The Healthy Active Lives (HeAL) international consensus statement aims to reverse the trend of people with severe mental illness dying early by tackling risks for future physical illnesses pro-actively and much earlier. The statement is being launched today by the Royal College of Psychiatrists, at a special event focusing on achieving parity between mental and physical health.

Compared to their peers who have not experienced psychosis, young people with psychosis face a number of preventable health inequalities:

• A lifespan shortened by about 15-20 years
• 2-3 times the likelihood of developing cardiovascular disease making it the single most common cause of premature death (more so than suicide)
• 2-3 times the likelihood of developing type 2 diabetes
• 3-4 times the likelihood of being a smoker

The HeAL statement reflects international consensus on a set of key principles, processes and standards. It aims to combat the stigma, discrimination and prejudice that prevent young people experiencing psychosis from leading healthy active lives, and confront the perception that poor physical health is inevitable.

The HeAL group have set themselves ambitious targets. Within the next five years, they want to see that:

• 90% of young people experiencing a first episode of psychosis and their families or supporters are satisfied that they made treatment choices informed by an understanding of their risks for future obesity, cardiovascular disease and diabetes
• Within a month of starting treatment, 90% have a documented assessment which includes risks for future obesity, cardiovascular disease and diabetes
• All young people receive a regular review of their medication to minimise the development of complications of obesity, cardiovascular disease and treatment
• 75% gain no more than 7% of their pre-illness weight two years after starting antipsychotic treatment
• 75% maintain blood glucose, lipid profile and blood pressure within the normal range two years after initiating antipsychotic treatment
• 2 years after the onset of psychosis:
  • 90% receive health promotion advice on healthy eating, tobacco and substance use, dental care and sexual health
  • Fewer than 30% smoke tobacco
  • More than 50% engage in appropriate physical activity.

Dr David Shiers, co-author of HeAL, said:

The evidence is now clear – weight gain, cardiovascular risk and metabolic disturbance commonly appear early in the course of emerging psychosis and are potentially modifiable. As clinicians, if we dismiss these disturbances as being of secondary concern to controlling their psychiatric symptoms, we may be inadvertently condoning a first critical step on a path towards physical health inequalities for these young people. This vulnerable group urgently need a far more holistic and preventive approach.

Professor Sue Bailey, President of the Royal College of Psychiatrists, said:

A person’s physical and mental health influence one another: deficiency in the care of one can lead to serious problems with the other. Having worked with vulnerable children and families for more than 30 years, I’m delighted to see the HeAL initiative tackling the physical health problems experienced by young people with psychosis, and ensuring both their mental and physical health are given equal attention.

The HeAL statement says that young people experiencing a first episode of psychosis have a number of rights:

• I should not lose the physical health I possess, as a consequence of my mental illness, or my care and treatment
• I have a right to a healthy active life
• I have similar expectations of good physical health and health care as my peers who have not experienced psychosis
• I, my family and my supporters, are respected, informed and helped to take responsibility for treatment medications where appropriate
• I am not discriminated against or disadvantaged in my physical health care because of my mental health difficulties
• I expect positive physical and mental health outcomes of my care to be equally valued and supported
• From the start of my treatment and as a fundamental component of my health care, I am helped to minimize my risks of developing obesity, cardiovascular disease and diabetes

Link 

Healthy Active Lives (HeAL): keeping the body in mind in youth with psychosis (PDF). Royal College of Psychiatrists, consensus statement, 19 Jun 2013.