Link between mental illness and metabolic disorders leads to new clinic for patients

A well documented link between mental illness and an increased risk of physical health problems was one of the reasons the Whitby Mental Health Centre (WMHC) introduced the Metabolic and Weight Management Clinic. There is a wealth of data highlighting the impact mental health has on a person’s physical health. Individuals with serious mental illness suffer from significantly higher rates of chronic disease and have up to a 20 per cent shorter life span than the general population, diabetes is two to three times more prevalent in patients with serious mental illness and schizophrenia has been recognized as an independent risk factor for type 2 diabetes.

WMHC provides a range of specialized, tertiary care mental health programs for inpatients and outpatients throughout its service area of almost 3 million people. Located east of Toronto, its services are designed to provide successful treatment, rehabilitation and the earliest possible reintegration into the community. Assessment and crisis services are provided, as well as consultation, education and community development. With a vision of recovering best health, WMHC focuses on providing specialized care, comprehensive services and innovative practices to support recovery, mental wellness and optimal health.

The Metabolic and Weight Management (MWM) Clinic offers inpatients and outpatients the opportunity to work with a multidisciplinary team to learn how to prevent and mitigate the risks of metabolic disease. The Clinic, which opened in July 2007, provides patients with a toolkit of easily accessible multidisciplinary services, support and education. Services include health assessments and screening, motivational counselling, individualized dietary and physical activity programming and medical and nursing management.

Patients at the MWM Clinic work with a multidisciplinary team to identify personal goals and develop an individual care plan. Patients attend evaluation sessions every two to four weeks during the first phase and as they continue to achieve their goals, the evaluations take place every three to six months.

The team consists of psychiatrists, general practitioners, nurse practitioners, dietitians, therapeutic recreationists, pharmacists and other health-care providers. Together, they monitor and evaluate evidence-based measurables in areas such as diabetes, hypertension, dyslipidemia, body mass index and waist circumference. “Patient outcomes have been very encouraging,” says Jason Moores, Nurse Practitioner with the MWM Clinic. “After three months, the average patient has lost a net of five kilograms and more than an inch from their waist. We have also measured global improvements in blood pressure, cholesterol and diabetic targets.” The success doesn’t end there. Care plans of patients who remain at the MWM Clinic are now 80 per cent more in-line with established best practice guidelines for the management of obesity, diabetes, dyslipidemia, hypertension and schizophrenia.

The MWM Clinic and the University of Toronto’s Medical School conducted a research project entitled ‘The impact of mental health on the quality of life of the Individuals with mental Illness.’ “The results showed that mental health patients are unaware of the dangers of increased weight and metabolic complications,” says Dr. Kopka, psychiatrist with the MWM Clinic. “Patients would not seek help or change their lifestyles if they are not encouraged by health-care professionals. This puts them in even higher risk for serious health consequences.”

Liz, a patient at WMHC, understands the value of a program like this as she continues to successfully recover from her mental illness. She has lost 34 pounds and four inches through her participation in the MWM Clinic and is very pleased with her progress but continues to work towards her individualized goals. “Through the support of the staff I have learned to eat better, make better food choices, improve my lifestyle decisions and I hope to make a successful transition back into the community,” she says.

Staff at the MWM Clinic provide educational training to other health-care professionals to increase awareness of the impact of psychotropic medications and the connection of mental illness and metabolic syndromes. “There is a strong link between mental illness and metabolic disease. Weight gain is the number one reason many patients stop taking their psychotropic medication,” says Dr. Kopka. “Our clinic addresses this concern, supports patients to manage their metabolic challenges and ensures they continue taking their medication to achieve optimal health outcomes.”

Through collaboration with external service providers, MWM Clinic staff identified the need to provide “mobile” MWM services in the community at the point-of-care. This ensures ease of accessibility and seamlessness of care. MWM Clinic provides treatment and recovery for other hospitals and organizations in the area such as Lakeridge Health Corporation and Rouge Valley Health System, Canadian Mental Health Association, and Homes for Special Care.

“These evolving partnerships with hospitals and community agencies will result in a truly regional service to allow partnering frontline staff to work collaboratively with the highly specialized clinic staff to triage referrals, share resources and ensure appropriate level of MWM Clinic services and support to the ever-growing patient population,” says Sheila Neuburger, Vice-President, Clinical Services.

For patients like Liz, the combination of care for her mental illness and physical challenges has changed her life. “I am pretty happy where things are,” says Liz. “The staff are like a family who have supported me throughout my recovery. With their support and programs like the MWM Clinic, I continue to set small goals for myself to achieve better mental and physical health outcomes.”