IMPACT – Improving Physical health and Substance Use in Severe Mental Illness.
Why are we doing this research?
People with severe mental illness (SMI) have very poor physical health, which sadly leads to a significantly higher mortality rate than the general population. A recent study found that the life expectancy of people with SMI was up to 17.5 years less than the national average (Chang et al, 2011). This excess mortality is mainly due to common preventable diseases that affect the ageing population, with cardiovascular disease being the single largest cause (Brown, 2000; Mackin and McAllister-Williams 2006).
The poor physical health of patients with psychosis is now a major priority for mental health services in general and for the Psychosis Clinical Academic Group (King’s Health Partners Accreditation Document, 2010) in SLaM and the IOP in particular.
A contributing factor to this excess mortality is that people with SMI tend to lead unhealthier lifestyles – they have a poorer diet, exercise less and smoke more than the general population. These lifestyle choices mean that these people have an increased risk of developing preventable diseases such as diabetes and heart disease.
Furthermore, people with SMI are more likely to have cardiovascular risk factors (listed below), which predict the chance of a person dying from a cardiac event such as a heart attack. These risk factors together are also known as the metabolic syndrome.
- abdominal obesity (fat around the waist)
- high blood sugar (insulin resistance/glucose intolerance)
- high blood pressure (hypertension)
- unhealthy fat levels in the blood (dyslipidaemia)
Having any one of these risk factors alone almost doubles the risk of a cardiovascular event happening in the next decade; and if this is combined with smoking, the risk is increased 5 times (Isomaa et al, 2001).
A higher proportion of people with SMI use cannabis and other drugs compared with the general population (Boydell et al., 2006). In people with SMI, this leads to more relapses and hospitalisation, lack of compliance with treatment, and longer duration of their illness (Grech et al., 2005). Physical health is also impacted, e.g. cannabis users who are admitted to psychiatric intensive care, not only have poorer mental health but also higher blood glucose levels compared to those who do not use cannabis (Isaac et al., 2005).
What are we doing?
This programme’s main aim is to develop a culturally appropriate, practical and effective intervention that will achieve better physical and mental health in people with SMI, by improving lifestyle choices and reducing substance use. In doing this, we hope to drive down the risk of developing health problems such as cancer, heart disease and diabetes and therefore reduce the excess mortality rate in this population.
There are three parts to the Programme.
Firstly, in a study named PUMP, we are following up people from their first presentation with psychosis to assess their physical and mental health after one year, to see in particular, how this relates to people’s lifestyle choices in terms of diet, exercise and substance use. We also hope to be able to identify people most at risk of subsequently developing cardiovascular risk factors when they first present with psychosis, so that we can try to stop these risk factors developing in the first place.
Secondly, we have devised a health promotion intervention (HPI) to work with people with psychosis to help them choose healthier lifestyles. We have now published an IMPACT Manual, an IMPACT Reference Guide and an IMPACT Service Users Handbook.
Finally, we are working with other NHS Trusts across the country on a randomized controlled trial of the HPI. We want to see whether training and supervising care coordinators in using IMPACT with their patients will result in better quality of life and fewer cardiovascular risk factors for the patients. We are also assessing whether the HPI is cost-effective.
Principal Investigators: Professor Sir Robin Murray and Dr Fiona Gaughran
Senior Investigators: Dr Khalida Ismail, Dr Shubulade Smith, Dr Zerrin Atakan, Dr Kathy Greenwood, Dr Anita Patel, Dr Daniel Stahl, Professor Anthony David
Principal Researchers: Poonam Gardner-Sood, Dr Stefania Bonaccorso, Ali Featherman, Conan O’Brien, Catherine Fung
Research Therapists: Dr Gill Todd, Manyara Mushore
Administrator: Keji Dalemo
Phlebotomist: Stella Anakwe-Umeh
PhD students: Poonam Gardner-Sood, Anna Kolliakou, Evangelos Papanastasiou. We also have 10 MSc Students and 3 BSc students attached to the Programme.
Service User Consultant: Maurice Arbuthnot
Carer Consultants: Philippa Lowe, Diana Orr
UK MHRN collaborators: Anthony Davis (Oxleas NHS Trust), Mark Hayward (Sussex NHS Trust), Hannah Antoniades (Somerset NHS Trust), Ben Reece (South Staffs and Shropshire NHS Trust )
Sweden: Prof Urban Osby (Karolinska University, Sweden), Dr Jonas Eberhard and Prof Lennart Lundin, (Gothenberg University), Dr Anniqa Foldemo (Linköping University)
Italy: Prof Lilian Dell'Osso and Prof Antonello La Salvia (Verona University), Prof Stefano Ferracuti (Rome University)
Who funds the study?
The National Institute of Health Research
Dr Fiona Gaughran; Mrs Poonam Gardner-Sood (0207 848 5581)