| People with severe and relentless mental illness | | | | in the community. Fitness assessments were |
| such as schizophrenia and bipolar disorder also | | | | repeated every three months to track progress, |
| bear a greater physical burden; they are at | | | | and there were regular celebrations during which |
| increased risk for obesity and chronic diseases | | | | participants received recognition for their efforts |
| including diabetes, hypertension, cardiovascular | | | | and incentive prizes. |
| disease, and nicotine dependence. Serious mental | | | | A pilot study was launched with the |
| illness is an important risk factor for morbidity and | | | | commencement of the In SHAPE program to |
| mortality; these patients die an average of 25 | | | | gauge participants' progress in improving their |
| years earlier than the average individual due to | | | | overall health. While Jue only expected 40 people |
| higher rates of medical illness than can lead to | | | | to enroll in the program, he was surprised to see |
| premature mortality. | | | | that 65 people had signed up, and more wanted |
| These gloomy statistics inspired Ken Jue, MSW, | | | | to join but couldn't due to limited funding. Three |
| CEO of Monadnock Family Services in Keene, | | | | months after beginning the program, participants |
| New Hampshire to start the In SHAPE program. | | | | exhibited increased exercise capacity and flexibility, |
| "What we're trying to do is prevent premature | | | | enhanced readiness to change, and improved |
| death of persons with serious mental illness," says | | | | mental well-being; weight loss was variable across |
| Jue. | | | | participants. Anecdotal evidence suggests that |
| Research shows that people with schizophrenia | | | | participants seemed to have greater confidence in |
| and other psychotic and mood disorders who | | | | social situations, reduction in their waist |
| exercise three times a week for approximately 4 | | | | circumference and blood pressure, and an overall |
| months lose weight, gain cardiovascular fitness, | | | | reduction in their depressive symptoms. While |
| and experience less depression and fewer | | | | In SHAPE does not promote exercise as a |
| psychiatric symptoms. But few programs exist to | | | | replacement for pharmacotherapy, preliminary |
| help people with SMI maintain healthier lifestyles; | | | | results suggest that the exercise and increased |
| for example, fewer than 20% of people with | | | | health awareness help patients better cope with |
| schizophrenia engage in regular exercise, and | | | | their mental illness. |
| approximately 40% are completely inactive. In | | | | Currently, the In SHAPE program is active in New |
| SHAPE is one of the few wellness and prevention | | | | Hampshire, Massachusetts, and Maine. Jue and his |
| program for individuals with SMI that seeks to fill | | | | team at Monadnock have strengthened In SHAPE |
| this void. | | | | by developing new programs that help address |
| In SHAPE seeks to improve physical health and | | | | challenges that come with varying populations with |
| quality of life, reduce the risk of preventable | | | | SMI. For example, Parents as Teachers is a new |
| diseases, and enhance life expectancy of | | | | initiative developed for mothers with mental illness |
| individuals with SMI. Each participant is teamed up | | | | on Medicaid. Through home visits, mothers are |
| with a trained health mentor to create a Self | | | | taught on how to grow and develop relationships |
| Health Action Plan for Empowerment (SHAPE) | | | | with their children with greater continuity and less |
| that includes physical activity, healthy eating goals, | | | | disruption as a result of their mental illness. While |
| and attention to medical needs. The program | | | | the program presents its own challenges for the |
| enrolls adults in community wellness activities such | | | | mothers involved, most participants are deeply |
| as exercise, dance classes, weight loss programs, | | | | committed to the one-year program and strive to |
| and smoking cessation activities. | | | | make significant changes for themselves and their |
| Until 2002, Jue continued to attend a number of | | | | families. |
| funerals of his patients that seemed far too | | | | Jue encourages other associations to support |
| young to be dying. He often looked at his patients' | | | | wellness and build partnerships with their local |
| photographs and noticed that they all looked | | | | healthcare clinics and organizations with a few |
| youthful and active at one time in their lives. Jue | | | | caveats: |
| started researching information about co-morbid | | | | >> Do not underestimate the insight of |
| medical illnesses among people with SMI and also | | | | people with mental illness: Patients with SMI are |
| interviewed Monadnock staff about patients' | | | | likely to readily acknowledge the need to make |
| medical conditions. Staff members confirmed that | | | | lifestyle changes to improve their health. |
| many of their patients had died prematurely or | | | | >> Emphasize local inclusion: Involving people |
| had a number of other chronic health conditions | | | | with SMI in community activities and exercise |
| exacerbated by their lifestyle choices and their | | | | centers will ultimately improve their quality of life |
| mental illness. Jue knew something had to be done | | | | and reduce local stigma. |
| to help this unique population, and so he outlined | | | | >> Seek community partnerships: Programs |
| key program elements that he would want to | | | | don't need to have their own exercise centers or |
| see in a program that helped people with SMI | | | | nutrition staff; they should leverage use of |
| improve their physical health. | | | | community resources by creating mutually |
| Instead of relying on formal referrals from mental | | | | beneficial partnerships. |
| health providers, Monadnock encouraged voluntary | | | | >> Employ a patient centered approach: |
| participation and began to form partnerships with | | | | Encouraging participants to set their own goals will |
| hospitals and organizations that would provide | | | | increase the likelihood that goals will be achieved. |
| exercise, nutrition, and general health services. | | | | Participants should understand that they have |
| These partnerships were critical to In SHAPE's | | | | responsibility for and control of their health. |
| success. The local hospital provided smoking | | | | >> Do not "medicalize" the program: Orient |
| cessation programs, while a large non-profit | | | | the program as an activity to promote the |
| medical clinic provided primary care services to | | | | participant's health and wellness, not as a |
| participants without a medical home at no charge | | | | response to his or her mental illness or medical |
| to the patient. The local YMCA and a dance and | | | | comorbidities. |
| fitness center also offered up their services to | | | | Funding for the In SHAPE program initially came |
| encourage creative forms of physical activity. | | | | from the New Hampshire Endowment for Health. |
| Graduates from Keene State College Department | | | | The Robert Wood Johnson Foundation also |
| of Health and Fitness were hired to serve as | | | | provided monies for program expansion and a |
| health mentors. They did not receive formal | | | | pilot study to test the effectiveness of the |
| mental health training so that they would not be | | | | program. Enrolled patients also pay a $5 monthly |
| influenced to think about and treat the participants | | | | membership fee to access exercise facilities and |
| as "ill" or "sick" patients. | | | | classes offered by In SHAPE partners. Recently, |
| Participants were not only given the chance to be | | | | the state of New Hampshire agreed to reimburse |
| educated on leading a healthy lifestyle, but they | | | | the In SHAPE program under the state's Medicaid |
| were also given the opportunity to meet other | | | | program. |
| people with similar challenges and to feel included | | | | |