Caring for patients, caring for yourself

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Working in a demanding job with factors such as stress, shift work, emotional attachment and poor resourcing can take a toll on clinicians, who turn to smoking, caffeine, sugar and other substances to ease the tension and help them get through the day. Accredited Practising Dietitian Janice Plain reminds clinicians how diet can contribute to good mental health.
With one in five Australian adults experiencing a mental health disorder in a given year[1] it is not unlikely that a number of clinicians are taking medication to help manage their depression, anxiety, bipolar or other mood disorder under the guidance of their own health professional. As any health professional will know, medication alone is not enough to make an ill person well – lifestyle support is needed, and none is more important than a healthy diet.
Obesity, diabetes and metabolic syndrome are two to three times more common in people with mental illness, particularly in those with schizophrenia. Minimising the impact of diet on obesity is important, as unfortunately obesity and its associated co-morbidities are also side effects of some psychotropic medications. Some psychotropic medications stimulate the appetite and some antipsychotics induce weight gain and metabolic syndrome. The conditions for which second generation antipsychotics are prescribed, often require prolonged treatment. The metabolic side effects of these medications can have significant long-term health consequences that require management.
From a practical perspective, excess weight gain can affect body image, mobility, physical health and quality of life, which can lead to non-compliance to medication. Together these factors can exacerbate both mental illness and metabolic disturbances. In light of these factors and in support of practice guidelines for the management of obesity, diabetes and cardiovascular disease, it is important to incorporate nutrition messaging into treatment as early as possible.
Those suffering mental health conditions may present with the medical conditions mentioned above, and quite likely with some of these compounding issues:

• Gaining weight quickly – including drinking excess cola, coffee or energy drinks and eating a lot of takeaway.


• Losing weight very quickly – with not eating much at all, limited access to food and finances to purchase food.


• Limited food storage and preparation facilities and knowledge.

The Queensland government website houses Nutrition Education Materials Online (NEMO) including nutrition support action plans that provide action-based resources to guide the care and advice you provide to someone with mental illness. These resources are useful as a first intervention, but what if you or your patient needs more support?
Accredited Practising Dietitians (APDs) can provide expert nutrition advice and additional focused support for patients with mental illness. APDs are skilled in counselling and helping patients change and maintain healthier habits. Whether issues arise from a lack of nutrition knowledge, poor food preparation skills, difficulties accessing healthy foods, low social support or other barriers, these considerations are incorporated into practical advice. For example, those with schizophrenia or bipolar disorder can experience apathy and depression and limited social interaction. These factors and other challenges contribute to lower levels of physical activity and poor food choices, such as low fruit and vegetable intake and high alcohol intake. With this in mind, APDs keep messages simple and work with patients to set realistic goals.
Nutrition and physical health in those with mental illness can be complex. Interactions between co-morbidities, side effects of medications, and the mental illness are the tip of the iceberg. Poor nutrition is a modifiable risk factor that affects patients’ physical and mental health, and makes a noticeable difference in quality of life. It is critical to work together as a multidisciplinary team to improve patients’ nutrition status and minimise the ongoing consequences of poor nutrition. Early identification and ongoing support by clinicians in partnership with APDs can lead to better physical and mental health outcomes for patients.
Health professionals have the training and experience to care for others with ill health, and to intervene before a condition worsens. But sometimes they neglect to care for themselves until it is too late. Don’t let it become too late for you.
Quick recommendations for better eating
EAT LESS - opt for smaller sizes when buying takeaway foods and drinks or when serving a meal.
BUY FRESH FOOD WHERE POSSIBLE - when buying packaged food look for lower sugar, lower fat and lower salt products.
SWAP SOFT DRINKS FOR WATER - (preferably), sparkling mineral water or lower energy versions.
BUY HEALTHIER OPTIONS - focus on what you buy at the supermarket or take away shop - it’s easier saying ‘yes’ once in the shops than ‘no’ 100 times at the pantry.
EAT MINDFULLY - think about and be aware of what and how much you eat.
MOVE MORE - look for enjoyable opportunities for exercise and incidental activity.
For individualised dietetic advice for your patients, Find an APD on the DAA website and select ‘Mental health’ under ‘Area of Practice’.
Janice Plain APD
Convenor of the Dietitians Association of Australia Mental Health Interest Group (MHIG)
Janice Plain APD is the convenor of the Dietitians Association of Australia Mental Health Interest Group (MHIG) and represents contributing authors from this group.
References
[1] Black Dog Institute (2012) Facts and Figures about mental health and mood disorders.