Making the Case for Integrating Healthy Eating into Mental Health Service Provision

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Executive Summary

Phase 2 of the Minding Our Bodies project, Eating Well for Mental Health, began with an environmental scan to locate and describe existing programs, understand their strengths and weaknesses, and identify both the challenges they faced and the successes organizations and participants experienced.

The environmental scan revealed that people with serious mental illnesses are participating in healthy eating programs throughout Ontario through their connection with community mental health agencies. While several barriers to implementing healthy eating programs were also identified, opportunities to build on existing provincial and local initiatives are numerous.

“Making the Case for Integrating Healthy Eating into Mental Health Service Provision” speaks to the value of building capacity within the community mental health sector to promote healthy eating as an essential element of recovery, through building and strengthening community partnerships. Their mandate, established relationships with clients, and willingness to partner with local health promotion organizations, places mental health agencies in a position to promote and provide healthy eating programs to consumers throughout Ontario.

The MOB Eating Well for Mental Health project has identified several opportunities for mental health agencies to support an increased availability of healthy eating programs for consumers. The key strategies recommended are outlined below.


Recommendations

1. Link mental health agencies to existing nutrition programs and resources suitable for consumers

The majority of respondents to the MOB survey identified that the time to develop and plan a program was a barrier to making healthy eating services available for consumers. The MOB Eating Well for Mental Health environmental scan identified that there are a variety of existing healthy eating resources and supports in Ontario that can be used “as is” or adapted slightly, to match the needs of people with a serious mental illness. Making maximum use of existing nutrition programs would reduce the workload and training costs associated with program development, as well as enhance program effectiveness.

There are also a multitude of healthy eating materials available that could be shared more widely, although not many identify the needs of people with a serious mental illness.

2. Enhance or adapt existing nutrition programs to suit the needs of consumers

Mental health agencies have successfully delivered a variety of healthy eating programs to consumers, including cooking classes, community kitchens, community gardens and chronic disease self-management programs. Unfortunately, there is a lack of documentation of how programs were adapted, if necessary, for the consumer population. There is also a lack of knowledge exchange about healthy eating initiatives within the community mental health system.

Targeted initiatives to support people with mental illnesses to engage in healthy behaviours can be adapted from existing healthy eating programs. These initiatives must recognize and deal with the impact of the illness, medications, poverty and other factors that affect people’s ability to engage in healthy behaviours. Given that 54% of respondents to the MOB survey were already delivering healthy eating programs, it would be cost efficient to build on the existing capacity of mental health service providers by identifying and making readily available effective nutrition programs and resources.

3. Increase mental health agency access to nutrition professionals through inter-agency collaboration

Respondents to the MOB survey identified “lack of access to a dietitian” as a barrier to planning and delivering healthy eating programs. Outside of the hospital setting, few mental health programs employ a registered dietitian.

Public health and community health centres are mandated to address local healthy eating issues, with a focus on priority groups such as people with a serious mental illness and individuals and families living in poverty. Almost all of these agencies employ public health nutritionists and registered dietitians, and these services are provided free of charge.

4. Build community capacity to support healthy eating for consumers through inter-agency collaboration

The MOB environmental scan identified that the majority of mental health agencies who have delivered healthy eating programs have already linked to other local health promotion agencies. Creative examples of successful partnerships will be included in the MOB Directory of Programs to encourage replication throughout Ontario.

5. Enhance the mental health literacy of nutrition professionals

Through discussions with staff of the Nutrition Resource Centre, Dietitians of Canada and others, the MOB project identified that registered dietitians, public health nutritionists and volunteers certified through the Community Food Advisor Program do not receive any significant training in mental health issues. Nutrition professionals who are not knowledgeable about mental illness or the unique challenges that affect consumers may not be comfortable delivering nutrition education to people with serious mental illness. Providing mental health literacy training to nutrition professionals would increase the access consumers have to existing nutrition programs and expertise.

6. Continue to explore the potential in training peer leaders/mentors

Peer support is an effective approach, in both chronic disease self-management programs and mental health service delivery. The Minding Our Bodies project has identified peer involvement in the planning and delivery of healthy eating and physical activity programs as an important element for success. Trained peer supporters can reach out to isolated and hard-to-reach individuals and develop supportive relationships based on shared experience. Mental health agencies and consumer/survivor initiatives can provide key opportunities for peer leadership training and development through engagement in physical activity and healthy eating programs.

The MOB Eating Well for Mental Health Project has funded the Mood Disorders Association of Ontario to develop the content for a healthy eating peer support program. The lesson plans and other resources created for this pilot will be shared as part of the Minding Our Bodies online toolkit.

7. Increase the awareness of health professionals that people with serious mental illnesses are a group at risk for a higher incidence of chronic physical health problems

While there has been an increased emphasis on addressing health inequities in recent government and association health promotion documents, people with a serious mental illness are generally not named specifically as a potential priority group in government policies. Whether at high risk of poverty, food insecurity or diabetes, special populations such as people who have serious mental illnesses are easy to overlook unless they are specifically identified in policy documents or initiatives.

For example, the Foundational Standard of the Ontario Public Health Standards contains requirements related to the identification of priority population sub-groups within each health unit area. The OPHS defines priority populations as “those populations that are at risk and for whom public health interventions may be reasonably considered to have a substantial impact at the population level.”

The purpose of identifying priority populations is to address the determinants of health by considering those with health inequities, including:

  • an increased burden of illness
  • an increased risk for adverse health outcomes
  • those who may experience barriers in accessing public health or other health services or who would benefit from public health action.

People with a serious mental illness experience all of these impacts of health inequities. Each health unit will need to identify their own priority populations.


Conclusion

To halt the current and growing trend towards poor eating habits, physical inactivity and the rising rates of chronic disease, it is imperative that Ontario develops healthy public policies and fosters supportive environments, particularly for priority populations such as people with a serious mental illness. Successful strategies to improve food selection and preparation in healthier populations can be adopted for those with serious mental illness and can be implemented in mental health service settings, or in partnership with other community agencies.

The purpose of mental health promotion for people with mental illness is to ensure that individuals with mental illness have power, choice, and control over their lives and mental health and that their communities have the strength and capacity to support individual empowerment and recovery. The Canadian Mental Health Association has emphasized the importance of understanding the mind/body connection which is well understood and supported by mental health service providers. Healthy eating has the potential to simultaneously improve both physical health and mental well-being, thus helping to support recovery.

Over half of the respondents to the MOB survey were already providing at least one type of healthy eating program while 23% where thinking of starting a nutrition initiative. A variety of healthy eating programs were provided or co-ordinated by mental health agencies and service providers, including: general healthy eating for optimal health, the impact of healthy eating on mental illness, food budgeting, menu planning and shopping skills, cooking skills classes, diabetes education, chronic disease self-management, and food security initiatives.

It is a logical fit to integrate healthy eating and food security programs into community mental health services given their existing relationships with consumers, and the frequency and duration of contact. Mental health practitioners also understand the illness, the impact of medications and challenges of recovery. Mental health agencies also have access to trained Peer Leaders who can support the planning and delivery of healthy eating programs.

Locating nutrition services at mental health service sites provides consumers with the social support of peers, in a comfortable environment. Healthy eating and food skills programs can be run as stand-alone programs, be incorporated into life skills education, or included as a component of a broader health promotion program.

The MOB environmental scan identified that many mental health service providers have already established partnerships with local health promotion agencies. Collaborations between community mental health agencies and public health departments, Diabetes Education Centres, Community Health Centres, Family Health Teams, and the Local Health Integration Networks, are already improving consumer access to healthy eating education, cooking skills classes, community kitchens, community gardens, diabetes education and chronic disease self-management skills.

It is recommended that Ontario continue to adopt a comprehensive approach that involves all stakeholders responsible for healthy eating.

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