Healthy Lifestyle programme at Rampton Hospital

Category:         Scheme best reducing the Burden of Chronic Disease

Name:               Irene Dove Cormac

Job Title:           Consultant Forensic Psychiatrist

Organisation:    Nottinghamshire Healthcare NHS Trust

Email:                irene.cormac@nottshc.nhs.uk

Telephone:        01777 248321

Key team:          Dr I Cormac, Ms S Hallford, Dr M Almiron, Ms A Thackray, Ms L Hart, Mr M Saint, Ms A Lang, Mr M Bridges, Ms E Goodwin, Ms J Frazer, Mr N Goodacre, Mr P Rayson, Ms J McNeill, Ms E Wilson

Title:                   Healthy lifestyle programme at Rampton Hospital

Psychiatric patients have higher rates of morbidity and mortality than the general population.

The Health Profile Study at Rampton Hospital found high rates of obesity and smoking than in the general population. In male patients 36% were obese, and a further 40% were overweight. In female patients, 75% were obese. The rate of smoking was 71% compared to 35% in the general population. It is Government priority to reduce modifiable health risks in the general population.  We expected the patients at Rampton Hospital with the most serious risk factors to benefit. We expected that the interventions that we have developed will benefit many psychiatric patients in different settings.

We aimed to reduce serious physical health risks in long-term psychiatric patients who were obese, smoked more than 20 cigarettes per day, and did not exercise. 

Who:

The patients have benefited who had the greatest health risk factors: male patients with learning disabilities, male patients with personality disorders and female patients.  These patients were obese and heavy smokers who did not exercise according to recommended national guidelines.

How:

A multidisciplinary team designed the Healthy Lifestyle Programme. The interventions included weight management, smoking cessation and exercise programmes especially for psychiatric patents, based on SIGN guidelines and current research evidence.

We are evaluating and modifying the programmes to make them as effective as possible for psychiatric patients in secure settings and to disseminate the work for use in psychiatric facilities in the wider NHS. We have been running sessions of weight management, smoking cessation with exercise to groups of patients.

Dr Cormac led the team, designed the strategy and set up working groups to develop the interventions.  Senior Dietician: Sheree Hallford designed and piloted a special Weight Management programme, including educational materials for a 12-week course based on SIGN guidelines.

The Smoking Cessation programme was designed and delivered by Clinical Psychologist, Maria Almiron, Health Promotion Nurse, Anita Thackray and Healthy Lifestyle Officer, Mike Saint The Exercise programme was designed by the Fitness Team: Lisa Hart, Michael Bridges, Evelyn Goodwin and Jan Frazer.  Assistant Psychologist Jay McNeill, Dietician Neil Goodacre, and Nutritionist Philip Rayson assisted with the delivery of the programme along most other members of the team.  Administrative support was provided by Elaine Wilson.  Senior nurse manager: Alsyon Lang gave managerial support.

Staff from many departments including hospital management, facilities, catering, security, psychology, personnel, IT, shop staff, medical and nursing staff have been involved in various ways in the success of the programme. 

No suitable programmes for long-term psychiatric patients: designed programmes based on research evidence. No funding: obtained £150,000 NHS Modernisation for a six months programme. No team: recruited staff internally and externally. No base: found offices. No venues for sessions: liaised with other staff and found some. No escorts for patients: did our own escorts. Prejudice: visited patients and staff. New NHS menu: staff made new dietary analyses. No equipment:  purchased some.  

All patients had mental disorders: gave additional support where needed.  Patients had different mental disorders such as learning disabilities, personality disorder and mental illness: adapted programmes.

The team delivered 11 group and 12 individual support sessions per week. We had a 90% attendance rate. All patients lost weight with 10 patients losing 3-6.5 kg in 10 weeks. At least 80% of patients lost over 4 cm in body measurements. Self-esteem, motivation and communication improved in patients. 73% of patients cut down on smoking. All patients enjoyed the fitness programme and felt healthier.  We are continuing the programme for the next 3 months and hope to gain funding for longer.

We did not expect all patients on the weight management programmes to lose weight as many had low motivation to change.  The mean loss of body fat was 2%. 

The patients enjoyed the exercise and nursing staff reported that the patients were calmer after exercise.  We found a significant reduction in hostility and psychotic anxiety levels on psychological testing.  There was a significant improvement in the global severity index in their mental state. 

The patients told us how improve the smoking cessation programme.  Based on this information, the smoking cessation programme will be further developed to deal with some of the specific problems, which the patients experience.