When Professor Felice Jacka first started questioning the links between diet and mental health disorders 10 years ago, the emerging idea faced scepticism from many within the mental health sector.
Prof Jacka, director of the Food & Mood Centre and president of the International Society for Nutritional Psychiatry Research, was determined to find out whether or not a poor quality diet contributed to the onset or risk of developing a mental health disorder.
Fast forward to 2020 and thanks to the pioneering work by Prof Jacka and the Food & Mood Centre, which included the landmark SMILES (Supporting the Modification of lifestyle In Lowered Emotional States) trial, clinicians are now changing their approach to the treatment of mental health disorders not only in Australia but across the globe.
In 2020, in a world first, the Royal Australian New Zealand College of Psychiatrists (RANZCP) guidelines for mental health clinicians and general practitioners now explicitly recommends lifestyle (diet, exercise, sleep and substance use reduction) as the foundational, or first-line, treatment for mood disorders. The 2020 Mental Health Productivity Mental Health Report also identified this area of mental health care, citing the work of the Food & Mood Centre (Adrienne O’Neil, Felice Jacka & Rachelle Opie).
“Ten years ago this idea would have been considered ‘hocus pocus’,” says Associate Professor Adrienne O’Neil, director of Heart & Mind Research at IMPACT and deputy director of Food & Mood Centre.
“And now to say that Australia is leading the way in this area, and to know that the Food & Mood Centre has been the first in many instances to generate the key data that has got us here, is something of which we’re incredibly proud.”
Prof O’Neil says it is the first time the productivity report has identified, based on submissions and their own research, that lifestyle comprised both risk factors and potential treatment targets for mental health.
“You’ve got that broader policy backdrop and recognition from the Government that this is a plausible and scientifically valid approach,” she says. “And then you’ve got the clinical guidelines that have the potential to aid clinicians in a way that they might offer this type of approach to their patients.
“I think those two things create a really promising way to go forward in the Australian landscape in terms of using this approach in an everyday practice.”
Prof O’Neil says work in this area is far from over—the impacts of the COVID-19 pandemic on mental health has put immense pressure on the mental healthcare system.
She is currently leading a Geelong-based trial, in partnership with Barwon Health’s Mental Health, Drug and Alcohol Services (MHDAS), to provide and evaluate an eight-week, group-based, telehealth program called CALM. This program is designed to reduce the mental health symptoms in adults with elevated psychological distress due to the COVID-19 pandemic.
Prof O’Neil says this program could provide a solution to the overburdened mental healthcare system that is currently facing long waitlists.
“What we are saying is that with the type of trials that I am currently leading this could be an alternative approach or one that could be used in conjunction with current care that is so heavily burdened—where you might have a wait time of six months to see a psychologist or psychiatrist if you live somewhere regionally,” she says.
“The idea of potentially being able to triage your patient to an accredited practising dietitian or an accredited exercise physiologist is really important, and it might be a way for the Government to think about how we re-fund mental health because there are a lot of ways to tap into an unlikely untapped workforce.”
Prof O’Neil hopes the findings from the trial will allow clinicians to feel confident that a referral to a registered practising dietician or an exercise physiologist for treatment is shown to be just as effective as a referral to a psychologist. She also says there are limited funding mechanisms within Medicare or financial reimbursement from the Government for lifestyle treatments to be used this way —she hopes their research will change that.
“We’ve got this potential to tap into this entire professional allied health workforce that could be helping to deploy mental healthcare right across the population’,” she says.
“I think they are the two areas of focus that I am really clearly wanting to achieve in the next two years. They are the remaining steps in actually integrating it into day-to-day practice so that any Australian can walk into their GP and access this type of care in a subsidised way.”
2020 was also the year that Prof O’Neil and Dr Wolfgang Marx established an international taskforce to lead the development of the World Federations for the Society of Biological Psychiatry & Australasian Society of Lifestyle Medicine guidelines for lifestyle-based mental health care. She says these guidelines were compiled based on a series of eight systematic review processes centred on the four lifestyle pillars (diet, exercise, sleep, and substance use reduction) and are designed to be used by any health professional in any setting.
“The first of all the clinical guidelines will be for depression, but we’re hoping to do a suite of psychiatric conditions to help clinicians and allied health professionals regardless of the settings they’re in or the country,” she says. “If they want practice or lifestyle-based mental healthcare in an evidence-based way we can help them do that.”
The taskforce plans to publish the first indication in its suite of guidelines for depression in October and will repeat this process for anxiety in 2023.
“So we’re starting to see these big wins and we just hope that every patient who presents with a mental health condition is able to have access to this care,” Prof O’Neil says.