Focusing on the physical health of young people with mental health challenges
Reprinted from "Mind-Body Connection" issue of Visions Journal, 2014, 10 (2), p. 31
One night in 2007, pediatric specialists Dr. Dina Panagiotopoulos (endocrinologist) and Dr. Jana Davidson (psychiatrist) were chatting after being called to BC Children’s Hospital emergency room. They discovered they had both noticed the same pattern in their patients. That is, when the youth were given medication for their mental illness—specifically, second-generation antipsychotic medications or SGAs)—they began to develop major metabolic side effects. The two most commonly prescribed SGAs in children in BC are risperidone and quetiapine.
Metabolism is the range of chemical processes by which our bodies use food and water to grow, heal and make energy. Metabolic side effects include: weight gain (especially around the belly), high blood sugar, high blood pressure, high cholesterol levels and high triglyceride levels.
The two doctors did some research. They found that, yes, although SGAs are the most effective way to manage some mental health disorders, they can cause unwanted metabolic side effects.1 Approximately 5,000 young people in BC are prescribed SGAs each year. And for some young people, SGAs are the only option.
Their findings prompted Dr. Panagiotopoulos and Dr. Davidson to create the Provincial Mental Health Metabolic Program (MHMP), a clinic that supports families in making healthy lifestyle choices to help reduce the metabolic side effects of SGAs.
Who and what the program addresses
Tips for Children and Youth on an SGA
Physical Activity Tips
The MHMP is located at BC Children’s Hospital. It provides outpatient care for children and youth who:
Are at high risk for metabolic side effects associated with taking SGAs, or
Have pre-existing metabolic conditions (excluding type 1 diabetes) and have also been diagnosed with a mental illness
The MHMP focuses primarily on diet and physical activity, and sometimes also addresses sleep and stress as we are learning that they, too, can impact metabolic health.
The MHMP has a team of health clinicians who work together to provide families with metabolic screening and assessment, healthy living education and support, and ongoing monitoring and follow-up. Our team includes a nurse practitioner, a dietitian, a physiotherapist, a consulting endocrinologist and a consulting psychiatrist. Together, we help patients manage the metabolic side effects by educating families and helping them set small and achievable healthy living goals.
Tools and supports
We know how difficult it can be for families dealing with mental health challenges to also focus on physical health. We also know how important it is for this to happen. For instance, the chronic condition of cardiovascular disease is one of the leading causes of death in people with mental health challenges.2
The MHMP, in collaboration with the Health Literacy team at BC Mental Health and Substance Use Services (BCMHSUS), has developed tools for both clinicians and families.
Healthy Living Toolkits for Families and Professionals
These toolkits help families to set small but sustainable goals toward healthy living, and help health professionals address these concerns in a helpful and consistent way. The development of these toolkits used focus groups with parents to find out what they wanted to know and how they wanted to learn it. Parents were clearly tired of the ‘eat right and exercise more’ information. They really wanted to know how to go about eating right and exercising more, and in a meaningful and sustainable way. Available at www.keltymentalhealth.ca/toolkits
A Guide to Second-Generation Antipsychotics
The booklet, Patient and Family Guide to Second-Generation Antipsychotics, is for families with young people who are on SGA medication. It provides tips and ideas on nutrition and physical activity to address specific metabolic concerns. Tips include ways to start on making lifestyle changes before visiting the MHMP. The resource can also be used by clinicians around the province. Available at www.bcmhsus.ca/resources/metabolic-program
Challenges and successes in changing behaviour
While it can be hard to make changes to healthy-living behaviours, families report wanting to know about the side effects of SGAs so they can start working on behaviour change early.3 When families support their children and make changes as a whole family unit, good things happen.
Jane,* an MHMP patient on an SGA, experienced big changes to her appetite; she felt hungry all the time and never felt satisfied after a meal. As a result, she was steadily gaining weight. After her weight had increased by 50 pounds, Jane’s family made health a priority.
It was hard for the family to find time in their busy schedules to fit in exercise, but they started going to the gym and running together as a family. It was also hard to stop buying and eating favourite foods, but they removed from the house foods that Jane had trouble stopping eating, and replaced them with nutritious options she liked.
To date, Jane’s weight has gone back down 20 pounds. But more importantly, she is feeling good, and the family has been able to reconnect in a very positive way.
About the authors
Kristine, a physiotherapist, joined the Provincial Mental Health Metabolic Program (MHMP) in January 2013. She believes helping families make small changes toward increased physical activity, improved sleep and decreased sedentary time is an important part of optimizing their mental health
Lorrie, a Registered Dietitian, has worked in the MHMP since 2010 (apart from time out to have a baby). She loves helping families find a good balance with nutrition in their lives, and does not force kids to eat their veggies
Panagiotopoulos, C., Ronsley, R., Elbe, D. et al. (2010). First do no harm: Promoting an evidence-based approach to atypical antipsychotic use in children and adolescents. Psychopharmacology, 19(2), 124-137.
De Hert, M., Dekker, J.M., Wood, D. et al. (2009). Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). European Psychiatry, 24(6), 412-424.
Xu, Y., Nguyen, D., Davidson, J. et al. (2012). Health information preference among youth and caregivers related to second-generation antipsychotic treatment. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 21(4), 302-309.