Addressing the barriers to improve metabolic health care for people experiencing a severe mental illness
- Publication Type:
- Thesis
- Issue Date:
- 2023
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𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱
People diagnosed with a severe mental illness experience significantly reduced life expectancies primarily driven by preventable health conditions. While lifestyle interventions have been shown to be successful in reducing these risk factors in this population, numerous barriers exist to the implementation of these interventions in mental health services.
𝗔𝗶𝗺𝘀 𝗮𝗻𝗱 𝗼𝗯𝗷𝗲𝗰𝘁𝗶𝘃𝗲𝘀
To explore ways to address the multi-level barriers to delivering metabolic screening and lifestyle interventions within mental health care services. This was achieved by: exploring the subjective experiences of people diagnosed with severe mental illness and clinicians who participated in separately designed lifestyle interventions, and developing a valid and reliable measurement tool to determine the effectiveness of a metabolic health care training workshop.
𝗠𝗲𝘁𝗵𝗼𝗱𝘀
This body of research used mixed method designs. Qualitative studies using semi-structured interviews were conducted with participants in lifestyle interventions programs for both people experiencing a severe mental illness and clinicians to determine their acceptability and impact. The development, validation, and reliability of an assessment instrument to measure the outcomes of training clinicians utilised both quantitative and qualitative design. A metabolic health skills workshop was evaluated using this instrument, a quantitative questionnaire with open-ended qualitative questions.
𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀
The study results were mapped against the barriers to improving metabolic health care for people experiencing a severe mental illness within the levels of the socioecological model of health and wellness. At the individual level lifestyle interventions delivered by a specialist metabolic health team addressed a lack of motivation and health literacy amongst people experiencing a severe mental illness. The same intervention improved social isolation and practical support were at the interpersonal level. At the organisational level interventions targeted at clinical staff members was able to demonstrate improved knowledge, confidence and attitudes towards metabolic health care and change organisational culture to be inclusive of delivering metabolic health care. At the community level provision of a reliable measurement tool can help reduce fragmentation of metabolic health care delivery.
𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻
Metabolic health care in mental health services should incorporate a multilevel approach that addresses clinician knowledge and confidence levels, workplace culture, and placement of specialist metabolic teams that can effectively link with primary health care. Future research should investigate scalability of interventions in this thesis to inform public policy in this area.
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