Organisations: Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Tees, Esk and Wear Valleys NHS Foundation Trust (in partnership with Northern England Clinical Network, OHID, Teesside University and local authorities).

Aim and rationale

North East and North Cumbria have high rates of being classified as overweight or obese, and rates are even higher in people with severe mental illness and learning disabilities.

The trusts identified that inpatients were likely to be discharged having gained a significant amount of weight, had high rates of obesity (particularly among those with psychosis) and high consumption of takeaways, and monitoring of their physical health (including BMI) was inconsistent.

To address this they designed and delivered a regional plan to support people with lived experience of mental health conditions and/or learning disabilities to achieve a healthy weight through nutrition and physical activity.

Development and implementation

• A regional steering group was established in 2016, followed by an engagement event with service users, carers, staff and partners.
• The ‘A Weight off Your Mind’ plan for the two trusts was co-produced with service users, carers and staff, and published in 2017. It identified commitments under 10 themes:

1. Leadership
2. Physical health screening
3. Food and nutrition
4. Improved access and opportunity for physical activity
5. Pharmacy and medicine management
6. Psychological therapies
7. Education and information
8. Developing pathways
9. Children and young people
10. Learning disabilities

Commitments focused on changes for inpatients (such as provision of healthy food and drink and physical activity interventions) and working with partners to make sure services in the community, such as physical activity and leisure services, proactively support and are accessible to those with mental health problems and/or learning disabilities.

A range of materials were produced to support the plan, alongside increased training for staff, including peer support workers, on weight management and Making Every Contact Count.

Following delays due to the Covid pandemic, the plan is being refreshed with service users and partners in 2023.

Overcoming challenges

• Time and effort were needed to engage staff, who had competing priorities and limited capacity.
• Some staff perceived CQC guidelines on restrictive practice as an obstacle; for instance, how to support healthier eating without restricting people’s choice to order takeaways.
• Lack of access to space for exercise (outdoor space, gyms, etc); creative ways to exercise needed to be found.
• The Covid pandemic interrupted the momentum of embedding the A Weight Off Your Mind plan. Also, a ‘treat culture’ was reinforced during the pandemic (eg many social activities were based around food, particularly ‘treat’ type foods), and work was subsequently needed to shift this culture and refresh the plan.

Outcomes

Impact on weight for service users was difficult to measure due to the turnover of inpatient populations, as well as not being able to attribute cause. However, achievements over the course of the work include:

• Website and resources developed, including accessible/easy read resources.
• Special events such as ‘lockdown challenge’ and ‘summer challenge’ were delivered and these have engaged staff and service users in different activities.
• Work with hospital shops has reduced the availability of ‘multi-buys’ and family/sharing size items. Stocks of many full sugar soft drinks have been replaced with diet versions or water.
• Nutritional analysis of inpatient menus – offering ‘healthy heart’ choices and identifying these on menus, and reviewing portion sizes.
• Guided walks developed across hospital sites with wooden markers and maps available at reception areas and online.
• Physical activity champions training and Making Every Contact Count training rolled out with a focus on healthy weight.
• A ‘building active communities’ event engaged multi-agency colleagues to discuss physical activity provision/opportunities for service users.
• Directory of physical activity and weight management opportunities created.

Recommendations

• A multidisciplinary steering group and a clear multi-strand plan are essential, alongside regular meetings to keep the work on track.
• Dedicated staff who can commit time are needed to lead the implementation and embedding of the plan.
• Executive team support and endorsement assist roll out of the work.
• Link into other work around physical health to enable a joined-up approach.
• Regular trust-wide communication to promote key messages.

Contact

Kate McBride, Kate.Mcbride@cntw.nhs.uk

PublicHealth@cntw.nhs.uk

A Weight Off Your Mind – Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (cntw.nhs.uk)