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Painted Brain | Factors Influencing Healthy Lifestyles In Adults With Serious Mental Illness
We're bridging communities and changing the conversation about mental illness using arts and media.
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lifestyles influences on mental health

Factors Influencing Healthy Lifestyles in Adults with Serious Mental Illness


Originally published on Creative Occupational Therapy Blog

An integral step in creating a community-based occupational therapy service through Painted Brain is developing an understanding of the needs of the population so that the service developed is relevant to addressing those needs. I began with a literature search, in hopes of learning more about the needs of adults with serious mental illness who live in the community. This search resulted in finding several relevant research studies. One study, by McKibbin et al. (2014), describes the barriers and facilitators in achieving a healthy lifestyle, from the perspective of mental healthcare providers in community-based settings. This is one of the first studies to look at the factors influencing attainment of routine healthy behaviors from the perspective of the people who are directly intervening to improve the overall health of individuals with mental illness.

Evidence shows that adults with serious mental illness are twice as likely to suffer from obesity than the general population (McKibbin et al., 2014). Obesity is associated with a variety of serious health problems, including diabetes, heart disease, and early death, and it is contributed to by a dynamic interaction of complex factors. The study by McKibbin et al. (2014) was conducted at 5 community-based mental health centers, and the authors used focus groups to gather information from psychologists, psychiatric nurses, case managers, social workers, professional counselors, and administrators who worked at the centers. The data was then analyzed using a grounded theory approach, which means that the information gathered from the focus groups was coded into themes that were then used to develop a theory as to why adults with serious mental illness have difficulty developing healthy lifestyle behaviors. Results indicated that a variety of factors contribute to this difficulty, and these factors emanate from the individual, social support networks, societal beliefs and values, and community and social policy. One of the factors mentioned by the providers in the study was a general lack of health-related knowledge in individuals with serious mental illness, such as lack of understanding of nutritional needs and the impact of high fat and sugar diets on overall health. This poor understanding of nutrition is compounded by community and social policy factors, such as the structure of the environment and social services. For example, adults with serious mental illness are more likely to live with low socioeconomic status and thus, use food stamps or food banks to support nutritional needs. Adults with serious mental illness may also live in neighborhoods that are in close proximity to fast-food establishments, which are more affordable. Due to the blending challenges of expensive prices of produce, easy access to foods that are high in fat and sugar, and the plethora of non perishable goods provided by food banks, people living in this situation do not have access to healthy food options.

healthy lifestyle mental illness occupational therapy

In addition to food choices, healthy lifestyle behaviors include recreation choices, such as physical exercise. Community and environmental factors that impact a person’s ability to engage in regular physical exercise include transportation, neighborhood structure, and public recreation services. Large cities typically provide affordable public transportation options that improve access to local parks or community recreation centers. However, adults who live in rural areas may not have access to public transportation systems, and availability of community recreation options may be scarce. Another study on environmental factors found that adults with serious mental illness were more likely to live in neighborhoods with higher levels of physical and structural inadequacy, drug-related activity, and crime (Byrne et al., 2013). These factors surely deter people from engaging in healthy lifestyle behaviors like walking, running, or playing neighborhood sports.

Other factors contributing to healthy lifestyle behaviors include family lifestyles and peer behaviors. These factors, however, can be looked at as facilitators or barriers to attaining healthy lifestyle, depending on whether the lifestyle of the family and the behaviors of the peers are healthy or not. For example, some families may have instilled healthy lifestyle habits into their loved ones, such as gardening or engagement in sports, while others may have relied on fast food diets and sedentary leisure activities. Likewise, some peers may engage in unhealthy behaviors, such as smoking and substance abuse, while others provide support and companionship while engaging in healthy behaviors like running or bicycling.

Social support systems are an important factor to consider in supporting the health of adults with serious mental illness, and in considering their impact it is imperative to understand the stigma surrounding mental illness and its effect on the attainment of healthy lifestyle behaviors. Stigma is described as being externalized as well as internalized, and either way it is extremely pervasive. Providers in the McKibbin et al. (2014) study believed that the internalization of stigma presented as self-consciousness, lack of empowerment, and lack of motivation to exercise in public. Another study found that the externalizations of the stigma surrounding mental illness contributed to the difficulty of adults with SMI in accessing healthcare services, an important contribution to a healthy lifestyle (Ostrow et al., 2014). For example, lack of comprehensive coverage and primary care providers who lack experience with mental illness or who discount physical health symptoms reported by adults with mental illness are barriers to accessing healthcare services.

The providers who participated in the study by McKibbin et al. (2014) offered recommendations for healthy lifestyle promotion programs, such as providing frequent sessions over a long period of time, individualizing services to fit a wide range of functional levels, offering group based interventions to increase social support, incorporating meaning and reward, being accessible on a regular basis, and involving the entire care team. The perspectives of providers indicated that they desired healthy lifestyle promotion programs to be delivered by professionals who are separate from themselves, and who are primarily responsible for those programs. They also desired professionals who represent expertise in a combination of both mental and physical health.

healthy lifestyle mental health occupational therapy

Taken together, the factors that contribute to the attainment of a healthy lifestyle in adults with serious mental illness are complex and include aspects of the individual, social environment, community and social policy, and societal beliefs and values. Community-based settings may be ideal to develop such programs, due to the accessibility of such settings, the frequency and duration that adults with SMI can access such settings, and the interdisciplinary nature of providers in such settings. Across disciplines, providers feel that this is an important need to address, and are open to collaborating with professionals who address this need. In regard to the professionals who develop healthy lifestyle promotion programs, the professionals should have a holistic perspective, provide a meaningful and client-centered service, and be able to provide education and facilitate support to individuals, groups, and families, while also incorporating support from other providers. While the authors did not specifically state this, the descriptions of the program recommendations sound like a perfect fit for occupational therapists, due to the comprehensive and holistic health knowledge obtained by occupational therapists, as well as the value of engagement in meaningful activities that is upheld by the profession.

Reading and appraising these articles contributed to my knowledge of the needs of adults with serious mental illness by illuminating the complicated dynamic of factors that contribute to overall health. This knowledge is extremely valuable in that it highlights that both providers and consumers are interested in addressing overall health and wellness, but current providers (especially those in the disciplines of psychology, nursing, and social work) do not feel that they are qualified to address these issues on their own. This new knowledge confirms my belief that occupational therapists are a vital component in community mental health treatment teams, and that occupational therapy services offered through Painted Brain will be valuable in addressing relevant needs in the population of adults with serious mental illness.

Sharon Vincuilla, OTR, CPDT-KA

USC Occupational Therapy Doctoral Resident

PaintedBrain.org

References

Byrne, T., Bettger, J.P., Brusilovskiy, E., Wong, Y.I., Metraux, S., & Salzer, M.S. (2013).   Comparing neighborhoods of adults with serious mental illness and of the general population: Research implications. Psychiatric Services, 64(8): 782-788. Doi: 10.1176/app I.ps.201200365

McKibbin, C.L., Kitchen, K.A., Wykes, T.L., & Lee, A.A. (2014). Barriers and facilitators of a healthy lifestyle among persons with serious and persistent mental illness: Perspectives of community mental health works. Community Mental Health Journal, 50, 566-576. Doi: 10.1007/s10597-013-9650-2

Ostrow, L., Manderscheid, R., & Mojtabai, R. (2014). Stigma and difficulty accessing medical care in a sample of adults with serious mental illness. Journal of Health Care for the Poor and Underserved, 25, 1956-1965.

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