Andrew Watkins

Issue Addressed: People with complex mental health conditions experience substantial reductions in life expectancy, largely due to preventable chronic disease. Mental health community‐managed organisations (CMOs) are well placed to support physical health, yet little is known about staff capability to promote physical activity (PA). Methods: A cross‐sectional survey was administered to staff at a CMO in Sydney. Staff barriers, attitudes, confidence and knowledge relating to PA and physical health were assessed using the Physical Activity Attitudes Confidence Knowledge (PACK) and modified Metabolic Barriers Attitudes Confidence Knowledge (mM‐BACK) questionnaires. PA promotional practices and personal PA behaviours were also assessed and relationships between these factors explored. Results: Fifty‐six of 78 eligible staff (72%) completed the survey. Mean scores were 34.8/45 (SD = 3.6) on PACK and 43.8/65 (SD = 6.7) on mM‐BACK. Perceived barriers were generally low; workload was among those most commonly identified. Across both tools, attitudes scored highest, while confidence and knowledge scored lower. Only 23% reported familiarity with PA guidelines. Although 82% discussed PA with clients in the previous five workdays, 63% made no formal referrals. In correlation analyses, PA conversations were associated with mM‐BACK attitudes ( ρ = 0.43, p < 0.001) and PACK confidence ( ρ = 0.34, p = 0.011), while capability was not associated with referrals. Conclusions: CMO staff held positive attitudes towards PA promotion and commonly discussed PA with clients, but gaps remain in confidence, knowledge and referral practices. So What?: Building workforce capability, clarifying referral pathways and embedding organisational support for PA promotion within mental health CMOs may help reduce preventable health inequities in this population.

Aims: This study aimed to explore dietitians' views, experiences, and perceived barriers and enablers to working with people with mental illness in Australian private and public mental health settings, with a focus on clarifying the contribution of private practice dietitians to mental healthcare. Methods: A combination of convenience and snowball sampling was used to recruit dietitians who primarily work in private practice or public mental health sectors. Virtual semi‐structured interviews were conducted in two discrete 3–6‐month blocks between 2021 and 2024. A constructivist‐interpretivist approach informed the development of the interview guide, data collection and analysis processes. Semi‐structured interviews explored experiences, facilitators and barriers of private practice dietitians working with people with mental illness. Data were analysed by three authors using reflexive thematic analysis using semantic, inductive coding. Results: In total, 14 dietitians completed interviews, comprising 7 working in private practice settings and 7 in public mental health services. Data adequacy was reached with interviews generating 5 main themes and 15 subthemes. Themes included (1) the complex needs of people living with mental illness, (2) access barriers and enablers to private practice dietitian services, (3) gaps in mental health‐specific training and support for dietetics, (4) structural limitations of the private healthcare systems and (5) advantages of integrated care in specialised mental healthcare settings for working with people with mental illness. Conclusions: To harness the full potential of private practice dietitians in mental healthcare requires targeted reforms to funding, training and referral systems to ensure equitable, community‐based nutrition support.

Australia is failing people with complex mental health challenges, who experience poorer physical health and a reduced life expectancy of 15–20 years. This inequity is driven largely by preventable physical illnesses, many linked to lifestyle-related behaviours including physical inactivity, poor nutrition, smoking and sleep disturbance. Evidence shows integrated physical health and lifestyle interventions are feasible and effective. Yet translation into routine care remains fragmented, with most initiatives failing to scale beyond pilots. As a cornerstone of Australia’s mental health system, community-managed organisations (CMOs) are central providers of recovery-oriented and peer-led psychosocial care to adults with complex mental health challenges. This uniquely positions CMOs to tackle such physical health inequities, yet they are under-resourced and underfunded, and their capability remains insufficiently recognised within national health policy frameworks. This Perspective presents a case for harnessing the capacity and capability of CMOs as a pathway for system reform, enabling better access to interventions that improve health outcomes and minimise health disparities. We outline opportunities for structured models of intervention, integrated care pathways, workforce development and policy and research priorities – all critical levers to enable sustainable, equitable physical health outcomes. It is time to elevate CMOs within mainstream health policy and strategically invest in their capacity to lead a systemic response to the physical health inequities of people living with mental health challenges.

Mental health consumers experience challenges in accessing regular physical healthcare. Staff working in mental health settings are well-positioned to address the issue; however, they often face significant barriers in delivering physical healthcare. The primary aim of this study was to identify important factors that support mental health staff to address the physical health of consumers; the secondary aim was to evaluate the utility of using a modified nominal group technique (NGT). Four main methodological modifications to standard NGT methods were made: (i) theoretical models (COM-B and Theoretical Domains Framework) were used to frame the NGT process, (ii) idea generation and ranking steps were conducted outside NGT sessions, (iii) both in-person and online groups were offered, and (iv) participants contributed to interpretation and dissemination of the findings. Individuals with expertise in the mental health sector participated in one of two NGT sessions, either in-person (n=13) or online (n=8). Considering Australian public mental health services, participants responded to the question: “What is needed for staff to optimally address physical health within their role?”. Additionally, participant experiences and acceptability of this modified NGT process were evaluated through follow-up interviews (n=6). A total of 55 concepts were generated within COM-B components: capability (n=18), opportunity (n=26), and motivation (n=11). Highest-ranking key concepts were awareness (capability), leadership support (opportunity), and beliefs (motivation). Qualitative data indicated that the modified NGT method was effective, particularly when using a framework to guide ideas generation; however, the additional time commitment may reduce feasibility.

Objectives: In 2013, a cluster‐controlled pilot study found the 12‐week Keeping the Body in Mind (KBIM) lifestyle and life skills intervention was able to prevent weight gain in a small sample of youth experiencing first‐episode psychosis (FEP) with fewer than 4 weeks of antipsychotic exposure. This study aims to evaluate the effectiveness of KBIM as routine care on anthropometry and metabolic biochemistry in a larger sample of youth with FEP across three community mental health services.Method: This retrospective chart audit was conducted on youth with FEP, prescribed a therapeutic dose of antipsychotic medication, and who engaged with KBIM between 2015 and 2019. Primary outcomes were weight and waist circumference. Secondary outcomes were blood pressure, blood glucose, and blood lipids. Outcomes were collected in at baseline and at 12 weeks. Data on program engagement were obtained from the participant's medical file.Results: One‐hundred and eighty‐two people met inclusion criteria, and up to 134 people had baseline and 12‐week data on one or more outcome. Mean number of sessions attended was 11.1 (SD = 7.3). Increases in weight and waist circumference were limited to 1.5 kg (SD = 5.3, t(133) = 3.2, p = .002) and 0.7 cm (SD = 5.8, t(109) = 1.2, p = .23) respectively. Eighty‐one percent of participants did not experience clinically significant weight gain (>7% of baseline weight). There were no significant changes in blood pressure or metabolic biochemistry.Conclusion: The prevention of substantial gains in weight and waist circumference observed in the initial pilot study was maintained with implementation of KBIM as part of routine clinical care for youth with FEP.

Issues addressed: People with severe mental illness have adverse health outcomes compared to the general population. Lifestyle interventions are effective in improving health outcomes in this population. Current cultural processes in mental health services do not generally incorporate physical health care practices. Innovative education is required to improve knowledge and confidence of staff in the delivery of preventative health measures.Methods: The Keeping our Staff in Mind (KoSiM) program delivered a brief lifestyle intervention to mental health staff. A qualitative analysis following the Standards for Reporting Qualitative Research was undertaken. Semi‐structured interviews designed to elicit information about the acceptability of the program and the impact of the intervention on participants' personal and professional lives. The interviews were analysed using thematic analysis, with coding independently developed and reviewed by three authors.Results: Of the 103 eligible participants, 75 were interviewed. Responses revealed four main themes: (i) positive changes in clinician's approach to physical health care, (ii) improvements in attitudes to self‐care and family wellbeing, (iii) positive changes in workplace culture associated with physical health care delivery and (iv) high levels of acceptability of the program.Conclusion: The KoSiM model may be useful in other settings as a means of changing the culture of mental health services to better integrate physical health care as a core part of mental health service provision.So what?: A novel approach using staff focussed lifestyle interventions model may cut through the resistance that is encountered when implementing proven methods of clinical intervention where cultural barriers exist.

The Northern Murray–Darling Basin (MDB) is a key Australian agricultural region requiring efficient Agricultural Drought Management (ADM), focused on resilience. Although a need for resilience in local farming communities has long been recognised, previous studies assessing ADM in the Northern MDB did not consider two key elements of resilient management: proactivity (preparing for drought prior to a drought event) and suitability (localised drought management targeted at decision-makers). This study assessed the current ADM Strategy (ADMS) implemented within five selected Northern MDB Local Government Areas (LGAs) (Paroo Shire, Balonne Shire, Murweh Shire, Maranoa Region, and Goondiwindi Region), specifically investigating the extent of ADMS proactivity, effectiveness, and suitability. To investigate suitability, drought risk extent of each LGA was determined. A region-specific drought risk index consisting of hazard, vulnerability and exposure indices was developed; risk mapping was conducted. All LGAs displayed very high levels of drought risk due to hazardous climatic conditions, vulnerable socio-economic attributes, and drought-exposed geographical features. A Criteria-Based Ranking (CBR) survey produced a quantitative effectiveness and proactivity rank for each major ADMS used in the Northern MDB. Government Assistance was the most proactive and effective ADMS. Strategy effectiveness ranks of the major ADMS used and drought risk extent found in each LGA were correlated to determine ADMS suitability. Overall, Balonne Shire and the Goondiwindi Region were identified as high priority areas requiring improved ADM. A user-centred Integrated Early Warning System (I-EWS) for drought could potentially increase ADM proactivity and suitability in such areas, strengthening drought resilience of farming communities.

People living with a severe mental illness experience a life expectancy gap compared to the rest of the population that is largely driven by preventable cardiovascular diseases stemming from lifestyle factors, and the side effects of psychotropic medications. Mental health nurses are well positioned to help address the gap using lifestyle interventions. However, many nurses don’t prioritise delivering such care, or lack the skills and confidence to implement these strategies. This study used a mixed method approach to determine the effectiveness of 2-day metabolic workshops that aimed to provide nurses with the skills to provide lifestyle interventions. The quantitative component compares pre and post measures of attitudes, confidence, knowledge and perceived barriers of providing metabolic care using a validated tool (M-BACK) and the qualitative component to elicit more details of the needs, expectations and plans of participants. Fifty-six nurse participants demonstrated statistically significant improvements in M-BACK post scores (p < 0.001), with 53 of the 56 participants (95%) achieving improved M-BACK scores. Participants identified three primary barriers to delivering metabolic care, related to individual staff members, consumers, and system issues. Prior to the course participants stated they hoped to improve their knowledge, enhance their practical skills and provide education for others. Following completion of the course participants planned to implement lifestyle education and interventions for consumers, provide education and support to other staff and integrate metabolic health care into clinical reviews and planning. This study demonstrates that education on metabolic health care can be effective in improving the attitudes, confidence, and knowledge of mental health nursing in providing metabolic health care and a decrease in the perceived barriers to delivering that care.