S51: Innovative Approaches & Partnerships in Clinical Practice

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By September 28, 2023 No Comments

Authors: John Zonnevylle, Martin Burke, Sarah Trobe, Phillipa Hay, Tessa-May Zirnsak, Kristen McCarter, Ashleigh Guillaumier, Catherine Brasier, Laura Hayes, David Castle, Billie Bonevski, Amanda Baker & Lisa Brophy

Year: 2023

Event: 2023 The MHS conference - Adelaide

Subject: Innovative Approaches & Partnerships in Clinical Practice

Type of resource: Conference Presentations and Papers

Presentation 1: Symbiosis: Lived Experience and clinical perspectives in partnership at Manatū Hauora.
Authors: John Zonnevylle & Martin Burke
Symbiosis arises in the natural world as well as in systems thinking. It refers to collaborative action/s to achieve mutual benefit. The Lived Experience and Clinical Advisory Rōpū (LECAR) at Manatū Hauora sees lived experience and clinical perspectives as critically linked in understanding how to achieve the best outcomes for people. The New Zealand Pae Ora (Healthy Futures) Act 2022 establishes a new health system design grounded in equitable health outcomes. It includes a set of Health Sector principles that support lived experience participation as well as mandating a code of expectations for health entities’ engagement with consumers and whānau.
This presentation will trace the evolution of LECAR towards an emerging state of symbiosis. Using the themes of purpose, values and actions, John and Martin will present how LECAR has contributed to the current transformative challenges in the New Zealand mental health and addictions’ landscape. LECAR directly informs national strategy and policy, elevating the voices of lived experience while also being guided by clinical expertise. Across a variety of projects (Repeal and Replace MH Act, COVID vaccinations etc) a combined approach has delivered better outcomes for people experiencing MHA challenges, and greater trust in Manatū Hauora amongst lived experience communities.
Learning Objective
To introduce the audience to a possible framework of LE/Clinical collaboration
To position that framework within NZ strategic Health and MHA guiding documents
To position that framework within actual real-life situations
To celebrate the work of the LECAR Group

Bate, P., & Robert, G. (2007). Bringing user experience to healthcare improvement. The concepts, methods and practices of experience-based design. Oxford: Radcliffe.

Government inquiry into Mental Health and Addiction. 2018. He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction. Wellington: New Zealand Government.

Presentation 2: Management of Eating Disorders for People with Higher Weight: Clinical Practice Guideline.
Authors: Phillipa Hay & Sarah Trobe
Introduction: The prevalence of eating disorders is high in people with higher weight, particularly those presenting for weight-loss and with metabolic co-morbidities. Despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there has been little to guide clinicians in the management of eating disorders in this population. The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations. It is based on the premise that every person with an eating disorder is deserving of equitable, safe, accessible, and evidence-based care regardless of their body size.

Materials and methods:
The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for Clinical Practice Guidelines of the treatment of eating disorders for people with higher weight. The Development Group followed the ‘Guidelines for Guidelines’ process outlined by the National Health and Medical Research Council. That is, these guidelines aim to be: 1 relevant and useful for decision making; 2 transparent; 3 overseen by a guideline development group; 4 identifying and managing conflicts of interest; 5 focused on health and related outcomes; 6 evidence-informed; 7. making actionable recommendations; 8 up-to-date; and, 9 accessible.
The development group included people with clinical and/or academic expertise and/or lived experience. The guideline underwent extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical, academic and/or lived experience.

Results: The guideline was written from the perspective of the adverse effects of weight stigma and the complexity of causes of eating disorders across people of all sizes. Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence grades. The recommendations sit across the areas of identification and assessment, psychological therapy, pharmacotherapy, physical activity, family and other interventions for adults, adolescents and children, nutritional and medical management, and other psychiatric therapy for co-occurring conditions. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed, with the lived experience perspective threaded throughout.

Conclusions: This guideline fills an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. It is hoped that this guideline will assist health care professionals in all relevant fields to understand the needs of people in their care who have an eating disorder who are of higher weight, and to support the clinician in providing appropriate management of the eating disorder. Moreover, it is hoped that the clinicians are more aware of, and responsive to, the adverse effects of weight stigma on the live, health, and treatment seeking of people with eating disorders who are of higher weight.
Authors of the guideline:
Angelique F Ralph, Leah Brennan, Sue Byrne, Belinda Caldwell, Jo Farmer, Laura M Hart, Gabriella A Heruc, Sarah Maguire, Milan K Piya, Julia Quin, Sarah K Trobe, Andrew Wallis, AJ Williams-Tchen, Phillipa Hay

Learning Objective
1. every person with an eating disorder is deserving of equitable, safe, accessible, and evidence-based care regardless of their body size.
2. All mental health professionals have a role in the identification, support and treatment of people experiencing eating disorders. Through education across all professions, we can break down barriers to people accessing treatment and achieve better treatment outcomes

Presentation 3: ‘Holding on to hope’: Follow-up qualitative findings of a study supporting consumers to quit smoking.
Authors: Tessa-May Zirnsak, Kristen McCarter, Ashleigh Guillaumier, Catherine Brasier, Laura Hayes, David Castle, Billie Bonevski, Amanda Baker & Lisa Brophy
Consumers of mental health services and other people who have experience of mental health conditions are more likely to smoke and less likely to quit than people without this lived or living experience. Rather than lacking desire to quit, continued smoking is related to factors such as alleviation of feelings of isolation and despair associated with social exclusion and trauma.
The Quitlink study was a randomised controlled trial of a peer researcher facilitated referral to a tailored Quitline plus nicotine replacement therapy for people receiving mental health services. In this presentation, we report on the medium- and longer-term data from interviews conducted at 5- and 8- months after recruitment with the aim of increasing understanding of the barriers and enablers to smoking cessation.
The six themes identified were: internal/external attributions for smoking; social relationships and relapse; hopefulness in quitting; the role of clinicians in initiating and maintaining a quit attempt; increasing cessation literacy; and perceived effectiveness of Quitlink. Overall, findings suggested that while participants’ quit attempts were often fragile, direct support and social connection contribute to the capacity to hope for a better future - a future without cigarettes.
Learning Objective
Quitting smoking poses unique challenges for people who experience mental health conditions, but with the targeted support, and help to hope for a non-smoking future, quitting is possible.
Baker, A. L., McCarter, K., Brophy, L., Castle, D., Kelly, P. J., Cocks, N., McKinlay, M. L., Brasier, C., Borland, R., Bonevski, B., Segan, C., Baird, D. E., Turner, A., Williams, J. M., Forbes, E., Hayes, L., Attia, J., Lambkin, D., Barker, D., & Sweeney, R. (2022). Adapting peer researcher facilitated strategies to recruit people receiving mental health services to a tobacco treatment trial. Frontiers in Psychiatry, 13, 869169-869169. https://doi.org/10.3389/fpsyt.2022.869169 Keller-Hamilton, B., Moe, A. M., Breitborde, N. J. K., Lee, A., & Ferketich, A. K. (2019). Reasons for smoking and barriers to cessation among adults with serious mental illness: A qualitative study. Journal of Community Psychology, 47(6), 1462-1475. https://doi.org/https://doi.org/10.1002/jcop.22197

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