Adults living with serious mental illnesses can improve their physical fitness, increase their lifespan and even alleviate their psychiatric symptoms by participating in a program known as In SHAPE, according to Stephen Bartels, director of the Dartmouth Centers for Health and Aging. With the help of a $10-million Medicaid grant awarded in the fall to the state of New Hampshire, The Dartmouth Institute and the Dartmouth Centers for Health and Aging will study the ways in which In SHAPE and health incentives programs can improve the well-being of mentally ill adults across the state, Bartels said.
The study will have two components undertaken by researchers over four years, according to Sarah Pratt, a professor at Dartmouth Medical School and TDI.
The component will compare the effectiveness of In SHAPE, Weight Watchers, gym membership vouchers and cash incentives in improving the physical fitness of 2,500 adults with serious mental illnesses, including schizophrenia, severe bipolar disorder and major depression, she said. The second will examine the efficacy of cash rewards in smoking cessation programs.
"We hope, ideally, to be a national model for quickly and significantly moving health behaviors that are very difficult to change in the right directions, toward increasing life expectancy," Bartels said.
Both studies will be open to adult volunteers on Medicaid and will be offered in each of New Hampshire's 10 major mental health centers. Each center will receive two full-time staff members to oversee the programs, she said.
In SHAPE which will undergo a large-scale expansion as a result of the study was created by Ken Jue, the former CEO of Monadnock Family Services. Jue said he designed the program in 2003 after becoming troubled by the number of his clients dying of natural causes in middle-age.
His research found that adults with serious mental illness most often die of cardiovascular disease, pulmonary diseases and conditions related to severe diabetes rather than suicide, as some people tend to assume, Jue said. As a result, their life expectancy tends to be 25 to 30 years shorter than that of the average American, according to Bartels.
"It appeared to me that this is the largest and most under appreciated health disparity in the population," Bartels said.
A number of factors make it especially difficult for people with serious mental illnesses to maintain physical fitness, resulting in their high vulnerability to heart disease, heart attacks and strokes. Often, conditions such as depression or mild paranoia can make people unwilling to leave their house to exercise, Bartels said, noting that mentally ill individuals often have unhealthy eating habits as well.
Some psychiatric medications can also cause lethargy or metabolic syndrome, which prevents individuals from feeling satiated after eating, contributing to weight gain, he said.
To tackle these challenges, In SHAPE pairs participants with "health mentors," certified fitness trainers who exercise with participants, provide motivation and emotional support and accompany participants on grocery shopping trips to teach them how to make healthy food choices, Pratt said.
Program participants have shown decreased blood pressure and hypertension, weight loss and better cardiorespiratory fitness, Bartels said.
The increase in self-confidence that accompanies weight loss has a dramatic impact on participants, Jue said, recalling one female participant who lost almost 80 pounds over 18 months in the program and now looks forward to putting on a bathing suit and going swimming, an activity that would have been unthinkable for her before entering the program.
The program's emphasis on exercise and fitness has also been shown to reduce participants' psychiatric symptoms, Jue said.
"They no longer feel as isolated and socially excluded," Jue said. "They're interacting with people other than other mentally ill individuals, and most people don't even know they have a problem."
Bartels said he first heard about In SHAPE while working as the medical director for the New Hampshire Bureau of Behavioral Health, and he organized a partnership between Monadnock Family Health Center and the Dartmouth Centers for Health and Aging to research the outcomes of the program.
With the aid of grants from the Endowment for Health in New Hampshire, the Center for Disease Control and the National Institute of Mental Health, Bartels implemented a series of studies in several states to examine In SHAPE's effectiveness.
These grants have enabled health centers to support mental health initiatives despite cuts in Medicaid and state funding, which Jue says has been one of the greatest challenges faced by the program.
He emphasized the importance of a holistic approach to mental illness treatment, focusing on physical health as well as psychiatric medication.
"I hope it will influence the field of mental health to think differently about what helps people with mental illness," Jue said.
