Presentation by Dr Susanne Stanley PhD and Lucia Ferguson - The Wellness Clinic: A model of integrated care for people with complex mental illness. Presented at the Western Australian Mental Health Conference 2019.

1. The Wellness Clinic
A model of integrated care for people
with complex mental illness
Dr Susanne Stanley (PhD)
Ms Lucia Ferguson

3. Overview
 Poor Physical Health in Mental Health
 Wellness Clinic:
– Cross-sectional
– Cohort
– Longitudinal
 Discussion
 Where to from here?

4. Poor Physical Health
0 50 100 150 200 250
Suicide
Accidental death
Respiratory system
diseases
Other circulatory
disease
Stroke
Other heart disease
Heart attack
Cancer
Death Rate
Mental Illness
WA Population
Figure 1. Death rates in people with mental Illness compared to the WA population (taken
from Coghlan et. al., 2001, p. 18).
15-25yr lifespan
difference

5. 0
5
10
15
20
25
30
%
Health Conditions
With mental and
behavioural condition
Without mental and
behavioural condition
Figure 2. People with selected long-term physical health conditions by mental and
behavioural condition status, 2014-15 (taken from ABS, 2015).

6. Wellness Clinic
 Introduced in August 2014 as an adjunct to Curtin
University project
 Aim - to attend to the physical health of people with
complex mental illness
 Integrates primary care into mental health
 WAPHA (phn) – Mental health into primary care
 Staff
- NP (0.5 FTE), CN (0.5 FTE), GP (0.2 FTE)
 Clinic
- 4.5 years
- 412 referred (22.6% did not attend)

7. Fremantle HMHS Wellness Clinic Model of Care
Community Mental Health Team
Early Intervention for PsychosisNo engagement with GPDepot Clozapine
Complete History
Medical History
Social History
Bloods
Waist/Girth
Lipids
BSL
Blood Pressure
Medication
Diagnosis
Allergies
Height
Weight
BMI
ECG
Spirometry
STIs
Alerts
Carers
Dental
Eyes
Feet
NURSING
STAGE 1
Referral
STAGE 2
Assessment
STAGE 3
Discharge /
Ongoing
Monitoring
Discharged
from CMHT
Nurse
Practitioner
General
Practitioner
+ Nurse
Practitioner
Discharged to
Community GP
General
Practitioner +
Clinical Nurse
Simple Typical Complex
Chest X-Ray (if smoker)
Full Pulmonary Lung Function
Cervical Screening
Lifestyle Modification
Exercise
Aboriginal & Torres Strait Islander
People
Ongoing Monitoring
Link with
Community GP
CMHT
Monitoring
Nurse
Practitioner +
Clinical Nurse
Figure 4. The Fremantle Hospital
Mental Health Service Wellness
Clinic Model of Physical Health
Care.

8. Cross-sectional Data
 Demographics
– 2:1 male to female ratio
– F20-F29 primary diagnosis (psychoses) - (87%M, 72%F)
 Clinic Services
– Engaged with GP - 22%
– Clinic appointments average -10M, 8F
– Referrals – dental, diet, cardio, respiratory, physio, gastro,
hepatology
– Scans/tests – initial FBC + STI, ECG, spirometry
• Chest X-ray, stomach/abdominal ultrasound, echo, urinalysis,
PAP smear
 Medication

9. Cross-sectional Data (cont.)
Smoking – 70.2%M, 58.3%F
Blood Pressure – Males sign. higher than Females but
averages both within normative range
Heart Rate – 88/87bpm – variance of 14bpm (range
74-102bpm)
Cholesterol / Younger age groups good;
HbA1c% / fBGL males & females abn 36yrs+
Weight / Girth / Male mean increased initially at 26-35yrs,
BMI then held stable for later age groups;
female mean increased with each age
group

10. Cohort Data
1.5
1.7
1.9
2.1
2.3
2.5
2.7
2.9
3.1
3.3
3.5
Baseline 12 Months 24 Months 36 Months
Male Psych
Male Other
Female Psych
Female Other
Males Age Females Age
Baseline 222 42 (11.4)* 97 42 (13.3)
12 Months 137 43 (11.0) 43 44 (13.0)
24 Months 80 45 (09.9) 24 45 (13.0)
36 Months 46 44 (10.2) 11 48 (12.0)
Figure 6. Mean number of psychiatric and other health medications for males and
females in each cohort.
Table 1. Number and average age of people in each time cohort
* Standard Deviations in parenthesis
Age
Medications

11. Baseline 12 Months 24 Months 36 Months
M F M F M F M F
Number of
People
208 90 133 41 78 21 46 10
Abnormal 62 23 33 7 24 5 21 2
% 30 26 25 17 31 24 46 20
Cohort Data (cont.)
0
20
40
60
80
Baseline 12
Months
24
Months
36
Months
Percentage
%
Time Periods
Male
Female
Figure 7. Percentage of people who smoke in each cohort.
Table 2. Abnormal Blood Pressure readings (outside of 140/80) and total percentage of abnormal results for each cohort.
Smoking
Abnormal BP

12.  Demographics
 46 males, 11 females
 91% had a primary diagnosis of F20-F29 – psychoses
 22% males had English as a second language, 0% females
 Females consistently prescribed more psychiatric and
‘other’ health medications than males
Longitudinal Data
Male Female
Antipsychotics 1.42 1.83
Mood Stabilisers/Anxiolytics 0.27 0.44
Antidepressants 0.32 0.45
Table 2. The mean number of psychotropic medications prescribed to males and females.

13.  No sig. changes for most Metabolic Syndrome factors:
 BP
 Triglycerides
 fBGL
 Girth
Longitudinal Data (cont.)
Baseline 12 Mths 24 Mths 36 Mths
fBGL M 5.8 6 5.8 6
fBGL F 5.4 5.6 5.5 5.6
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
6
6.1
mmol/L
Time Periods
Figure 19. Mean fasting Blood Glucose Levels over time for males and females.

14. Longitudinal Data (cont.)
 HDL-C (‘good’ cholesterol) improved significantly over time
Baseline 12 Mths 24 Mths 36 Mths
HDL-C M 1.1 1.1 1.1 1.2
HDL-C F 1 1 1.1 1.2
0.9
0.95
1
1.05
1.1
1.15
1.2
1.25
mmol/L
Time Periods
Figure 9. Mean HDL-C levels over time for males and females

15.  People with mental illness:
 Reduced life-expectancy (15-25 years)
 Difficult to engage with their GP
 Need situation appropriate support
 The Wellness Clinic
 Collaborative, holistic, aligns with SHR Strategies
 Keeps physical health stable over time
 Improve physical health - Prevention/Intervention
1. Solidify the existence of the Wellness Clinic
2. Develop an Intervention for 26yrs+
Discussion

16. Exercise physiologist/physiotherapist
Nutritionist/Dietician
Community Mental Health Team
Psychiatrist/Pharmacist/GP/Nurse
Practitioner