Health of individuals with psychiatric conditions
Persons with psychiatric conditions experience much higher rates of and burden associated with major chronic disease, in particular cardiovascular disease, respiratory illness and cancer, than the general population. These chronic diseases lead to reduced lifespans among individuals with psychiatric conditions who are estimated to die 15-25 years earlier than the general population with about half of these deaths resulting from modifiable risk factors. Factors associated with these poor health outcomes include lack of integrated mental and physical healthcare; poor access to healthcare; disparities in receipt of medical care due to stigma among health care providers; medication side effects; and lifestyle factors such as poor nutrition, lack of exercise, smoking and alcohol use, self-neglect and lack of motivation.
The Center has long recognized the health disparities experienced by individuals with psychiatric conditions and the critical need for health promotion services to address these issues, to improve functional health and quality of life of people with psychiatric conditions. Over the years, we have developed several programs geared towards health promotion integrating physical and mental health.
Hope and Health
In the early 2000s we developed a pilot program called Hope and Health, which was designed to provide an intensive health promotion day treatment program co-delivered by teams of peer providers and health professionals. The program combined four evidence-based practices- Illness Management & Recovery, Physical Activity, Food Education, and Health Literacy. Hope and Health was delivered at the Center and took advantage of Boston University resources such as trained nutrition professionals and access to physical fitness facilities. The Center partnered with the Massachusetts Department of Mental Health to offer this program and drew its participants from their clients. Individuals enrolled in the program experienced improvements in physical activity and nutritional practices. The experiences in this program highlighted the major barrier of poverty experienced by many participants and emphasized the need for environmental supports to encourage lifestyle change. Although Hope and Health is not operating currently, this newsletter describes it as well as health and wellness initiatives at the Center and beyond: https://cpr.bu.edu/wp-content/uploads/2020/01/14.-Wellness-and-Recovery-Pledge.pdf
The need for integrated physical and mental healthcare is widely recognized and several models of integrated care have been developed and tested by researchers nationally in the last couple of decades. Between 2005-2010 we developed and tested an intervention to integrate physical health services in a community mental health setting. This involved a nurse practitioner (NP) employed by and located within a community mental health agency. The purpose was for the NP to coordinate with primary care and mental health care, facilitate access to specialty care, and complement care by supporting clients to make healthy lifestyle choices. More information about this study can be found here.
Complementary and Alternative Health Practices
In the 2000s, we also conducted a study to understand the mental health benefits of complementary and alternative medicine (CAM) given the growing interest in the approach among individuals with serious mental illnesses. We conducted a mail survey to explore the specific benefits attributed to CAM by a national sample of 255 individuals with a serious mental illness who experienced CAM as having a positive impact on their mental health. Results revealed a wide spectrum of benefits that encompassed all major areas of human functioning, including physical, emotional, cognitive, self, social, spiritual, and overall functioning, and addressed both the improvement of psychiatric symptoms and to promote better day-to-day functioning. Study findings provided valuable information to guide both everyday clinical practice and future research on the efficacy of CAM for individuals with psychiatric conditions. More information about this study can be found here.
Health Promotion Classes in Recovery Education Program
Over the years the Center has continued to develop classes geared toward health promotion, some of which have become regular offerings in our Recovery Education Program. These include supported physical activity such as exercising at the BU gym and walking groups, mindful eating, yoga and Qigong to name a few. You can check out the offerings each semester.
The mindful eating program offered in the Recovery Education Center combines nutritional education and mindfulness strategies to overcome the effects of medication, negative moods, stress and anxiety on eating behaviors. The program has shown promise in helping participants eat with greater awareness and overcome emotional eating. We are working to enhance this program based on participant feedback and studying it further to evaluate effects on health outcomes.
Watch this section for updates on research on mindful eating.
In summary, the Center and the mental health field, in general, consider the physical health status and well-being of individuals experiencing psychiatric conditions to be critically important for overall recovery. We will continue to address these issues in a variety of ways. Other national and international organizations and advocates are doing the same. The National Association of State Mental Health Program Directors (NASMHPD) considers physical health to be a critical part of their mission. The National Institute for Mental Health (NIMH) addresses issues of mental health and physical co-morbidities, the World Health Organization (WHO; https://www.who.int/mental_health/evidence/guidelines_physical_health_and_severe_mental_disorders/en/) has examined the global burden of physical health, the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) and the National Alliance for the Mentally Ill (NAMI) have addressed these issues as well.