scholarly journals Phew! time to focus on physical health and wellbeing: improving the assessment and management of physical health in an early intervention in psychosis service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S179-S179
Author(s):  
Bethany Cole ◽  
Emma Bailey ◽  
Liz Ewins
Keyword(s):  
Physical Activity ◽  
Early Intervention ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Service Users ◽  
Lipid Levels ◽  
Key Factors ◽  
Health And Wellbeing ◽  
Lifestyle Choices ◽  
Early Intervention In Psychosis

AimsNICE guidelines recommend that patients under Early Intervention (EI) in Psychosis Services have systematic monitoring and intervention of cardiometabolic risk factors. We undertook a Quality Improvement Project (QIP) in the Bath and North East Somerset (BaNES) EI Team to improve rates of compliance with national guidelines. We aimed to increase the percentage of service users with a physical health assessment documented in the past 12 months. Other aims included improving monitoring of physical health parameters in those taking antipsychotic medication and increasing the delivery of interventions for abnormal results.BackgroundThe most common cause of premature mortality in people who experience psychosis and schizophrenia is cardiovascular disease. The 'Standards for Early Intervention in Psychosis Service' states that patients should be offered personalised healthy lifestyle interventions, including advice on diet, physical activity, and access to smoking cessation services. Physical health should be monitored at least annually, with more frequent assessments if antipsychotic medication is prescribed.MethodWe identified seven key factors for improving physical health: Body Mass Index (BMI), Blood Pressure, Glucose Regulation, Blood Lipids, Smoking, Alcohol and Illicit drug use. Baseline compliance and intervention rates were measured in March 2019. Six ‘Plan, Do, Study, Act’ Cycles were completed over the following ten months. Examples of the changes made included: a new online diary and whiteboard, abbreviation of the assessment form, teaching for the EI team, and a new weekly ‘Physical Health and Wellbeing’ (PHeW) Clinic. This clinic involved phlebotomy, discussions around lifestyle choices, review of medication side effects, and neurological examination.We measured the compliance with guidelines each month and the total number of interventions delivered at three-monthly intervals. We collected qualitative feedback on these changes in team meetings and with written questionnaires (including feedback from patients).ResultDocumentation of all key factors doubled from 30.2% at baseline to 63.3% in January 2020. The total number of interventions for raised BMI and lipid levels also increased. Feedback from staff and patients was positive. The clinic helped start conversations with patients about lifestyle choices, prompting improvements in weight, physical activity, lipid levels, and alcohol intake. Patient awareness and ownership over their physical health also improved.ConclusionThis project utilised multiple strategies to reduce health complications for BaNES EI service users. A structural change in the assessment and management of physical health proved to be an effective and sustainable solution to optimise the health and wellbeing of this patient group.

scholarly journals Pregnancy audit in the PATH (Psychosis Prevention, Assessment and Treatment in Hertfordshire) early intervention in psychosis service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S34-S35
Author(s):  
Jessica Kershaw ◽  
Zohra Taousi ◽  
Hildah Jiah ◽  
Giovanni Borghini ◽  
Debbi Knight ◽  
...  
Keyword(s):  
Early Intervention ◽  
Physical Health ◽  
Health Assessment ◽  
Training Programme ◽  
Service Users ◽  
Service Information ◽  
Child Bearing ◽  
Assessment And Treatment ◽  
Early Intervention In Psychosis ◽  
In Pregnancy

AimsTo identify whether staff from the PATH Early Intervention in Psychosis (EIP) Service routinely ask female service users of child bearing age about their plans for pregnancy, whether risks of medication in pregnancy are routinely discussed and whether contraception is routinely discussed.MethodIn May 2019, a report was run capturing all female PATH service users of child bearing age (16-50 years) who were on the pathway at this time. This totalled 177 service users, all of whom were included in the sample. We used the search terms “pregnant”, “pregnancy”, “having children”, “contraception”, “conceive”, “baby”, “conception”, “miscarriage”, “abortion”, “IVF”, “still born” to interrogate the patient records . Auditors searched case notes, clinic letters, recent physical health assessment and recent wellbeing plan for evidence as to whether staff had asked about pregnancy plans, contraception, offered a referral to the Community Perinatal Team, and discussed risks about medication in pregnancy.ResultOf the 177 service users, 34 were asked whether they had plans for pregnancy (19%). Of the 177 service users, 28 were given advice regarding contraception (16%). Of the 34 service users who were asked about pregnancy plans, 27 did have plans for pregnancy. Of these 27 service users, 15 were offered a referral to the Community Perinatal Team (56%). Of the 27 service users who did have plans for pregnancy, 12 received advice and or information about risks of antipsychotic medication in pregnancy (44%).ConclusionIt is clear that PATH staff are not routinely having discussions with female service users of child bearing age about their plans for pregnancy or contraception; this audit has identified that this occurs in less than 20% of cases. Of service users that did have plans for pregnancy, only 56% were offered a referral to the Community Perinatal Team; we should strive for this to be 100% so service users can access specialist support and advice. Work is underway to include information on pregnancy in the PATH service information leaflet to ensure women referred to PATH expect staff to ask them about their plans for pregnancy and contraception. Questions about pregnancy planning and contraception are to be embedded in the Trust's Physical Health Assessment care document to act as a prompt for staff. Finally, the topics of pregnancy and contraception in women with psychosis have been incorporated into the PATH physical health training programme which will be delivered with support from the Community Perinatal Team.

Physical Health—Te Taha Tinana

2021 ◽  
pp. 111-120
Author(s):  
David Beaumont
Keyword(s):  
Physical Health ◽  
Mediterranean Diet ◽  
Western Medicine ◽  
Heart Attack ◽  
Intermittent Fasting ◽  
Health And Wellbeing ◽  
Lifestyle Choices ◽  
Nutrition And Diet ◽  
The Relationship

The Māori model of health considers physical health as the cornerstone of Western medicine. Maslow’s understanding of homeostasis. Seligman’s PERMA model and vitality. The relationship between vitality and ageing, and the author’s experience after a heart attack: ‘You look like an old man.’ Telomeres, stress, and ageing—‘you are only as old as you feel’. Professor Elizabeth Blackburn (and her PhD student Carol Greider)’s Nobel Prize-winning research on telomerase. The concept of healthspan. Lifestyle choices and optimum health and wellbeing. Epigenetics and Dr David Sinclair’s book, Lifespan: Why We Age – and Why We Don’t Have To. Sir Harry Burns on the role of the environment and Glasgow effect. Tertiary prevention and the author’s experience. The science of nutrition and diet. The work of Professor Grant Schofield, author of What the Fat? and What the Fast?, who promotes a healthy fat, Mediterranean diet, with low carbohydrates and intermittent fasting. The science of sleep and its role in obesity.

Carers' and service users' experiences of early intervention in psychosis services: implications for care partnerships

2016 ◽  
Vol 12 (3) ◽  
pp. 410-416 ◽  
Author(s):  
Jon Allard ◽  
Susan Lancaster ◽  
Sara Clayton ◽  
Tim Amos ◽  
Max Birchwood
Keyword(s):  
Early Intervention ◽  
Service Users ◽  
Early Intervention In Psychosis

Exploring the impact of peer support in early intervention in psychosis

2017 ◽  
Vol 21 (2) ◽  
pp. 102-109
Author(s):  
Hannah White ◽  
Laura Price ◽  
Tom Barker
Keyword(s):  
Early Intervention ◽  
Peer Support ◽  
Qualitative Methodology ◽  
Service Providers ◽  
Service Users ◽  
Content Type ◽  
Service Engagement ◽  
Mental Health Settings ◽  
Early Intervention In Psychosis ◽  
The Impact

Purpose Peer support (PS) has, over recent years, been implemented across a variety of NHS adult mental health settings. In November 2015, peer support workers (PSW) were introduced to an Early Intervention in Psychosis Service (EIS) in the Midlands. The purpose of this paper is to focus on organisational factors, asking how do PS impact on an early intervention in psychosis multi-disciplinary team (MDT). Design/methodology/approach Six EIS MDT members participated in an hour-long focus group. The data were analysed using thematic analysis, in line with a qualitative methodology (Braun and Clarke, 2006). Findings Two themes were generated, including “The values of PS” (consisting of three sub-themes: improving service engagement; personal qualities; and the peer relationship); and “The peer support role” (consisting of three sub-themes: living experience; boundaries; and alternative perspectives). Findings imply that PS in the current EIS related to: improved service engagement and greater understanding between service providers and users; which could be linked to better outcomes for service users (such as reduced duration of untreated psychosis (DUP)). Originality/value It has been suggested that PSWs facilitate an improved understanding between service providers and service users (Repper and Watson, 2012). However, research into organisational and team benefits of PS is lacking, with a need for more exploration (Repper, 2013). The current study begins to address the lack of literature regarding the organisational impact of PS, and even further regarding early intervention.

scholarly journals Exploring the Benefits of Participation in Community-Based Running and Walking Events: A Cross-Sectional Survey of Parkrun Participants

2020 ◽  
Author(s):  
Helen Quirk ◽  
Alice Bullas ◽  
Steve Haake ◽  
Elizabeth Goyder ◽  
Mike Graney ◽  
...  
Keyword(s):  
Physical Activity ◽  
Life Satisfaction ◽  
Health Status ◽  
Physical Health ◽  
Online Survey ◽  
Activity Level ◽  
Perceived Benefits ◽  
Cross Sectional ◽  
Health And Wellbeing ◽  
Deprived Areas

Abstract Background: Whilst the benefits of physical activity for health and wellbeing are recognised, population levels of activity remain low. Significant inequalities exist, with socioeconomically disadvantaged populations being less physically active and less likely to participate in community events. We investigated the perceived benefits from participation in a weekly running/walking event by those living in the most socioeconomically deprived areas and doing the least physical activity.Methods: A cross-sectional online survey was emailed to 2,318,135 parkrun participants in the UK. Demographic and self-reported data was collected on life satisfaction, happiness, health status, physical activity, motives, and the perceived benefits of parkrun. Motivation, health status and benefits were compared for groups defined by level of physical activity at parkrun registration and residential Index of Multiple Deprivation.Results: 60,000 completed surveys were received (2.7% of those contacted). Respondents were more recently registered with parkrun (3.1 v. 3.5 years) and had a higher frequency of participation than non-respondents (14.5 v. 3.7 parkruns per year). Those who were inactive at registration and from socioeconomically deprived areas reported lower happiness, lower life satisfaction and poorer health than the full sample. They were more likely to want to improve their physical health, rather than get fit or lose weight. Of those reporting less than one bout of activity a week at registration, 88% (87% in the most socioeconomically deprived areas) increased their physical activity level and 52% (65% in the most socioeconomically deprived areas) reported improvements to overall health behaviours. Previously inactive respondents from the most socioeconomically deprived areas reported greater improvements to fitness (93% v. 89%), physical health (90% v. 85%), happiness (83% v. 79%) and mental health (76% v. 69%).Conclusion: The least active respondents from the most socioeconomically deprived areas reported changes to their activity levels and benefits to their health and wellbeing since participating in parkrun. Whilst the challenge of identifying how community initiatives like parkrun can better engage with the least active and most socioeconomically deprived remains, if this can be achieved, then such interventions can have a critical public health role in addressing inequalities in benefits associated with recreational physical activity.

scholarly journals Impact of school closures on the health and well-being of primary school children in Wales UK; a routine data linkage study using the HAPPEN survey (2018-2020)

2021 ◽  
Author(s):  
Michaela James ◽  
Emily Marchant ◽  
Margaret A. Defeyter ◽  
Jayne V. Woodside ◽  
Sinead Brophy
Keyword(s):  
Physical Activity ◽  
Physical Health ◽  
Sleep Time ◽  
Activity Levels ◽  
School Closures ◽  
Health And Wellbeing ◽  
School Competence ◽  
Physical Activity Levels ◽  
The Impact ◽  
General Wellbeing

AbstractIntroductionIn response to the COVID-19 pandemic, school closures were implemented across the United Kingdom. This study aimed to explore the impact of school closures on children’s health by comparing health and wellbeing outcomes collected during school closures (April – June 2020) with data from the same period in 2019 and 2018.MethodsData were collected online via the ‘HAPPEN At Home’ survey, which captured the typical health behaviours of children aged 8 – 11 years between April - June 2020. These data were compared with data in 2018 and 2019 also collected between April-June, from HAPPEN. Free school meal (FSM) status was used as a proxy for socio-economic deprivation. Analyses were repeated stratifying by FSM.ResultsComparing responses between April – June in 2020 (n=1068), 2019 (n=1150) and 2018 (n=475), there were improvements in physical activity levels, sleep time, happiness and general wellbeing for children during school closures compared to previous years. However, children on FSM ate less fruit and vegetables (21% (95%CI (5.7% to 37%)) and had lower self-assessed school competence compared to 2019. Compared to those not on FSM they also spent less time doing physical activity (13.03% (95%CI: 3.3% to 21.7%) and consumed more takeaways (16.3% (95%CI: 2%-30%)) during school closures.ConclusionThis study suggests that schools play an important role in reducing inequalities in physical health. The physical health (e.g. physical activity and diet) of children eligible for FSM may be impacted by prolonged school closures.What is already known on this subject?In response to the COVID-19 pandemic, by mid-March 2020, 138 countries had implemented national school closures to reduce the number of social contacts between pupils, therefore interrupting the transmission of COVID-19 as part of pandemic plans. UNESCO warned that the global scale and speed of the educational disruption would be unparalleled. There is an ongoing debate with regard to the effectiveness of school’s closures on transmission rates, but the fact schools are closed for a long period of time could have detrimental impacts on pupil’s physical and mental health.This study provides evidence of any differences in the health and wellbeing of children prior to and during the COVID-19 enforced lockdown and school closures between March and June 2020. These findings could have a significant impact for the future and support schools to better understand their pupil’s physical, psychological, emotional and social health. It also contributes to a significant literature gap regarding the impact of school closures on school-aged children.What this study adds?Improvements in physical activity levels, sleep time, happiness and general wellbeing were observed in general for children during school closures compared to previous years. However, children on FSM reported eating less fruit and vegetables and had lower self-assessed school competence compared to 2019. Compared to those not on FSM they also spent less time doing physical activity and consumed more takeaways during school closures. These trends are not evident among children not on FSM. All children reported improvements in wellbeing during lockdown especially on the happiness with family measure.Overall, findings suggest schools help to reduce inequalities in physical health for socio-economically deprived children. During school closures children from deprived backgrounds are likely to have poorer physical health (e.g. less time spent doing physical activities and poorer diet) and this is not observed in children who are not in receipt of FSM. This research suggests that school closures will result in widening health inequalities and when schools return measures will need to be in place to readdress the widened gap in physical health.

scholarly journals Access and Waiting Time Standard for Early Intervention in Psychosis: At Risk Mental State Identification and Interventions Accepted within a Routine Service

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Vidyah Adamson
Keyword(s):  
At Risk ◽  
Early Intervention ◽  
Waiting Time ◽  
Mental State ◽  
Psychotic Symptoms ◽  
Service Users ◽  
Routine Service ◽  
Time Standard ◽  
Early Intervention In Psychosis ◽  
At Risk Mental State

Aim: Following the introduction of an access and waiting time standard for Early Intervention in Psychosis (EIP) services, the identification and treatment of people experiencing an At-Risk Mental State (ARMS) for psychosis has become a national priority. However, there is a dearth of literature concerning what is offered to and accepted by ARMS service users within routine services. Methods: This descriptive evaluation reports upon the assessment and treatment of people with an at-risk mental state identified during the first year of a routine service operating in line with the EIP standard. The paper details referral sources, referral to treatment times, socio-demographic characteristics, ARMS subgroups and the interventions accepted by these service users. Results: A total of 138 ARMS cases were identified over the evaluation period, with 73% (n=101) aged between 18-34 years and 86% (n=118) meeting attenuated psychotic symptoms criteria. The majority (64%) of service users engaged in multiple interventions; 54% (n=75) accepted psychoeducation and coping skills enhancement work, 42% (n=58) participated in a sleep programme, 33% (n=45) undertook coping with voices and visions work and 28% (n=39) engaged in individual psychological therapy. Conclusion: The findings indicate that the majority of ARMS service users presenting to the EIP service were aged 18-34 and experienced attenuated psychotic symptoms. A range of NICE and CBT informed interventions as well as individual psychological therapies appear to be acceptable to ARMS service users and many engaged in multiple interventions offered.

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