Finalist
Healthy Me – a journey not a destination
Adult Community Mental, Health & Addiction Service, Whakatāne Hospital & Emerge Aotearoa.
Left to right: Sally Webb, Sue Mackersey, Prue Rangi, Trish Bennett, Lily Vesty, Debbie Brierley-Broad, Meheta Jacobs, Hester Hattingh, Hayley Warner,
Kim Hansen, Jamie Smith.
Background Research has shown that clients with Serious
Mental Illness (SMI) have an increased prevalence of obesity,
metabolic syndrome, diabetes mellitus, cardio vascular disease
and respiratory disease, and have an increased risk of death by up
to 5 times or as much as 30 years life lost. This gap is increasing
(Scott and Happell, 2011). Antipsychotic medications contribute
to this problem, potentially leading to even greater inequalities for
those with a psychotic mental illness.
In Whakatāne, a high proportion of our Tangata Whaiora are
Māori. Māori experience greater baseline rates of metabolic
syndrome, and the EBOP is socio-economically poorer than
WBOP and NZ (EB PHA, 2012). There is also a significantly
elevated rate of antipsychotic medication associated metabolic
syndrome in Māori compared to Pakeha (Cameron, et al, 2009) ,
so it was especially important to aim the programme at a culturally
competent level, using tikanga to help Tangata Whaiora reach out
to services which they may not feel culturally safe to otherwise.
Aim Whakatāne’s Community Mental Health service piloted the
‘Healthy Me’ programme this year to provide Tangata Whaiora with
knowledge about important physical health issues, to empower
them to develop ways to improve their physical health/Hauora
tinana and wellbeing.
Method The programme was developed by staff in line with
the Ministry of Health’s “Equally Well” approach and builds on
the metabolic monitoring programme already in place, adding a
group education and activity component to assist in improving
physical health. It uses a recovery and client-led approach, and
provides health information from service staff and community
partners such as smokefree, and green prescription, along with a
range of physical activities and support to meet the participant’s
own personal health goals. The pilot participants were long-term
service users with a diagnosis of major mental illness who were
taking antipsych otic medication. Priority was given to those with
metabolic syndrome.
8
Results Of the 9 people who signed up, 7 completed the
programme; although not all were able to complete the post-
programme evaluation.
Reaching the target group:
• 7 were long-term clients and using anti-psychotic medication.
• 4 were men and 3 women.
• 6 were Maori and 1 Pakeha.
Improving physical health:
• Less cigarette and alcohol consumption.
• Reduced BP.
• Better total/HDL cholesterol ratio.
• Reduction in weight and waist measurements.
• Increased physical activity and progress to personal health
goals.
• Increased understanding of and confidence to access services
for physical health problems.
Conclusion This programme:
•
•
•
•
•
•
Had a measurable effect on physical well-being in just 10
weeks - significant change in two of the most important cardio-
vascular risk factors for our client group: smoking cessation,
and reduced BP/ management of hypertension.
There was a major shift in attitude amongst the group which
lead to chronic service users working towards a healthier
lifestyle, most of whom likely would not have otherwise.
Tangata Whaiora were able to see what they do, can make a
difference.
All-inclusive and safe learning environment provided for
all levels of learning ability, & gave Tangata Whaiora an
opportunity to experiment with cooking and other activities
which they would not have the funds to try out otherwise.
Group aspect provided socialisation, learning and peer
support, while individual screening meant that Tangata
Whaiora were able to set individualised goals.
Is community based, and partners with NGOs, GPs, and Māori
Health providers built on other “Equally Well” initiatives such
as the metabolic monitoring project.
Finalist
Sword Swallowing at the DHB
Brandon Hitchcock, ENT Specialist and Fiona Hewerdine, Team Leader Speech Language Team
Left to right: Sally Webb, Jan Burns, Fiona Hewerdine, Brandon Hitchcock.
Background Our laryngectomy patients have their voice
boxes removed secondary to cancer and then receive a six
week course of radiation. For many of these patients they then
experience changes in tissue flexibility and become less and less
able to swallow over a period of time. To remediate this, they
require to attend day stay or have general anaesthetics to have
dilatation performed to break down the fibrous tissue to enable
them to swallow again. Unfortunately this process is not long term
and they may be required up to a frequency of every six weeks.
The ENT service and Gastroenterology Consultants have been
involved in the innovation.
Aim The objective has been to empower our laryngectomy
patients to perform self-dilatation at home. This technique has not
been used here in New Zealand. It has been used internationally
which was the seed for our consideration that there was a good
evidence base supporting it before we considered adopting it here
in the Bay of Plenty.
Left to right: Doctors Pierre de Villiers and Joe Bourne.
Outcome Our patient cohort of laryngectomies have been
trained in outpatients, provided their own dilatation equipment
and are able to perform the self-dilatation at home. This has
empowered the patient as they now no longer require the service
of ENT or Gastroenterology surgeons, and are able to maintain
their own quality of life and swallow successfully.
Conclusion Our patient cohort of laryngectomies are now
able to swallow successfully. They no longer need to travel to
hospital for this procedure or have transport related costs. They
don’t require surgical services or surgeons or the time in theatre
or day-stay and feel a sense of empowerment being able to be
masters of their outcomes so that power of experience has been a
real shift and a gain.
Fiona Hewerdine.
9