Transcript of LIVE WELL: Empowering positive lifestyle changes in older consumers (SWS LHD) - YouTube
[Project title slide: LIVE WELL: empowering positive lifestyle change in consumers | Dr Carmelo Aquilina & Lachlan Best, South Western Sydney LHD]
Rod McKay: I am going to invite South Western Sydney and Dr Carmelo Aquilina and Lachlan Best to come forward.
[Applause]
Carmelo Aquilina: Hello, everyone. I'm Carmelo Aquilina. I'm the Clinical Director of Old Age Mental Health in Southwest Sydney and this is—
Lachlan Best —Lachlan Best, I'm a senior OT working with the MacArthur All the Persons Mental Health Team and I'm also the, I guess, project lead for the LIVE WELL Program.
Carmelo: And we'd like to just start by giving a quick run through all the factors which make us healthy and where our gap is – not just in the implementation gap, but in the opportunity gap.
[Slide 2: What makes us healthy]
So, 50% of health is due to lifestyle and behaviour. It only gets 4% of Health spend and the opportunity to invest more in lifestyle – to get more health – is an opportunity to get the best return on healthcare investment and this is especially important in mental health.
[Slide 3: The problem]
So, you know, people were mental with mental illness more likely to be physically unwell, to have physical disability, to be inactive, die 10 years earlier than the general population. It is not an implementation gap, but it is a need – a desperate need – to make people healthier.
Reasons for poor mental poor physical health outcomes and longevity includes the direct effects of the illness, medication effects, stigma and disadvantage and lifestyle. Lifestyle is – like everyone else – it's an important major contributor to poor physical health in people with mental health problems and I'm just going to give you a very short introduction to the various factors that come into play.
[Slide 4 video 1: What matters in lifestyle?]
Audio from video: We all should save money for our future. By building up our savings we make sure that not only will we have all our comforts, but also have enough to cope with unexpected costs. What if we could do the same with our health? By not looking after our health, we end up being unwell and frailer for longer. Quantity of life is no fun without the quality. It doesn't have to be that way. Just like money, the more you put into your health, the more you get back. You'll become healthier, feel better and bounce back more quickly from any illness. How do we get to be like this? It's not due to luck, your genes or the medicines you take. The secret of staying and feeling well is how you live your life. At any age, these six key features of Living Well matter. Keeping your body active, eating well, keeping your mind active, keeping in touch with others, keeping mentally well, staying positive and optimistic. You don't have to make big changes, do everything at once or make changes quickly. Like saving money, making small improvements in your life can build up over time into big changes. Invest in your future. Live Well, Feel Well, Stay Well.
[Slide 5: RANZCP]
Carmelo: Seven years ago, the Royal College of Psychiatrists issued the challenge to all services: "Health promotion mechanisms should become core elements in all our services." And this is the big gap in our approach. We have become quite reactive; we have become quite focused on the illness, and we do not do enough prevention and early intervention work. So, I'd like to pass on the baton to Lachlan to explain how we have attempted to incorporate prevention and early intervention as something that any worker in mental health can do with every patient in every encounter.
Lachlan: Thanks, Carmelo. All right, so, we're just going to start with a quick video. So, just to introduce, we were able to develop a range of resources and some of these resources are video resources which are on the Southwest Sydney PHN website as well as the District YouTube channel. So, this is a very brief overview of what the LIVE WELL project looks like, and we show this to potential participants – people that we're working with – as a way for them to understand what the process will be.
[Slide 6 video 2: What is LIVE WELL?]
[Music]
Audio from video: What is LIVE WELL? LIVE WELL is a simple intervention that can help people make small steps to improve their life, which will over time help keep them well, recover from illness more quickly and feel better. Here's what happens.
The first step is to learn more about how you live and how that affects your health. You may not have thought about this before and this is a chance to learn more.
The next step is to look at your own lifestyle. You'll be asked to complete a short questionnaire to see how healthy your lifestyle is now and to help you reflect on what you can improve. Your responses will look at six areas of healthy living, physical activity, healthy eating, keeping your mind active, staying connected to others, managing stress and staying optimistic. Which of these do you do well? Which ones could improve?
The next step is to choose one of these areas you can make a small change in that can make you healthier. You'll be helped to make a simple change. Your plan will be written down to help you take the first steps to a healthier life. You choose what you want to do, how often and when to do it. You are in charge. The next time you meet your health worker they'll ask you how you're doing. If you're happy with what you're doing they'll help you continue that change and make it better. If you want to try something else, you'll get help with your new goal. If you don't think this is for you and you've stopped, it's okay you can always change your mind later. Like saving money, making small improvements in your life can build up over time into big changes so start investing in your future. Give yourself a longer and healthier life don't just live. Live Well, Feel Well, Stay Well.
Lachlan: So, that's one of the resource videos that we've done. So, I'm just going to take you through very quickly what the actual process is like when someone wants to have these health promotion-, wellness- and resilience-building conversations with someone.
[Slide 7: LW – AWARENESS]
So, we start with building someone's awareness because we know that people want to make change when there's knowledge and also when they're equipped to do that. So, having a conversation around, "have you ever thought about how you live can affect your health?" And in mental health, a lot of the times these questions haven't been addressed, they've been done poorly, or they've been done in an ad hoc way where the tools aren't really available to be able to see those conversations well. And that's where increasing the awareness can improve the information about lifestyle and health. So, there's a range of resources. You've seen a couple of videos that we've got on the website. We've got a Consumer and Carer Guide and we've also got quite generously, the Southwest Sydney Primary Health Network are hosting all of these resources on their website as well, where there's a range of resources in multiple languages as well.
[Slide 8: LW – ASK]
From there we step into asking, "well if you're aware, are you then actually interested in changing your lifestyle?" And at the moment we're currently in the clinical trial phase of this and so, we go through the Informed Consent to do the LIVE WELL program. It can be a bit clunky at the moment because it is a clinical trial. Once we get through that and we're able to evaluate it, the informed consent doesn't need to be done through Ethics and all of that and it is a much more organic and seamless conversation. And so, there's the example of just the consent form.
[Slide 9: LW – ASSESS]
And then we assess. So, "what is your lifestyle like?" And so, we do a very simple quick baseline questionnaire that looks at the six different domains of health that was covered in the video. And then you can explore each one. So, if someone indicates that, say, they're fine with their physical health but their social activity isn't great and they would like to improve that more, then you can have a more in-depth conversation around that. And there's a range of videos and we've got a video for each of the different domains. And what that does is that just can provide some basic information. It sparks a conversation. And there's also other resources on the website and that we've developed as well. And so, there's a very, very small picture of the Health and Wellness Questionnaire going through each of the six areas.
[Slide 10: LW – ADVISE]
And then we can look at providing a little bit of advice. So as a health professional, we're able to walk alongside the person but also provide a little bit of input. We definitely ask for family and carer input where appropriate as well, and particularly we want the person's involvement. We want their view and their opinion on what they would like to choose. I think the previous presentation said that if you enjoy it, if you're willing to do it – that motivation to change, that willingness to engage – is really important. So, having that buy-in is really important. So, review the questions from the Health and Wellness Questionnaire and it starts a good conversation where you can look at: what are they concerned about for the future and what like they'd like to improve now. And then we can go through the information resources.
[Slide 11 video: LW – ADVISE resources]
Okay, and then we've got some of the other resources to help. So, we're just going to show another quick video and I think this one is on mental activity.
Audio from video: Did you know that your brain is like a muscle? Like muscles, the more you use it, the stronger it gets. Brain activity stimulates brain cells to increase the number of connections between those cells. The more connections brain cells have with each other, the healthier they are. A healthy brain will keep your memory sharp and be less vulnerable to mental health problems. It's never too late to build a healthier brain. How do you build up a strong brain? Easy! Just make it work more. What can you do? The best brain activity is fun, interesting and new to you, as when you're reading a new book. So, join a library or read a book or a newspaper every day. Listen to music. Listen to an interesting program on the radio. Play games that make your mind work like jigsaw puzzles, Mahjong or chess. Be creative: painting or writing or playing a musical instrument are great boosters for your mood as well as your mind. It's never too late to learn more skills or new subjects. Join a local college or Adult Learning Centre. It's fun and also a great social activity as well. Keep your brain active to keep it strong and young. Live Well, Feel Well, Stay Well.
Lachlan: Okay, so it's engaging, it's bright, it's interesting. It's not prescriptive though. It starts a conversation, and it keeps it very, very positive.
[Slide 12: LW – ASSIST]
So, then we look at assisting and looking at people as getting some assistance on how to set a goal. Are there any obstacles that can get in the way? What resources are out there? And then I guess the really, really key part – particularly around the motivation – is looking at setting a SMART goal. And the reason why we do that is because, 1) we want any changes that people are starting to be small. We're looking at very, very simple small changes that can then accumulate over time. And the reason we do SMART goals is because it's very specific, it's very measurable, it's very contained. And SMART goal setting in itself is very therapeutically helpful in helping with motivation to change.
We've also got a range of local resources that are out there as well. So, for example: if someone wants to join a local walking group or different interest groups – things like that – across all the six domains.
[Slide 13: LW – ASSIST – anticipate obstacles]
So, we want to look at, you know, what are the possible obstacles that people may encounter? So, are they around their health? Are there issues around medication? Around the things that we as health professionals actually ask people to take but then there may be extra barriers that are encountered because of that. And then of course, there's also system-related issues as well. In South Western Sydney you've got all the way through from very densely packed, highly multicultural areas, all the way through to quite sparsely, you know, rural – rurally populated – areas down the Southern Highlands. Obviously not as sparse as parts of Western New South Wales, but compared to the rest of Sydney, you have a lot of very, very different demographics there.
[Slide 14: LW – ASSIST – seek resources]
Yeah, so we look at the different resources and so, we help people to potentially look at what's out there, tap into family, tap into their GP and we can also provide that. And there's also a list of resources on the PHN website. Yeah, and so we're looking at online resources as well.
[Slide 15: LW – ASSIST – SMART goal setting]
And so, I've touched on SMART goal setting. For those who've done OT, it's been done to death in our undergrad but it's very important to have a specific goal that's measurable, it's achievable or attainable, that it's relevant to the person, and we time it so it's clear what they're doing. So, an example of a goal: so, there's a picture of someone's fridge with their goal up on it and you can't actually see it but it's actually in Spanish. We're able to use some of the language resources. And the goal on this fridge was this lady was going to be writing three items every week in a gratefulness journal with the assistance of her daughter-in-law. So, very specific, very contained and very understandable. And it's been working beautifully for that lady. So, here we go. And here's an example of a social goal: "I'll call my younger sister by phone for 15 minutes twice a week." So very, very small and attainable.
[Slide 16: LW – AFTER]
And then we review it six and twelve weeks. So, "How did it go? How do you feel?" And then we amplify or help them to increase. Do they adjust or do a review? And some people want to pull out and that's up to them.
[Slide 17: quote from Bartels (2015)]
Carmelo: So, there's a paper from the US that said, the greatest barrier to increasing the life expense expectancy in consumers is not knowledge. None of these domains that we talked about are new. They're not new knowledge that no one's ever heard of. They are things that we don't do. So, the implementation gap is the biggest barrier to us achieving these interventions with our consumers. And for a busy service, for a busy clinician, it has to be something that they can do quickly, they can learn quickly and incorporate that into routine care. Having something that is special and over and above what you have to do is a barrier to doing it. So, this is what we have provided.
[Slide 18: Why LIVE WELL: consumers]
We think this tool gives consumers knowledge, confidence, the tools to achieve that and the support. And we aim in a solution-focused way to give, to start and sustain small, safe directed changes and lifestyle, and we hope to improve health, well-being and resilience.
[Slide 19: Why LIVE WELL: clinicians]
But the other side of the coin is not just the consumer, it's the clinician who has to do that. If we're going to ask them to do it, we want to give them knowledge, confidence, the fluency and the language to do that, and the support to do that. And they should be able to start a conversation about lifestyle that is easy to learn and quick enough to use during routine care. So, we've got resources in six languages to support consumers. I'll just give you a very quick extract now.
[Slide 20 video: Change - Yes we Can]
[Music. Audio from video in Arabic]
Carmelo: So, "Don't eat cookies when you're bored, just eat an apple."
So, clinicians also have brochures, a Clinician Toolkit, a Local Resource Guide and the Clinician Manual for someone who's starting. There is a step-by-step guide complete with QR code so we can take people through the step that is appropriate. You don't have to do all of it with each person, every time, but you can be supported.
[Slide 21: Change – Yes We Can]
We also offer QR codes quickly so that you can talk about anything, at any time. And if a picture is worth a thousand words, a short video has to count for at least five thousand.
[Slide 22: LIVE WELL Project Team]
And this is our team. We have received great support from the PHN who have provided generous funding. The inspiration was originally from the Fountain of Health Project in Canada, and we are grateful to them for allowing us to develop our own approach to this. And finally, Southwest Sydney Local Health District Mental Health who have enabled us and encouraged us to follow this through. So, thank you.
[Applause. End]