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Hi everyone, my name is Rebekah Carney and I’m a Research Associate and Project Manager at the Youth Mental Health Research Unit in Greater Manchester Mental Health NHS Foundation Trust. I’m also an honorary Research Associate at the University of Manchester working with ARC-GM.
I am very passionate about reducing the disproportionate physical health problems of people with mental health diagnoses and using lifestyle interventions to promote physical and mental wellbeing in young people and adults with mental health difficulties. I currently lead several NIHR funded studies including; Motiv8, which is a Randomised Controlled Trial of a weight management intervention for people in secure inpatient services, and a multisite physical health monitoring study for inpatient Child and Adolescent Mental Health Service (CAMHS) with ARC-GM and ARC Yorkshire and Humber (ARC Y&H).
I am also conducting and managing lots of smaller studies in the areas of physical health promotion, digital health innovation, inpatient care, early intervention, and health care provision in CAMHS. Some of my colleagues and I have recently published findings from a research project where we reviewed available literature to assess the physical health and behavioural risk factors of young people receiving treatment from specialist child and adolescent inpatient mental health units, which I’d like to tell you about in this blog.
What is the issue?
The physical health problems experienced by people with mental health difficulties have been long established. Children and Young People (CYP) on CAMHS inpatient units are a particularly vulnerable group whom we need to consider. This is because we know they experience increased restrictions on movement which mean they are less likely to be active, have high levels of mental distress, receive pharmacological treatment, and also have less control over their dietary intake (generally being limited to hospital provided food). However, I was really surprised when we started doing work in the area, to find that most research to date has been focused on adult populations. In fact, there’s been comparably little work done with younger people. This is despite the fact that we know lots of these physical health problems occur at an early stage, often during the early stages of illness.
What did we do?
Our recent review published in General Hospital Psychiatry aimed to combine the previous research looking at physical health and behavioural risk (such as smoking, inactivity and diet) in CYP receiving treatment from mental health inpatient units. We looked at data from 39 studies containing a total of 809,185 young people who were admitted to various CAMHS inpatient units across the world. CYP had a range of mental health diagnoses such as mood, psychosis or anxiety disorders, as well as other acute mental health or behavioural disorders. (For this review, we decided to exclude those with severe eating disorders, due to pre-existing complexities with physical health.)
A link to the paper can be found here:
Carney, R., Firth, J., Pedley, R., Law, H., Parker, S. and Lovell, K., 2021. The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis. General Hospital Psychiatry.
What did we find?
In our review we found:
- Over half of young people included were either overweight (32.4%) or obese (15.5%)
- Average BMI varied from 18.2 – 32.5 (although critically, none of the studies used BMI percentiles which is recommended for under 18s)
- 51.5% of young people reported being current tobacco smokers and 68% consumed alcohol
- A high prevalence of physical health conditions and other indicators of metabolic syndrome such as dyslipidaemia (up to 53% had at least one diagnosed physical health problem)
- Preliminary indicators of low levels activity and poor diet (although subject to some methodological limitations)
What does it mean?
The physical health of CYP receiving inpatient care needs urgently addressing. Even at this early stage, vulnerabilities to poor physical health are present in the form of elevated weight, high smoking and alcohol use and presence of the early signs of metabolic syndrome. Despite what we know about the physical health morbidity and mortality gap in adults, this remains a substantial and shocking finding that young people are experiencing issues at such a young age which cannot be ignored. As we know that a large proportion of physical health conditions experienced later in life can be prevented, more research and attention is needed in this area. Further to this, we know that many of these young people may be prescribed medications which have a negative impact on their physical health and will continue to find it more difficult than their peers to live a healthy lifestyle. Initiatives to promote and protect the physical health of CYP are imperative in reducing the premature mortality gap experienced by young people later in life.
What are we doing now?
We still have a lot of work to do! The available studies did not allow us to be able to look at young people’s physical health over time, nor could we look at a matched control sample. Additionally, we could not disentangle the effects of any medications, or specific conditions. We are focussing our research efforts in this area, in a bid to improve the physical health of CYP on CAMHS inpatient units and prevent the onset of conditions in the future.
Our current work through ARC GM and ARC Y&H is expanding on our findings as we conduct one of the first multi-site, longitudinal monitoring studies in UK CAMHS inpatient units. Find out more here: ARC GM | Trajectory of physical health of adolescent inpatients: a 6 month prospective study (nihr.ac.uk). This prospective study is being conducted in collaboration with ARC Y&H and recently started recruitment in March 2021. This is currently taking place on units in Greater Manchester, Humber, Leeds and York, with plans to also include Pennine.
We are also in the process of analysing qualitative interviews conducted at Greater Manchester Mental Health NHS FT with young people and clinicians from CAMHS inpatient units. These interviews offered us a really unique opportunity to hear about the barriers faced to living a healthy lifestyle on inpatient units for young people and provided us with some context to the more data driven work we have been doing. Through this work we hope to learn more about how we can optimise service delivery for young people. There’s still a lot to be done – however, we hope that by making a start and raising awareness of this issue for young people, we can focus on bridging the gap between physical and mental health.
For more information please do get in touch, we would love to hear from you:
Dr Rebekah Carney (Rebekah.firstname.lastname@example.org)
Youth Mental Health Research Unit
Twitter - @RebekahCarney10
The views and opinions expressed in this presentation are those of the authors and do not necessarily reflect those of the NHS, the National Institute for Health Research or the Department of Health and Social Care