculator in the Healthy Lifestyle booklet) • Watch your portions – try using a smaller plate, eat slowly and stop eating as you start to become satisfied • Plan your meals ahead of time – make a list and stick to a budget to avoid impulse buys • For snacks, try a healthy option like fruit, low-fat yogurt or a drink instead of biscuits, chocolates and crisps

37. Implementing MECC: Advise: Mental Wellbeing

38. Implementing MECC: Advise: Mental Wellbeing Why is it important? • Our overall wellbeing involves both the body and the MIND • Mental wellbeing helps us to: • Feel good about ourselves and the world around us • Get the most from our lives • Achieve the goals we set for ourselves • Good mental wellbeing is also important for our physical health

39. Implementing MECC: Advise: Mental Wellbeing Suggestions you can make: 5 ways to wellbeing: Connectwith other people who make you feel good: friends, family, colleagues, neighbours Be active (ideally 30 minutes exercise a day) Take a walk, go cycling, garden, dance or play a game of football Give: Do something for a friend, neighbour or stranger. Volunteer and give back to the wider community Take notice: pay attention to the beauty in life. Smile! Keep learning: join a class or learn a new skill, consider taking up a hobby

40. Implementing MECC: Advise: Sexual Health Sexual Health

41. Implementing MECC: Advise: Sexual Health Why is it important? • A healthy sex life is an important part of a person’s wellbeing. Poor sexual health can result in: • Unplanned pregnancy • Sexually transmitted infections • Low self esteem, anxiety or depression • Relationship problems.

42. Implementing MECC: Advise: Sexual Health Suggestions you can make Use a condom every time you have vaginal, oral or anal sex Learn how to use a condom correctly - you will get better the more you practice. Practice opening and using a condom alone and in the dark Use contraception to avoid unplanned pregnancy – there are lots of types, find out which is right for you Talk to your partner about sex ahead of time Get tested to make sure you are STI free

43. Implementing MECC: Assist Signposting to further information and support

44. Implementing MECC: Assist Smoking: Stop smoking providers are located at: • GP Surgeries, • Halo Leisure Centres and • Most pharmacies in Herefordshire To help someone find out where their nearest adviser is: • Signposting Directory under “smoking” – all providers listed • http://www.herefordshire.nhs.uk/stopsmoking- click on “find out where your nearest adviser is”

45. Implementing MECC: Assist Alcohol: Staff trained in alcohol Identification and Brief Advice (IBA) should continue to offer this as part of MECC If service user needs more intensive intervention, can direct them to DASH Signposting Directory under “alcohol” – includes DASH and sources for further information

46. Implementing MECC: Assist Physical Activity: Many local opportunities to get and stay active Signposting Directory under “physical activity” – includes Walking for Health, Healthy Hearts Trail, information on cycling in Herefordshire, sports clubs and Halo Leisure Centres, national resources and information

47. Implementing MECC: Assist Healthy Eating/Weight Management: Signposting Directory under “healthy eating/weight management” – includes Change 4 Life, NHS choices sites, BMI calculator, Weightwise – site just for young people

48. Implementing MECC: Assist Mental Wellbeing: Signpost around the 5 ways to wellbeing: be active, take notice, keep learning, connect and give Signposting Directory under “mental wellbeing” – includes signposting for 5 ways to wellbeing, NHS mental wellbeing, Living Life to the Full (free online course) and self help booklets

49. Implementing MECC: Assist NHS Health Checks Your service users may have received invites to a free NHS health check. As part of signposting, you can remind them to take up this opportunity A health check can help them prevent heart disease, stroke, type 2 diabetes and kidney disease

50. Implementing MECC: Assist What information gaps are there if any to support you in MECC? Any confusion over what to do regarding a particular lifestyle issue? Questions?