Human Rights: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval: The study protocol was approved by the South Eastern Sydney Local Health District Human Research Ethics Committee (HREC 15/054).

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Introduction: Antipsychotic medication (APM) initiation is associated with rapid and substantial weight-gain and high rates of obesity. Obesity leads to premature onset of cardiometabolic diseases and contributes to the 15–20 year shortfall in life expectancy in those experiencing severe mental illness. Dietary energy intake excess is critical to weight management but is yet to be quantified in youth with first episode psychosis (FEP) receiving APM. This study aimed to describe the degree of energy overconsumption and the food sources contributing to this in youth with FEP.Materials and Methods: People aged 15–30 years with FEP receiving APM completed diet histories through qualified dietitians to assess energy imbalance and food sources. Outcome measures were: (i) energy balance; and (ii) intake of core and discretionary foods.Results: Participants (n = 93) were aged 15–29 years (mean = 21.4 ± 2.9 years) and exposed to APMs for a median for 8 months (Interquartile Range (IQR) 11 months). Energy balance was exceeded by 26%, by a median 1,837 kJ per day (IQR 5,365 kJ). APM polypharmacy and olanzapine were linked to larger excesses in dietary energy intake. The greatest contributors to energy intake were refined grain foods (33%) and discretionary foods (31%).Conclusion: Young people with FEP receiving APMs appear to have markedly excessive energy consumption, likely contributing to rapid weight-gain, and thereby seeding future poor physical health. Larger, prospective studies are needed to gain a greater understanding of dietary intake, and its effects on health, in people with FEP.

The physical health concerns of people with severe mental illness (SMI) has long been under-diagnosed and under-treated, and consequently high rates of premature mortality within this group exist. 1,2 The SMIs refer to those with a psychotic component, such as schizophrenia, schizoaffective disorder, bipolar disorder and depression with psychotic features. The life expectancy for someone with an SMI is on average 15 years younger than the general population. 3 This gap, labelled as a "scandal of premature mortality" 4 and "one of the biggest health scandals of our time", 5 is widening as the general population experiences an increase in life expectancy. 4

Issues addressed: People with severe mental illness have adverse health outcomes compared to the general population. Lifestyle interventions are effective in improving health outcomes in this population. Current cultural processes in mental health services do not generally incorporate physical health care practices. Innovative education is required to improve knowledge and confidence of staff in the delivery of preventative health measures. Methods: The Keeping our Staff in Mind (KoSiM) program delivered a brief lifestyle intervention to mental health staff. A qualitative analysis following the Standards for Reporting Qualitative Research was undertaken. Semi-structured interviews designed to elicit information about the acceptability of the program and the impact of the intervention on participants' personal and professional lives. The interviews were analysed using thematic analysis, with coding independently developed and reviewed by three authors. Results: Of the 103 eligible participants, 75 were interviewed. Responses revealed four main themes: (i) positive changes in clinician's approach to physical health care, (ii) improvements in attitudes to self-care and family wellbeing, (iii) positive changes in workplace culture associated with physical health care delivery and (iv) high levels of acceptability of the program. Conclusion: The KoSiM model may be useful in other settings as a means of changing the culture of mental health services to better integrate physical health care as a core part of mental health service provision.So what? A novel approach using staff focussed lifestyle interventions model may cut through the resistance that is encountered when implementing proven methods of clinical intervention where cultural barriers exist.