Tackling obesity in mental health secure units: a mixed method synthesis of available evidence

Abstract

BackgroundThe prevalence and incidence of obesity are high in people with severe mental illness (SMI). In England, around 6000 people with SMI access care from secure mental health units. There is currently no specific guidance on how to reduce the risk of obesity-related morbidity and mortality in this population.AimsTo identify international evidence that addresses the issue of obesity in mental health secure units.MethodA mixed method review of evidence (published 2000–2015) was carried out to assess obesity prevalence, intervention and policy change, as well as barriers to change.ResultsEvidence from 22 mainly small, non-comparator studies (reported in 21 papers) using a range of methods was reviewed. Dietary, physical activity and cultural interventions being implemented within secure units to address the problem of obesity showed some promising outcomes for physical health and health education. These were facilitated by adequate organisational resources, staff training and motivated staff. Holistic interventions that included a social and/or competitive element were more likely to be taken up. Involving patients in decision-making mediated the tension between facilitating behaviour change and imposing control. Barriers to successful outcomes included patient movement in and out of units, severity of mental health condition and resistance to change by patients and staff.ConclusionsDespite the promising outcomes reported, further assessment is needed of the feasibility, acceptability and effectiveness of interventions and policies targeting the obesogenic environment, using robust research methods.Declaration of interestNone.

Involving service users to identify research priorities in a UK forensic mental health service

“… 9 , 11 , 12 The explanation for this notable difference may lie in the recent incentivised drive by commissioners of secure mental healthcare in England for providers to take demonstrable steps to improve physical health, particularly through achieving a healthy weight. 15 , 16…”

“…9,11,12 The explanation for this notable difference may lie in the recent incentivised drive by commissioners of secure mental healthcare in England for providers to take demonstrable steps to improve physical health, particularly through achieving a healthy weight. 15,16 There was overlap with the findings of a previous study showing that service users, as well as professionals, prioritise epidemiological research into factors associated with crime and recidivism, and research oriented toward recovery topics such as the future use of mental health services and employment. 11 Further consistency was found in the high priority given by both clinicians and service users to research about effective treatments and interventions.…”

“…Although such responses may reflect limitations of the phrasing of questions used to elicit the initial views of service users, they may also reveal a lack of evidence of context-specific effectiveness and acceptability of interventions in forensic services. 15 This is evident by the aforementioned current emphasis on finding effective ways to achieve weight loss among service users in secure mental health settings. The use of existing consultation structures is recommended for ascertaining the research priorities of service users within forensic mental health services.…”

Mealtime care and dietary intake in older psychiatric hospital inpatient: A multiple case study

“…HPHE meals and between meal snacks have been shown to be clinically effective in the acute setting (Mills et al, 2018). There needs to be careful consideration of how these could be implemented in this setting where overeating and undesirable weight gain might be concurrent nutritional concerns (Johnson et al., 2018). Dietetic assistants may be beneficial through providing assistance with meal ordering and encouraging intake to patients at risk of malnutrition (Dijxhoorn et al, 2018; Duncan et al, 2005).…”

Thinking inside the box

“…As part of this, it is helpful to form and express a vision of challenging topics in daily routine practice, such as those mentioned above. Involving both HCPs and patients in this kind of decision-making throughout the change process can prevent inconsistencies and tensions which could undermine the proper implementation of lifestyle interventions [83].…”