A systemic shift in mental health care, including a greater emphasis on the role dietitians can play in mental health treatment, could be on the horizon if a national policy roadmap created by a diverse mix of mental health experts is implemented.
Over a period of 12 months, more than 60 individual professional and lived-experience experts contributed to the Equally Well Australia’s Being Equally Well Roadmap – a collective impact strategy released in August 2021 that prioritises the physical health of people living with mental illness for all levels of government.
Contributing to the plan from the Food & Mood Centre was co-director Professor Adrienne O’Neil, and Dr Tetyana Rocks, an accredited practicing dietitian, Research Fellow and head of Translation and Education at the Food & Mood Centre.
Dr Rocks joined the Equally Well Working Group in 2020 and is the rapporteur for the quality improvement group, one of six working groups that developed the policy roadmap.
‘Our working groups united discussion between prominent Australian clinicians, researchers, policy makers and consumers,’ Dr Rocks says.
‘The idea behind “equally well” is the aim to reduce comorbid presentations and health inequality between people with and without mental health illnesses.
‘We know that currently people who experience mental health disorders have poorer metabolic health and poorer physical health than those without mental health illnesses. This includes life expectancy, which is 15 to 20 years shorter than those without mental health illness.
‘It is quite a complex picture when determining why it is happening, and what are the health risks and problems that we must address. But we have united people who are passionate about the topic and who are also working on the issues and coming together to put together that policy report.
‘Right now, I’m working as part of the group round tables to discuss implementation and what exactly we need to do to implement the roadmap that we proposed.’
According to the roadmap, one of the key issues described by consumer and carer experts was a lack of concern from mental health services about diet and physical activity needs. It acknowledged that ‘dietitians, physiotherapists, exercise physiologists, social workers and psychologists have significant contributions to make to supporting physical and mental health’.
‘When we think about depression or schizophrenia, a dietitians is not what comes to mind, however, quite a high percentage of individuals with mental health disorders do have comorbid physical disorders – about 80 per cent – and metabolic disorders are the most common,’ Dr Rocks.
‘We have pretty strong evidence showing us that diet intake and mental health outcomes are also linked. There are a lot of reasons to refer an individual to a dietitians, but it traditionally has not been done.
‘Dietitians are not regularly included as part of a mental healthcare team but having more dietitian input is what we’re trying to achieve.’
Nine recommendations were made, including: the development of shared care guidelines for serious mental illness; a plan for the development of the role of pharmacists in shared care and medication support; and the implementation of mental health nurse navigators, who can support people navigating the shared-care health system.
The Roadmap also recommends the establishment of recurrent Medical Research Future Fund rounds supporting research into health system design and delivery. One priority research area was exploring efficient and cost-effective interventions and strategies to improve diet and physical activity in people with serious mental illness
‘Unfortunately, in our current society the way we acquire our food, and our food production processes have changed so much compared to past generations,’ Dr Rocks says.
‘The majority of us know very little about food or how to prepare simple food from scratch. With people experiencing mental health disorders it becomes even harder, everything becomes even harder.
‘So what is the issue? Lack of motivation, fatigue, sometimes conflicting recommendations, and conflicting priorities.
‘I have heard from individuals who are living with mental health issues, that sometimes they feel like they need to choose between the physical and mental health, that they can’t seem to address all this together or the system can’t support them addressing both together.’
Dr Rocks says other challenges people with mental health illnesses face include a lack of resources, challenging family circumstances and challenging social circumstances or employment.
‘People just don’t have enough in their budget to actually buy food and prepare food at home or to store food,’ she says.
The Mitchell Institute and Equally Well Australia have begun work with the stakeholder organisations and leaders hosting roundtables on the Roadmap’s implementation strategy.
For Dr Rocks, who sits on those roundtables, the roadmap provides a pathway for allied health practitioners, such as dietitians, occupational therapists and physiotherapists, to play a more prominent role in the treatment and prevention of mental health issues.
“I have been a dietitian for about 10 years now and I’m a passionate advocate for the role of dietitians in healthcare teams, whether it be physical healthcare or mental health,’ she says.
‘It would be fantastic to increase dietitian participation and increase the dietetic workforce in mental health.’
