Mental health services must urgently increase investments in lifestyle interventions to improve care and help to fill the gap in life expectancy of 15 years facing people with mental illness, a new Lancet psychiatry committee Report warns.
Living style interventions targeting physical activity, nutrition, sleep and smoking are essential to mental health care, and not to optional extras, according to the report of a team of 30 authors from 19 countries.
“Our lifestyles can change the trajectory of our mental and physical health,” said Dr. Scott Teasdale, principal author, Dishat Teasdale, dietitian and principal researcher in the neuroscience network of the discipline of psychiatry and mental and the Mindgardens of Sydney health.
“Many people living with mental health challenges are confronted with obstacles to be physically active, to eat a balanced diet rich in nutrients, to sleep of quality and to quit smoking. These, in turn, have an impact on their mental health and contribute to physical health disparities, “said Dr. Teasdale.
Bringing changes to lifestyle risk factors facilitates symptoms and improves overall health, making it a significant addition to psychological therapy and drugs, he said. But people with mental illness need support to make such changes.
It is not only a question of change in individual behavior, it is a question of transforming systems to support health and well-being. “”
Dr Scott Teasdale, chercheur diététitien et senior avec UNSW Sydney Discipline of Psychiatry and Mental Health and Mindgardens Neuroscience Network
A roadmap for reform
The Commission’s report, implementing lifestyle interventions in mental health care, describes a roadmap to improve care worldwide-to call on exercise and nutrition specialists to change labor attitudes to prioritize a holistic approach.
It is based on a 2019 commission report on the protection of physical health in people with mental illness – who die 13 to 15 years earlier than the general population, largely due to avoidable conditions such as cardiovascular disease and diabetes.
The researchers reviewed 89 recent interventions on lifestyle, targeting physical activity, nutrition, smoking and sleep withdrawal, to determine the most effective approaches, resulting in eight recommendations and 19 priorities for action. These were examined by people with lived experience and a global advisory group of 14 experts from low-income countries and countries affected by conflict to ensure that they could be adapted to various contexts.
The increase in funding, the implementation of mental health personnel and access to a wider range of allied health professionals will be essential to better integrate lifestyle interventions into care.
“Mental health services have traditionally focused on medication, crisis care and therapy, and lifestyle had not been prioritized – in financing, training or provision of services,” said Dr. Teasdale. “Previously, we did not have the evidence of the benefits of lifestyle changes, but this is no longer the case. »»
Although the delivery methods must be adapted to local contexts, many basic principles are universal, said Simon Rosenbaum, principal teacher of the author of the UNSS.
“We have identified common elements that should apply to care, whether you are in a refugee camp in Bangladesh or at the Sydney eastern suburbs,” he said.
This includes the creation of psychologically safe environments and the guarantee of empathy support staff and the skills necessary to provide trauma and culturally sensitive care.
“The integration of these interventions must be carried out in partnership with people who live with mental illness and with attention to the social and economic realities that they face,” said Professor Rosenbaum.
Global South Advisory Group Co-Maître-Chair Pillaveetil Sathyadas Indu, of the University of Health Sciences of Kerala, said that the recommendations were adaptable in various contexts, including its country of origin in India.
“In countries with limited resources, the emphasis can be placed on the establishment of existing staff and non-specialist workers and engaging family members to help provide life-style interventions,” said the indu.
Incorporating specialists in exercise and nutrition in mental health services in the best training and research establishments would also help stimulate systemic change, she said.
Changing clinical practice in Australia
The transition to care focused on lifestyle is underway in Australia, with lifestyle changes included in clinical practice guidelines for mood disorders since 2020.
“An ideal treatment plan no longer starts and ends with support for drugs and psychology. He is now starting with lifestyle changes and psychological support as a foundation, with drugs added if necessary, “said Dr. Teasdale.
But the change was slow, in the midst of budgetary constraints and an extensive workforce, and it is necessary to be done by the government, health services and education providers to better integrate lifestyle interventions.
Although this requires a higher initial investment, this would long reduced health care and greater societal costs, said Dr. Teasdale.
“Improving these lifestyle factors is crucial for the mental well-being of each person and in the prevention and management of mental illness. »»
The report is one of the two published by La Lancet Psychiatry Physical Health Commission On Wednesday, with the other, led by the University of Queensland, focused on the side effects of the physical health of drugs.
