Psychiatry HeAL thyself!

Somatic comorbidities, including diabetes and cardiovascular disease are key contributors to premature mortality in people with mental illness. The mental–physical divide within psychiatric care is eroding, and a growing number of successful lifestyle interventions targeting this population are emerging. However, staff culture can be a formidable barrier to achieving integration of physical health programmes as a core component of mental health services. Health professionals engaged in healthy lifestyle behaviours themselves are more likely to promote such behaviours among their patients (Fie et al., 2013), which is more likely to impact long-term behaviour change. Hjorth et al. demonstrated that an intervention promoting physical health among staff of mental health facilities impacted upon patient physical health (Hjorth et al., 2015). Staff who participated in the study improved key measures of cardiometabolic risk, achieving reductions in their own waist circumferences, while noting that the staff had acted as positive role models for patient behaviour change. Following the successful implementation and integration of a multi-disciplinary lifestyle intervention for patients of the Bondi Early Psychosis Program (Keeping the Body in Mind [KBIM] programme) at South Eastern Sydney Local Health District in 2014 (Curtis et al., in press), funding was provided for District-wide implementation of KBIM. An investment in the mental health workforce, to build capacity and initiate culture change, was developed – ‘Keeping our Staff in Mind’ (KoSiM). Staff were offered first-hand experience of the KBIM physical health assessment and a brief individualised lifestyle intervention programme. It was hypothesised that KoSiM would be a catalyst for building capacity in the workforce and facilitating culture change, with the aim of improving the physical health of mental health consumers. Specifically, KoSiM aimed to develop staff ‘champions’ to drive the District-wide KBIM implementation while identifying and addressing potential barriers that prevent staff from addressing the physical health of consumers, such as lack of knowledge or confidence. An additional potential benefit of the KoSiM initiative is an improvement in staff wellbeing. Of 702 potential participants (existing mental health staff), 204 (29%) completed a baseline survey, and 154 staff agreed to participate in the 4-week individualised lifestyle intervention. The HeAL declaration (www.iphys.org.au) challenges health professionals and organisations to maintain and protect the physical health of people experiencing psychosis. The KoSiM programme is a first step towards system-wide implementation and integration of comprehensive physical health care for this high-risk population.