Bondi fitness scheme turns the tide on treating mental illness
A groundbreaking “lifestyle medicine programme” developed on the surfers’ paradise of Bondi Beach in Australia will be used by the NHS to improve the scandalously neglected physical health of people with serious mental illness.
There are more than 300,000 people in England diagnosed with conditions such as schizophrenia, bipolar disorder and psychosis. But their antipsychotic medication, while reducing disturbing symptoms such as hearing voices and experiencing hallucinations, also causes rapid weight gain within two months of starting a course, precipitating diabetes and heart and circulatory diseases. Weight gain is often why some patients who stop taking their medication relapse and have to be sectioned and return to hospital.
In addition, many people with mental illness are heavy smokers, have chaotic lifestyles, take little exercise and have poor diets and it is hardly surprising that they die, on average, 15 to 20 years earlier than the general population. Gaps between those responsible for mental healthcare and physical wellbeing were revealed in the 2012 National Audit of Schizophrenia, a survey of 5,000 NHS patients with a diagnosis of schizophrenia. It found that only 29% received an adequate assessment of risk factors for cardio-metabolic disease (body mass index, smoking, blood pressure, blood glucose and cholesterol).
About five years ago, health workers in the Bondi Beach suburb of Sydney who were treating young people experiencing their first episode of serious mental illness, started to raise concerns about their patients’ rapid weight gain.
Professor Katherine Samaras, a diabetes and obesity specialist at the University of New South Wales, and one of the architects of the Bondi programme, told the Guardian that despite international expectations of a sunny climate and beach culture Bondi, Sydney (and Australia in general), shares first-world problems of inactivity and overeating calorie-rich foods. Antipsychotic medications also increase feelings of hunger and encourage inactivity, she says, thereby creating a potentially lethal mix.
As a result Keeping the Body in Mind, a multidisciplinary programme was devised, providing patients with vital life skills: what to eat, where to buy it, how to cook it, and how to exercise.
Each patient gets 12 weekly individual sessions with a dietitian and exercise physiologist, weekly group education sessions and access to a gym.
The “show how to cook/exercise/eat/shop” part of the programme was so popular, it was integrated with seeing the psychiatrist and mental health workers, which boosted attendance and engagement, says Samaras. “We have compiled a cookbook of recipes, to which the young people contributed to as well, with their favourite recipes.”
Pilot research presented at the international congress of endocrinology in Chicago earlier this month compared 16 young people who took part in the lifestyle intervention programme with a control group who received the usual care. Over the course of 12 weeks, the lifestyle intervention group gained an average of 1.2 kg, compared with 7.3 kg in the control group. Now the programme is undergoing a formal cost effectiveness analysis.
“Our programme was relatively cheap and of course this early investment in health offsets the cost of treating heart disease and diabetes,” says Samaras.
Some 60 young people aged 15-25 come through the Bondi model. It now forms part of the National Institute for Health and Care Excellence (Nice) guidelines on the care of young people with serious mental illness. And it is being piloted by the NHS in Worcester under the guise of Shape – the Supporting Health and Promoting Exercise – programme for young people with psychosis with a view to it being rolled out across the NHS.
The Bondi model dovetails with the introduction from April this year of physical health “MOTs” for seriously ill inpatients in every NHS mental health trust in England.
Dr Geraldine Strathdee, NHS England’s national director for mental health, describes the MOTs as the world’s largest ever initiative to improve the physical health of people with mental illness and a “clinical quality game changer”.
As part of the MOTs, trusts will be paid to ask patients about smoking status and diet, and monitor weight, blood pressure, glucose and cholesterol levels.
Mental health nurses, psychiatrists, health care assistants and psychologists will carry out the MOTs. This marks a sea change in the way psychiatric patients are treated. It is hoped this will prevent them from falling through the gaps in services historically divided under physical or mental health banners.
Back in Bondi Julio De Le Torre was 21 when he was diagnosed with bipolar disorder in 2012. He says the Keeping the Body In Mind programme helped him shed some 20kg he gained as a result of medications, enabling him to finish his degree and pursue a career in engineering. He is back on the surf and says: “I feel like a normal person now”.