What is effective in promoting a healthy lifestyle in secure psychiatric settings? A review of the evidence for an integrated programme that targets modifiable health risk behaviours

Abstract

Purpose – The purpose of this paper is to describe healthy lifestyle initiatives in a secure psychiatric facility and the evidence base for these interventions. Design/methodology/approach – Following a detailed review of the literature on the physical health of psychiatric inpatients, a trans-diagnostic approach to behaviour change is advocated in selected areas. Findings – Lifestyle strategy proposals were produced that incorporate the principle of “libertarian paternalism” in making changes to eating and exercise behaviour; a programme of motivational and reinforcement strategies; and facility-specific environmental restructuring to include maximising the therapeutic use of green space. Practical implications – Instituting described changes needs to be accompanied by a programme of evaluation to assess intervention-specific physical health changes. Originality/value – This paper provides a synthesis of findings in key areas of behaviour change relevant to improving the physical health of psychiatric patients in secure settings. It is a co-ordinated and interlinked lifestyle strategy that has applicability to similar services.

Less Medication Use in Inpatients With Severe Mental Illness Receiving a Multidisciplinary Lifestyle Enhancing Treatment. The MULTI Study III

“…This indicates that the decrease of psychotropic mediation was not a result of just increasing physical activity. We hypothesize that, with an organizational culture change as a base, multiple components that complement physical activity contribute to improvements, including focus on dietary habits, psycho-education, personal tailoring, and support by peers and qualified participating staff, in line with recent studies advocating the use of such elements (29, 30, 51–53). Such a holistic approach, in which patients are encouraged to do any activities instead of none (i.e., decreasing sedentary behavior), may be more feasible and beneficial in the longer term for inpatients with SMI.…”

Tackling obesity in mental health secure units: a mixed method synthesis of available evidence

“…Long et al , 9 in a review of healthy lifestyle interventions in secure units, supported the value of involving staff and patients in the endeavour to change the culture and environment within mental health secure units to facilitate an integrated approach to improving physical health.…”

Implementing a brief healthy‐lifestyle group program on a psychiatric inpatient unit

“…This suggests the opportunity to start education with the patient in the hospital and then refer him or her to outpatient programs upon discharge, in which he or she can participate for extended periods and sustain weight loss . In a systematic review that addresses the promotion of a healthy lifestyle in secure psychiatric units, Long et al recommends the promotion of initiatives that involve physical activities to foster habit formation that can persist after discharge.…”

“…First, the healthy lifestyle group program was delivered over only 5 days, which may not be long enough to observe any behavioral changes among participants. Nevertheless, considering not only the acuity of psychiatric symptoms of patients, but also the variable participation in inpatient group programs, a brief group program of this sort indeed is a viable option to provide patients exposure to helpful resources. Second, this HE program measured only the amount of time that the patients engaged in exercise rather than the amount that the patients exercised, which would be a more accurate measure of exercise.…”