Potential questions from our clients…….

• Can diet and lifestyle changes made early in life make a

difference years later?

• How can dietary factors overcome genetic vulnerability?

• Are common neuropsychiatric conditions influenced by diet and lifestyle?

• When should I consider a probiotic? Does it really work? • What is the best way to take it?

Garlic Oats Onions Soybeans and soybean

products such as tofu Wheat

Artichokes Bananas Barley Chicory Flax

Folate, Fiber, Choline, Omega-3 fatty acids

Zinc, Vitamins B12, D and E among other nutrients. Iron

Case Management – evolving roles ? • “I started taking a protein shake to build some weight

while working, it says to contact a physician first if you have any psychological disorders or are on medication. It contains 200% daily protein, 200% vitamin B6, 100% riboflavin, 200% folate, 400% vitamin D and 400% Zinc. Would this be OK? You take half in the morning and half at night. I hope to have some weight this winter when I go in for my surgery….”

“After this long list of additives, it lists the expiration date. Does that pertain to the product or the person who eats it?”

If you are going “ talk the talk “ then you may need to “walk the walk “

12

Clinical Case 33 y o woman, single, living independently since 2011

She has a diagnosis of a Schizoaffective Disorder

BMI 33.9 kg/m2, lost 39 pounds last year, exercises regularly 1hourX5/w

smokes, maintains a fairly healthy diet, BP106/70, family Hx Db

Glycosylated HB 5.7 % , Cholesterol 7.87 mmol/l

Triglycerides 2.57, HDL cholesterol 1.61 ,LDL cholesterol 5.09

EKG NSR– QTc 492

Stable on Clozapine 400mg, Sertraline 100mg,Topiramate 200mg

•How do we share information ?

• Whose role is what ?

MODEL OF CARE

Assessment Recognition & Screening

TREATMENT

Psychosocial Management: • Work • School • Relationships

Family Education Modules

Medical Management

Individual

Family Intervention

Mental Health

Recovery Services

Research Staff • Symptoms, side effects, quality of life, genetic, etc.

Case Manager, Psychiatrist

Psychotherapy Group intervs.

Adapted from Specialized Early Intervention Approach CPA, 2011

Multi disciplines-Multi strategies

16

Care Coordination Models

• Routine sharing of clinical information with other providers

(primary and specialty healthcare providers as well as mental

health providers)

• Care integration where services are co-located

• Implement a physical health wellness approach that is consistent

with recovery principles, including supports for smoking cessation,

good nutrition, physical activity and healthy weight.

• Attend to cultural and language needs

17

Recovery Principles

Recovery is described by Anthony (1993) as a “deeply personal, unique process of

changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living

a satisfying, hopeful, and contributing life even

with limitations caused by the illness”.

18

Mental Health Recovery Services

Recovery Programs

•Open Discussion

•Peer Support

•Social Activities

•Coping Skills Group

•Addictions Therapy

Primary Care

Wellness Programs

•Nutrition

•Health Education

•Music Therapy

•Yoga

•Tai Chi

•Walking Club

•Footcare

•Smoking Cessation

Psychosocial Programs

•Housing

•Employment Skills & Opportunities

•Reading, Literacy, Back to School

•Volunteer & Community Integration

•Creative Arts

Building Mental Wellness in a Caring Community

Canadian Mental Health Association

Narcotics Anonymous

Schizophrenia Society

19

Recommendations For Behavioral Change

Joint ESC Guidelines May 2012

Prescribed Exercise

Research studies have shown that physician intervention to discuss physical activity (including the wide array of health benefits and the potential barriers to being active) need not take more than three to five minutes during an office visit but can play a critical role in patient implementation.

(AAFP, march 2003)

Guiding Principle of Care “…individuals with diabetes must be

supported in the skills of self-management since their involvement in disease management is absolutely necessary for success. People with diabetes require

training in goal setting, problem solving and health monitoring, all of which are critical components of self-management.”

(Canadian Diabetes Association- Clinical Guidelines 2013)

Client Centred Wellness Approach

….Therapeutic decisions are made at the level of the relationship between the healthcare professional and the patient. That relationship, along with the importance of clinical judgement, can never be replaced by guideline recommendations.

Evidence-based guidelines try to weigh the benefit and harm of various treatments; however, patient preferences are not always included in clinical research, and, therefore, patient values and preferences must be incorporated into clinical decision making.

(Canadian Diabetic Association-Clinical Guidelines 2013)

Strategies

Support consumer wellness and empowerment to improve personal mental and physical well-being

• educate / share information to make healthy choices

regarding nutrition, tobacco use, exercise, implications of psychotropic drugs

• teach /support wellness self-management skills • teach /support decision making skills • motivational interviewing techniques • Implement a physical health Wellness approach that is

consistent with Recovery principles, including supports for smoking cessation, good nutrition, physical activity and healthy weight.

• attend to cultural and language needs

Strategies Care coordination Models

Routine sharing of clinical information with other providers (primary and specialty healthcare providers as well as mental health providers

Care integration where services are co-located

Canadian Cardiovascular Society 2006 Guidelines for the Management and Treatment of Dyslipidemia and

Prevention of Cardiovascular Disease

26

Thanks for your attention

Anne Marie Creamer, NP Kimberly Chenier, RN

Claudia Lamschtein, MD Joanne Tynski,BScN,RN,MEd lamschtein@gmail.com

14th Canadian Collaborative Mental Health Care Conference