What’s working in mental health REALLY like?

I’m currently heading toward the end of my second student dietetic placement – and my goodness have I learned a lot about mental health! My placement is at a community mental health service which specialises in preventative and rehab of people experiencing severe mental illness (some include schizophrenia, psychosis and bipolar disorder).

So here’s a little taste of what I’ve learned in my short time in community mental health.

Why do people with severe mental illnesses need lifestyle interventions?

For a very long time and even to this day where there is an increased awareness of mental health – most people experiencing severe mental illnesses do not get the appropriate care to their physical health. This is called diagnostic overshadowing – that is the mental health diagnosis outweighs the physical health issues or complaints a person may have. This has essentially led to a 15 to 20 year mortality gap between people with mental illness and the general population. Yes, that is absolutely outrageous! And it is mostly attributed to poor cardiovascular health – leading to increased risk of heart disease, type 2 diabetes, obesity and metabolic syndrome.


Image: Exodus

The treatments used for severe mental illnesses can cause rapid weight gain that actually exceeds the weight gain of pregnancy. These medications can:

  • Increase hunger
  • Reduce sense of fullness
  • Increase drowsiness leading to reduced motivation to be active and also self-care

These side effects are compounded by a number of other factors including:

  • Symptoms of their mental illness: paranoia (regarding food or leaving the house to be active) and lack of motivation
  • Lacking in cooking or food preparation skills
  • Inexperience with being physically active
  • Night hunger, fast eating and disordered meal patterns (e.g. one meal per day)
  • Poor nutrition education or misinformation
  • Excessive takeaway and other “junk” type foods
  • Poor fruit and veg, legumes and milk intake
  • Substance use (alcohol, cigarettes, illicit drugs)
  • Difficulties with budgeting or meal planning

Diet and lifestyle are changes that can be made that can improve health, promote weight maintenance and start to narrow that mortality gap of 15 to 20 years. Only a few centres in the state have recognised this and have dedicated teams of dietitians, exercise physiologists and clinical nurse consultants that help prevent the metabolic impact of medications in young people (symptom onset is typically between 18-25 years old).


Image: nditv mag

So, what is it REALLY like?

Working in mental health is challenging and rewarding. It’s always going to be difficult when the medications and the person’s symptoms are working against you. However, these people DO want to make changes to their life. Overall, my experiences have been very pleasant – they’re people who are willing to learn and improve themselves and they are strong enough to be there actively taking control of their health (physical or mental).

Engagement is key to being effective in practice – which can, of course, be challenging when they may be experiencing symptoms which include hearing voices. They may just pick up and leave during a nutrition education group. They may participate really well. I think having an open attitude and be accepting of whatever unfolds and simply be understanding of their state of wellness or unwellness at that particular point in time.


Image: Intermountain Health Care

I felt it was most important to not contribute to any stigmatization people living with mental illness already experience. Simply focusing a conversation on what a person’s good at, what’s going on for them, what do they like and just simply having a normal conversation is all it takes. I guess it would be normal to feel anxious but that’s simply something that media has portrayed. People living with schizophrenia are violent or abusive is generally not the case, more often than not they are the victims of violence.


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