Transcript Slide 1

Making the Case for integrating physical activity
programming into mental health services settings
Target Population
Physical
Activity/
Exercise
Impacts on
PHYSICAL
HEALTH
General
Population
Health
Promotion
Impacts on
MENTAL
HEALTH
SMI
Health
promotion
General
Population
Mental health
promotion
SMI
Mental health
promotion &
Recovery
High-level Value of Physical Activity for
People with Serious Mental Illness
Physical activity is an
effective health promotion
strategy that improves
physical health and mental
well-being
• SMI is a risk factor for chronic disease (e.g.,
heart disease, diabetes and obesity)
• SMI are more likely to die from co-morbid
cardiovascular problems than from mental
illness
Physical activity has the
• SMI respond in a highly individual-specific
potential to simultaneously
way to traditional treatments and therapies
treat mental illness and
facilitate recovery as a stand • SMI may experience adverse side-effects to
current drug treatments and financial
alone or complementary
barriers to obtaining non-drug therapies
intervention
Why Now?

Solid empirical findings that
people living with serious mental
illness are usually less active and
more sedentary than the general
population

Recent research has concluded
that strategies to change physical
activity behaviour which have
proven successful in healthier
populations can be adopted for
SMI population
 Growing scientific
evidence that physical
activity/ exercise has a
multitude of physical,
mental and social
benefits for persons with
serious mental illness
Why Now?

Increasing knowledge and
lessons learned are surfacing
from community mental health
service providers – locally and
globally - who have pioneered the
integration of physical activity
programming for consumers.
These will be shared shortly…

Body-mind connection is better
understood and supported by
primary health care practitioners
and mental health clinicians
 Ontario government is
committed to implementing a
holistic and integrated
approach to health which
includes funding community
partnerships that address
health promotion initiatives
such as physical activity and
mental health promotion
Why Mental Health Services?

Physical activity can support
recovery  fits with mandate of  Well-positioned to partner with
community mental health services
local health promoting

Established professional
relationships & ongoing contact
with SMI population

Specialized training and
sensitivity to address barriers
facing SMI population with
respect to participation in
physical activity programming
agencies
 Opportunity to reduce service
coordination issues within and
outside of mental health care
sector thereby that enhancing
access to lifestyle intervention
supports for SMI population
Presenting the Evidence:
Data Collection Methods
1. Evidence-based studies from literature review
2. CMHA Ontario environmental scan (2008/09)
– Eight in-depth interviews with mental health service providers running a
physical activity program
 6 out of 8 interviewees provided a successful running and/or walking
group (as part of their program)
 Other programming activities included basketball, tennis, racquetball,
swimming, ping-pong, weights, yoga and dance
– 144 responses to an online questionnaire by mental health service
providers
 41% (n = 59) were running a physical activity program
 59% (n = 85) were not running a physical activity program
Reported Physical Health
Benefits of PA* Program
• Promotes weight
loss
• Makes breathing
easier
• Strengthens
NOTE: Benefits muscles and
are similar to
improves flexibility
those found in
• Increases energy
general
level and stamina
population
• Increases ability to
perform daily tasks
with greater ease
and less fatigue

Improves cardiovascular
functioning and strength

Mitigates epic problem of weight
gain and metabolic disorders
(e.g., diabetes)

Improves muscle toning

Improves posture

Helps to normalize sleep patterns

Helps to wean off medications for
metabolic issues and high blood
pressure
Reported Mental Health
Benefits of PA* Program
ABLE TO THINK CLEARER
Elevated mood
ENHANCED SELF-CONFIDENCE
AND SELF-ESTEEM
GENERAL CAPACITY
BUILDING AND SKILLS
DEVELOPMENT
SENSE OF IDENTITY
IMPROVED
Sense of accomplishment
and empowerment
Opportunity to re-live
enjoyable PA
experiences that were
interrupted by mental
illness
“someone who does
Pilates rather than
someone with a mental
illness”
Lower scores on
measures of
depression and
anxiety
HIGHER SCORES ON
MEASURES OF SELFEFFICACY
FEELING OF CONTROL OVER
HAVING THE CHOICE WHETHER TO
EXERCISE OR NOT; SENSE OF
PREDICTABILITY AND SECURITY
PA provides structure,
purpose and something
positive to focus on
NORMALIZING EXPERIENCE
SERVES AS A BRIDGE/
PRELUDE TO INVOLVEMENT
IN OTHER INITIATIVES
(WORK, VOLUNTEERING)
Pushed away auditory
hallucinations
Reported Social Benefits of
PA* Program
 Serves as a bridge to
engaging with other agency
groups and activities
 Natural stage for rehearsing
social skills without feeling in
the spotlight
 Companionship; “physical
needs bring clients to PA
program, but social benefits
keep them there.”
 Opportunity to “step out of
shell” despite having arrived
in a withdrawn state
 Social interaction, social
support and motivation
 Sense of belonging to a group
provided
Community integration e.g., through
involvement in community races,
public presentations regarding the
group, etc.
&
Additional Benefits of PA* Programs for
the Seriously Mentally Ill
 Physical activity is associated
with minimal adverse sideeffects – in contrast to
pharmacological interventions
 Physical activity can be
sustained indefinitely by the
individual, unlike
psychotherapeutic treatments
which often have a specified
end point
 Many other non-drug
treatments (e.g., cognitive
behavioral therapy) are
expensive and often in short
supply
 Physical activity is a
normalizing health-focused
experience, unlike drug
treatments and other clinical
interventions that are a
constant reminder of one’s
illness
Current Landscape: PA* Programming in
Mental Health Services Settings
 There is always a lag between
evidence-based research
findings and program
implementation
 Despite the recognized
physical, mental and social
benefits of regular physical
activity/ exercise, the
systematic prescription of
therapeutic exercise is not
common in mental health
settings
 Some mental health service
settings have incorporated
physical activity programming
into service delivery, however
this is still not viewed as an
essential element of recovery
 Programs that do offer
physical activity programs
tend to be ad-hoc initiatives of
a staff person(s) with interest,
passion and dedication
Systemic Barriers to Implementation of
PA* Programs in SMI Population
 Views and attitudes of
Western medicine: The mindbody disconnect in terms of
treating physical and mental
health conditions
 Mental health clinics lack
knowledge about the
therapeutic benefits of regular
physical activity/ exercise
coupled with unclear
“prescription” guidelines as
to how much exercise is
beneficial
 The perceived simplicity of PA
programs contrasted against
the reality that many
practitioners are daunted by
how to motivate clients with
low self-esteem, significant
weight gain and low energy
(whether a side-effect of
medication or the illness itself)
 Lack of communication and
knowledge exchange within
the community mental health
system
Organizational Barriers to Implementation of PA*
Programs in SMI Population
 Access to adequate facilities/
physical space
 Challenges to motivate
participants and provide
individualized support
 Availability of funds to support
staffing and other program
expenses
 Staff time management with
competing priorities
 Lack of staff motivation and
knowledge about physical
activity programming benefits
 Program evaluation
challenges: difficult to
establish a meaningful
baseline and post-exercise
measures given continuous
intake process
Participant Barriers to Implementation of
PA* Programs in SMI Population
 Health and mental health-related concerns (e.g.,
medication sedation, weight gain and body image,
distracting thoughts and ability to focus, and fear of
unsafe conditions and of being injured)
 Social anxiety
 Transportation costs to attend the program and other
costs associated with participation
And Now for the Good News!
How to Overcome these Obstacles and Build Capacity
CMHA’s
ENVIRONMENTAL
SCAN identified 3
main strategies to
address barriers
to PA* program
start-up and
maintenance
Build community
partnerships and
inter-agency
collaborations
Engage and
develop peer
mentors/ leaders
Tap into existing
resources and
volunteers
Community Partnership Building
and Inter-agency Collaboration
Community Partnership Building
and Inter-agency Collaboration
 Community-specific
partnerships are developed
through the establishment of
professional relationships
between two or more groups
that share a mutual goal
 Opportunity to raise
community awareness about
mental health issues and debunk myths/ stigma
associated with mental illness
Public Health
Organization
Family
Health
Team
Arthritis
Program
Community
Health
Centre
Mental
Health
Service
Provider
Cancer
Society
Healthy
Heart
Program
Community
Fitness
Facility
YMCA/
YWCA
TYPES of Partnerships
(from CMHA Environmental Scan)
 FACILITIES: free or subsidized

sharing of resources between
mental health agencies in the
same area
use of community centre, church
space, community swimming
pool, local gym facility
 EXPERTISE: working with a
community food advisory
program; working within a large
interdisciplinary mental health
facility where recreation staff
consult with dieticians and
doctors to understand interaction
between medication, diet and
exercise; access to a team of
health professionals on a
consultancy basis
RESOURCES AND STAFFING:

FINANCIAL DONATIONS:
tapping into a charitable
community program that collects
and distributes lightly used
running shoes and fitness
apparel; partnership with
community running race that
donates part of charitable
proceeds to PA program
Tapping into Existing Resources
 The ideal staffing complement to run a physical activity group
includes those with an adequate knowledge of physical activity –
not necessarily a qualified fitness leader – coupled with a genuine
passion and empathy for helping those living with mental illness
 Adequate knowledge of physical activity was described as valid
whether it was achieved through prior self-learning, on-the-job
training or through partnering with fitness experts in the field
Tapping into Existing Resources
 Staff training and program start-up costs can be kept to a minimum
in large part due to the availability of several free online physical
activity resources, including:
 Canada’s Physical Activity Guide
 Ontario’s Active 2010
 Heart Health Resource Centre
 Recent research findings advocate for adapting mainstream
physical activity programs for use with SMI populations, rather
than creating entirely new programs from the ground up
 Mental health providers who partner with community fitness
leaders can tailor an existing PA program so that its structure and
pace meets the needs of SMI participants in that group
Tapping into Your Volunteer Base
 Community colleges and universities are optimal places to seek
out volunteers who may already bring some knowledge and
experience in the physical and social sciences; student work
placements can provide invaluable real-life exposure to the field
of community mental health for individuals considering this
career choice
 Volunteers can assist with running a PA group, training staff and
peer leaders, participant follow-up and attendance reminders as
well as raising funds and awareness about the importance of
physical activity to mental health
Peer Mentors and Leaders:
A Win-Win Approach
Peer leaders can derive many personal benefits from
their role

Improved physical and mental health, and athletic skills

Enhanced leadership and communication skills

Ongoing social connections

Increased self-confidence and satisfaction of helping others
Peer Mentors and Leaders:
A Win-Win Approach
Peer leaders can serve as a powerful motivator for
encouraging fellow peers to reach their fitness goals

Real-life experiential observation of success in someone else
who shares similar barriers and health conditions can be very
inspirational

Peer support can make one’s personal goals feel more
attainable as these individuals are living proof of the benefits of
physical activity
Peer Mentors and Leaders:
A Win-Win Approach
Peer leaders can provide staff with additional support
to help reduce the pressures of competing service
demands and diminishing resources
 Helpful support functions expressed by respondents included:
peer workers picking up new clients at their home who had a
hard time getting to the PA group; peer workers providing
friendly phone call reminders the night before a PA group
 These types of support were identified as especially useful
when trying to engage secluded and hard-to-reach individuals
who are without access to transportation
Concluding Remarks
 Everyone can benefit from
regular physical activity –
regardless of age or fitness
level
 Successful strategies to
change physical activity
behaviour in healthier
populations can be adopted for
those with serious mental
illness, and can be
implemented in mental health
service settings or in
partnership with other
community agencies
 Physical activity has the
potential to simultaneously
improve physical health and
mental well-being, and treat
mental illness

It’s a logical fit to integrate PA
programs into community mental
health services given their
frequency and duration of contact
with the SMI population and their
specialized training and expertise
in understanding the needs and
sensitivities of this group
Concluding Remarks
 The risks of PA program implementation are extremely low
 Starting up a PA program need not be complicated nor expensive
 PA programs can start very small – such as organizing a running
or walking group – and slowly expand to include other physical
activities
 The evidence-based benefits of investing in these initiatives far
outweigh the costs of failing to do so from and individual and
public health care perspective
Concluding Remarks
As noted by one respondent:
“ Exercise is a wonderful metaphor for
understanding the struggles associated with
recovery from serious mental illness and life
itself. Exercise – like recovery – is an ongoing
effort that must be taken one step at a time.”