Mind (is) your body

There is a well-established link between mental and physical health. People with mental health issues live 10 to 25 years less than the general population, and are almost three times more likely to die from preventable physical illnesses such as type 2 diabetes and cardiovascular disease. Despite this, physical health assessment is not commonly performed in mental health services. Key factors such as lifestyle, medication side effects, drug and alcohol use, pre-existing conditions and social determinants have an impact on the physical health. Therefore, regular monitoring of these indicators is an important step towards improving health and wellbeing of mental health patients.

The Physical Health Diary app was primarily developed to address this gap in mental health services. It is founded on the evidence-based—Clinical Guidelines for the Physical Care of Mental Health Consumers: Assessment and Monitoring Package (1-3). The app is available in Android and IOS and can be used on a phone or tablet.

The app accommodates multiple stakeholders and consumers. An individual can login as a consumer, a carer, or a health practitioner. Each version of the app is slightly different, based on the intended audience. The app empowers consumers with knowledge and means to longitudinally track key indicators (see Figure 1). This allows them to engage in productive discussions with carers and clinicians (see Figure 2), and take notes about making positive lifestyle choices and planning their own recovery. Only consumers can record notes and share test results with others (their health practitioner or carers). Once the consumer has enabled sharing, others can then record test results for the consumer.

Figure 1 Weight parameters and monitoring.

Figure 2 Recommended testing and medication side-effects.

Push notifications for health assessments, an integrated care team contact list of care team (doctors, dentists and specialists, or informal carers), and an easy access website are additional features associated with the app. The website login is only available if an app account has been created. The consumers can utilise the website to record and save the same kind of information that can be stored on the app such as test results which can be shared with others, and personal notes that aren’t shared. However, the website does not generate push notifications.

Health practitioners are provided with monitoring parameters and decision trees to guide general health examinations including the Metabolic Syndrome as shown in Figure 3. Health practitioners, support staff and carers who are working closely with consumers can put test results into the app on the consumer’s behalf. This can be done remotely or during consultation, and the charts can then be used as discussion points so that consumers have a visual representation of their progress. Once people become more independent they can put in their own results, and the health practitioner/carer can see those results too. In this way, consumers are not alone in their efforts as their care team can work with them on improving their health. As with the carer version, the app can be used to manage multiple clients, increasing efficiency and reducing costs.

Figure 3 Clinical algorithms for physical health monitoring in people with mental health issues.

While consumers, carers and practitioners all see the same information and visuals, the differences are in the language used for each audience, and extra information dependent upon that audience. So for example, consumers and carers will see the metabolic syndrome algorithm in the Medication section whereas practitioners will also see algorithms for ECG, Prolactin, etc. That said, once the app is downloaded, people can login as any of the three (using different user names and email accounts) if they wish.

The Physical Health Diary is an important step towards filling a gap in mental health services and empowering mental health consumers. Its uniqueness lies in connecting consumers with providers and providing evidence-based content to the practitioner to guide patient care. The ability to track health indicators over time allows the individual and the doctor to easily see changes in detrimental health indicators and take action to prevent major health problems.

To ensure that local mental health services are aware of and have access to the app for consumers, information has been placed on a number of webpages—the University of Western Australia—Psychiatry (http://www.psychiatry.uwa.edu.au/research/community-culture/physical-care-clinical-guidelines), the Western Australian Association for Mental Health (https://waamh.org.au/mental-health-promotion/mental-health-resources/physical-health-diary-app.aspx), and the Western Australian Office of the Chief Psychiatrist (http://www.chiefpsychiatrist.wa.gov.au/physical-health-diary-app-and-website/). Social media has also allowed the app to be promoted more broadly to reach international audiences through a Facebook app page (https://www.facebook.com/PhysicalHealthDiary/) and an Instagram page (https://www.instagram.com/physical.healthdiary/?hl=en). It is hoped that mental health services world-wide will see the value in the app and utilise it to assist consumers.

Acknowledgements

The authors would like to thank the University of Western Australia and Richmond Wellbeing for their support in funding the development of the app, and mHealth for reviewing the Physical Health Diary app.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

1. Stanley SH, Laugharne JD. Clinical guidelines for the physical care of mental health consumers: Assessment and monitoring package. Available online: http://www.psychiatry.uwa.edu.au/research/community-culture/physical-care-clinical-guidelines
2. Stanley SH, Laugharne JD. Clinical guidelines for the physical care of mental health consumers: a comprehensive assessment and monitoring package for mental health and primary care clinicians. Aust N Z J Psychiatry 2011;45:824-9. [Crossref] [PubMed]
3. Stanley SH, Laugharne JD. Physical health algorithms for mental health care. Aust N Z J Psychiatry 2014;48:889-94. [Crossref] [PubMed]