Improving quality of life in adults with severe mental illness

Collaborator

PROBLEM: People with SMI have low HRQoL, and a 2-3 times higher risk of preventable chronic diseases such as cardiovascular disease, than the general population. Contributors to this heightened risk include lifestyle factors such as low exercise, and metabolic side-effects of medications prescribed to treat SMI. Exercise intervention can improve HRQoL and metabolic health in people with SMI; however, mental health services have limited capacity to provide exercise services, and functional and psychosocial difficulties associated with SMI hinders access to such services in the community. National policy urges governments and services to implement integrated models of care to improve health outcomes for people with SMI. RESEARCH GAP: Exercise can improve HRQoL in people with SMI; however, routine mental health care is suboptimal for improving health-related lifestyle factors: Clinicians report low capability in addressing physical health with patients, resulting in low rates of monitoring and intervention. Improving workforce capability in addressing lifestyle factors may improve practice (quality-enhanced usual care), but it is unknown whether this will effectively improve HRQoL or reduce metabolic risk. Additional capacity to provide evidence-based exercise interventions may improve HRQoL and metabolic health of patients; however, there is a lack of translational evidence to inform effective and cost-effective implementation of such models of care. This project will address the question: How much benefit does an exercise service add to quality-enhanced usual care for improving health outcomes in people with SMI? PROPOSAL: This will be an effectiveness-implementation Hybrid Type 1 design with five mental health service sites in Queensland, conducted over four years. All five sites will receive a quality improvement package designed to improve usual care in addressing health-related lifestyle factors (which we have piloted), and additional capacity of a full-time Accredited Exercise Physiologist (AEP). A best-practice referral algorithm for addressing metabolic risk will be implemented, and patients will have direct access to an exercise intervention pathway. The AEP will provide an exercise service that we have developed and piloted over 6-years of iterative development with consumers and project partners. An implementation science framework will be used to evaluate the barriers and enablers of implementation, with the primary outcome of HRQoL, and secondary outcomes of cost-effectiveness and metabolic health. SIGNIFICANCE: Exercise is an evidence-based therapy for improving HRQoL in people with SMI. Findings from the 2022 QLD Parliamentary Inquiry into Mental Health recommend embedding exercise physiology into mental health services. In line with this recommendation, this trial will generate evidence on the implementation effectiveness and cost-effectiveness an AEP service embedded in clinical practice. Leveraging our long-standing partnerships with health services, community organisations and national advocacy bodies, findings will be broadly disseminated to maximise uptake and translation into practice.

01 Jan 2024

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