Q Exchange
Diet and mental illness: How can we do more?
- Proposal
- 2023
Meet the team
Also:
- Dr Reem Abed
- Paul Reeves
- Helen Barlow
- Elaine Harrison
- Project manager (TBC)
- Dr Mike Hunter (Executive Sponsor)
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
Research highlights that adherence to healthy dietary patterns can improve mental health. Even with Severe Mental Illness (SMI), which includes major depression, bipolar disorder, and schizophrenia, there is evidence to show the impact of dietary changes in terms of quality of life, less time in hospital and less medications. In fact, in one study in a psychiatric hospital, 64% of patients were discharged on less psychiatric medication after following a ketogenic diet. Ketogenic diets are just one example of diets that have been shown to be support significant improvements in body weight, blood pressure and blood glucose.
It is clear that diet can support mental health, however it is unclear how to implement evidence around into practice. We know from our practice that health care professionals often do not feel confident with bringing up this topic and we know improvement science can help to make research recommendations into standard practice.
What does your project aim to achieve?
This project aims to empower multi-disciplinary teams & support networks to work together to improve service user’s mental and physical health by improving diets which we know make a big difference for both physical & mental health. This will help to provide more holistic care for people with mental illness and improve quality of life for them and their families. Research suggests if this if diet improvements are made successfully, it can help to reduce the need for medications and help to reduce the need for longer hospital admissions.
We know that the conversations around diet are often difficult to initiate. Therefore, we want to co-produce a guide with healthcare professionals, support staff including cooks and housekeepers, service users, carers & charities to help with clear interventions to test which will help to make recommendations around diet into everyday practice within our SHSC. In order to do this improvement science will be used.
How will the project be delivered?
This project will be delivered using a range of improvement methods. The first step will involve stakeholder mapping to ensure all the right people are involved at the right time. This will help to develop the project team who will act as an “expert faculty” and every decision around a specific aim, objectives and interactions of the guide will be agreed by the expert faculty.
The expert faculty, which will include service users and nutrition specialists, will work with 2 teams to understand their current processes and start testing the changes around diet with based on data.
A draft guide with evidence-based interventions related to diet will be developed and tested by the team and this guide will be iteratively improved over a 6 months, after this the guide will be tested in a further two areas and the first two teams will act as buddies to the second teams.
How is your project going to share learning?
The end result of this project will be a guide for how to go about the process of improving diets for people with mental illness. This guide will be made available to other Q members. We have already had comments Q members telling us this is something they would like to test. Despite the evidence & experience we have in this area, we know it is not easy to start testing changes & have the confidence to have the right conversations & the guide will share our learning to help others.
The draft guide will be available to all, and we are hoping to publish the final guide after 12 months through BMJ Open Quality so it is openly accessible to all. We will provide updates on the Q website including links to progress that include data regarding improvements in physical health metrics & admissions, but also qualitative data around service users and staff experiences.
How you can contribute
- Please share any feedback you have about our idea with us - we really want to get it right for maximum impact & to achieve big improvements.
- If anyone has conducted any similar improvement work, or is aware of any – please do let us know.
- We would welcome any other Q members who would also like to test the guide & contribute to its development.
- We would also welcome interest in being part of our Expert Faculty for the development of the guide from those who experience in this area.
- Our key focus is to improve the quality of life for service users, not just in our Trust but nationally & even internationally using improvement science. So we welcome anything that will help us to do this.
- We're excited to have a new member on the team from Housekeeping & Cook staff, who have unique relationships with patients which will be valuable.
Plan timeline
| 5 Mar 2023 | Continue testing guide with first teams using model of improvement |
|---|---|
| 16 Jul 2023 | Stakeholder Mapping to identify Expert Faculty and other stakeholders. |
| 6 Aug 2023 | Advertise for nutritionists, experts by experience and other consultants required |
| 3 Sep 2023 | Initiate bi-weekly Expert Faculty meetings (reduced to monthly after 2 months) |
| 4 Sep 2023 | Start literature review to support development of guide for testing |
| 2 Oct 2023 | Initiate Phase I: Bi-weekly QI coaching to support guide testing |
| 8 Oct 2023 | First few coaching sessions to focus on current process mapping |
| 31 Oct 2023 | Develop SMART aim for teams by end of month |
| 5 Nov 2023 | Start sending weekly data to teams based on aims |
| 25 Feb 2024 | Update guide for Phase II, including data from Phase I |
| 3 Mar 2024 | Repeat coaching structure (or updated structure as needed) for 6 months |
| 3 Mar 2024 | Second Phase with two new teams and Phase I buddies |
| 31 Oct 2024 | Complete Final Copy of guide with data from both phases |
| 5 Jan 2025 | Submit Quality improvement Report with final guide to journal |
Comments
Helen Crimlisk 28 Mar 2023
How fantastic to have a conversation today with our Housekeeping Lead at SHSC, Elaine, who has joined the team!
Housekeepers and cooks who work in our mental health inpatient teams have a unique relationship with service users and are familiar with approaching conversations about eating and diet. It will be great to bring this group into the project and learn from their experiences as well as thinking about how we can work better together to improve conversations about diets and support healthier eating habits .
Jenny Fainberg 28 Mar 2023
Hi Helen
if you look on the Joined up care Derbyshire website and search 'Quality Conversations' a page will come up with lots of information on it
If you need anything further just ask me, my team have done a whole project using it as the baseline conversation for the direction of the project, it has been really successful
Parya Rostami 28 Mar 2023
Hi Jenny,
I have just had a look at the resources and website and wow - great to come accross all of this.
Actually, we have been trying to do somehting similar with one of our other ideas and we also think better quality means asking "what matters to you" rather than "what's the matter". The resources are so helpful - we will definitely be in touch. We would love your feedback on our other idea if you get a chance too as you have done great work in this are already.... - The “What matters” Quality framework | Q Community (health.org.uk)
Thanks,
Parya
Jenny Fainberg 26 Mar 2023
glad you thought my comment was useful
In prison there are so many people whose lives are the intersectionality you detailed.
The conversation is hard but let's embrace that, if it was easy we would already know what to say and be talking about it. I think your guide will be very useful.
Derbyshire uses the Quality Conversations as a way to navigate an uncomfortable conversation, I am sure there are similar approaches everywhere.
As health care professionals it is very important we are really comfortable with the uncomfortable, it is our job.
Helen Crimlisk 27 Mar 2023
thanks Jenny - Id be interested to hear more about the Quality Conversations model.
I think it IS uncomfortable but our staff are good at having uncomfortable conversations - risk, medication, side effects, MHA etc. Perhaps this feels more uncomfortable because it strays into people's personal choices which we would of course want to respect, but this should be done in the context of psychoeducation (around diet) which our staff feel less comfortable with (the example of smoking comes to mind as a comparator)
Equipping staff with support and guidance should make these issues easier to raise and behaviour changes encouraged
Helen Crimlisk 25 Mar 2023
Thanks for the help and suggestions Parya- the more I have heard from the team and through reading comments on the Q Exchange website the more I appreciate the importance of clear methodology and testing of interventions. To make sustained and evidence informed decisions we need to focus on engagement, data collection and coproduction of any interventions to ensure they are safe, acceptable and sustainable. I feel very excited to lead on this project with the EIS team. This team work in a holistic way and are involved at the early stages of mental illness where patients are more likely to be invested in their recovery and where families are routinely involved in interventions. This makes it fertile ground for rapid testing cycles and rapid quality improvement in an under examined and developed area of mental illness and well being
Jenny Fainberg 14 Mar 2023
great idea, i thought about this when i did some work in a prison as i know how much a diet like this helps me and i wondered if it was something prisons could adopt to support mental health.
Helen Crimlisk 25 Mar 2023
Thanks Jenny, yes sometimes we forget how important the simple things like diet are and how much they can be impacted on if you are mentally I’ll, socially disadvantaged or economically challenged ( intersectionality is common).
Your experiences working in a prison are a further example of where on the one hand nutritional practice is pretty poor and on the other hand there are unique opportunities to do better with added benefits to patients from supporting healthy licit and sensible diets with multiple benefits
Parya Rostami 23 Mar 2023
Hi Jenny,
That is really interesting - as you can see the idea is in its earlys stages and perhaps the project could develop a guide for diet interventions to support mental health to test that are evidence-based? This could be then used in other settings including prisons. We will look have a deeper look at the research and perhaps refine the idea in this way so that there is a guide or a blueprint for others wanting to do the same!
Thanks for the great idea!
Best wishes,
Parya
Helen Crimlisk 13 Mar 2023
This is a really novel idea - thinking about primary, secondary and tertiary interventions in psychosis using diet.
It would be interesting to think more about how to approach conversations like this with people at risk of psychosis and recovering from psychosis- this is not something most mental health workers feel confident with. Creating some case examples and sample scripts about how to engage in this conversation might be helpful?
I am also interested in the "dose" effect of dietary manipulation. There may be people interested in changing their diet somewhat but not more radically. Do we know how this might impact on the potential benefits. Might it be interesting to map the behavioural change drivers in a patient population?
Parya Rostami 25 Mar 2023
Hi Helen, thank you for this helpful guidance and sharing comments on here and also offline.
To update Q members - Having read more into the area I can see why at this stage the work needs to be more evaluative and have updated based on Helen's comments and those of others we recieved here and offline.
Helen, has agreed to lead on this idea with Reem who is a consultant psychiatrist in SHSC's Early Intervention Service and first came up with this idea which has now been developed by the wider team :)
Kind regards,
Parya
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