Objective Few studies targeting obesity in serious mental illness report clinically significant risk reduction, and none have been replicated within community settings or have demonstrated sustained outcomes after intervention withdrawal. This pragmatic clinical trial aims to replicate positive health outcomes demonstrated in a prior randomized effectiveness study of the In SHAPE program across urban community mental health organizations serving an ethnically diverse population. Methods Persons with serious mental illness and BMI>25 receiving services in three community mental health organizations were randomized to the 12-month In SHAPE program (health promotion coach and membership to a public fitness club) or to fitness club membership alone. Primary outcomes were weight and cardiorespiratory fitness (measured with the 6-Minute Walk Test) collected at baseline, 3-, 6-, 9-, 12-, and 18-months. Results Participants (N=210) were ethnically diverse (46% non-White) with mean baseline BMI=36.8±8.2. At 12-months In SHAPE (n=104) compared to a fitness club membership alone (n=106) contributed to greater reduction in weight and improved fitness. Primary outcomes were maintained at 18-months follow-up. Approximately half of In SHAPE participants (51% at 12-month program completion and 46% at 18-month follow-up) achieved clinically significant cardiovascular risk reduction (≥5% weight loss or >50 meter increase on the 6-Minute Walk Test). Conclusions Sustained weight loss and improved fitness can be achieved by community mental health organizations providing health promotion coaching and access to fitness facilities. Health promotion should be integrated into mental health services for persons with serious mental illness at risk for cardiovascular disease and early mortality.

Objectives This report describes one, two, and three-year outcomes of a combined psychosocial skills training and preventive health care intervention (Helping Older People Experience Success – HOPES) for older persons with serious mental illness. Design A randomized controlled trial compared HOPES to treatment as usual (TAU) for n=183 older adults (age≥50) with serious mental illness (mean age=60.2; 28% schizophrenia, 28% schizoaffective disorder, 20% bipolar disorder, 24% major depression). Setting Two community mental health centers in Boston, MA and one in Nashua, NH. Intervention Twelve months of weekly skills training classes, twice-monthly community practice trips, and monthly nurse preventive health care visits, followed by a 1-year maintenance phase of monthly sessions. Measurements Blinded evaluations of functioning, symptoms, and service use were conducted at baseline, one-year (end of the intensive phase), two-year (end of the maintenance phase), and three-year (12 months after the intervention) follow-up. Results HOPES compared to TAU was associated with improved community living skills and functioning, greater self-efficacy, lower overall psychiatric and negative symptoms, greater acquisition of preventive health care (more frequent eye exams, visual acuity, hearing tests, mammograms, and PAP smears) and nearly twice the rate of completed advance directives. No differences were found for medical severity, number of medical conditions, subjective health status, or acute service use at 3-year follow-up. Conclusions Skills training and nurse facilitated preventive health care for older adults with serious mental illness was associated with sustained long-term improvement in functioning, symptoms, self-efficacy, preventive health care screening, and advance care planning.

As the potential of smartphone apps and sensors for healthcare and clinical research continues to expand, there is a concomitant need for open, accessible, and scalable digital tools. While many current app platforms offer useful solutions for either clinicians or patients, fewer seek to serve both and support the therapeutic relationship between them. Thus, we aimed to create a novel smartphone platform at the intersection of patient demands for trust, control, and community and clinician demands for transparent, data driven, and translational tools. The resulting LAMP platform has evolved through numerous iterations and with much feedback from patients, designers, sociologists, advocates, clinicians, researchers, app developers, and philanthropists. As an open and free tool, the LAMP platform continues to evolve as reflected in its current diverse use cases across research and clinical care in psychiatry, neurology, anesthesia, and psychology. In this paper, we explore the motivation, features, current progress, and next steps to pair the platform for use in a new digital psychiatry clinic, to advance digital interventions for youth mental health, and to bridge gaps in available mental health care for underserved patient groups. The code for the LAMP platform is freely shared with this paper to encourage others to adapt and improve on our team's efforts.

People with serious mental illness are at disproportionate risk of COVID-19 morbidity and mortality because of high rates of risk factors that directly parallel those related to poor coronavirus outcomes, including smoking, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes, along with housing instability, homelessness, food insecurity, and poverty. Community-based behavioral health organizations are also at risk of adverse outcomes because of dramatic declines in revenues and a diminished workforce.The State of Massachusetts has responded to this crisis by rapidly implementing a variety of policy, regulatory, and payment reforms. This column describes some of these reforms, which are designed to enhance remote telehealth delivery of care, ensure access to needed medications and residential care staff, and support the financial livelihood of communitybased behavioral health services.