We know lifestyle changes help mental health, so why aren’t we funding them?
Lifestyle interventions should be urgently funded and better integrated into mental health care to improve quality of life and life expectancy for people with mental health conditions, international experts say.
People with mental illness have a life expectancy up to 15 years shorter than the general population, mainly due to cardiovascular disease and diabetes, and have up to double the rates of cardiometabolic risks and diseases, researchers said in a report in The Lancet Psychiatry.
“Physical health conditions are responsible for 70% of the deaths of people with severe mental illness,” the researchers said.
“Lifestyle risk factors, such as high smoking rates, low physical activity, high levels of sedentary behaviour, low cardiorespiratory fitness, lower diet quality, detrimental eating behaviour, and poor sleep hygiene, are prevalent in this population.
“Lifestyle interventions that target these risk factors are effective adjunctive therapies in people living with mental illness, alleviating mental health symptoms while protecting physical health and promoting wellbeing.”
The 30 authors from 19 countries called for more investment and training to improve access to lifestyle interventions in clinical practice.
Lead author Dr Scott Teasdale, a dietitian and senior research fellow with UNSW Sydney’s Discipline of Psychiatry and Mental Health and Mindgardens Neuroscience Network, said many people with mental health conditions faced barriers to being physically active, eating a healthy diet, getting quality sleep and quitting smoking, which further affects their mental health.
Dr Teasdale said mental health services have traditionally focused on medications, crisis care and therapy, while the funding and delivery of lifestyle interventions has not been prioritised.
“There’s been a lot of focus on proving that lifestyle programs work, but not enough about how to make them part of everyday care,” he told TMR.
“It’s no longer a lack of evidence, it’s about how to close the implementation gap. We’ve got to start looking at the systems and funding and supports available so that it’s more comprehensively available to people, not just a lucky few that can access it.”
Dr Teasdale said the mainstay mental health treatments of psychological support and medication were critical, but for many patients they were only partially effective.
“We now know that programs that include exercise and diet modification can also be powerful additions to improving mental health,” he said.
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“We’re looking at systemic benefits across physical and mental health and in turn, reducing the mortality gap, health care costs and societal costs.”
Dr Teasdale said that while patients faced individual challenges in making lifestyle changes, the qualitative research had shown that patients recognised that improving their physical health benefits their mental health.
Their research showed that patients were willing to make changes to improve their physical health and lifestyle if interventions were flexible so it could meet their needs, and if healthcare professionals were trained in mental health, and included peers with lived experience, he said.
“When we’re talking to people to see what their priorities are, it has been surprising that we can often assume that people don’t want to think about their physical health and lifestyle, but a lot of people do,” Dr Teasdale said.
“Once people get started and can see the benefits, it helps with their motivation.”
Dr Teasdale said Australian clinical practice guidelines for mood disorders now recommended psychological support and lifestyle changes as the first line of treatment, followed by medication if needed.
