Wellness 10x10 Tools
Please be sure to visit the Wellness 10x10 Tools Archive to read previous issues.
Wellness 10x10 Tools: An Update from the SAMHSA 10x10 Wellness Campaign
Volume 3, Issue 1
May 2010
Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA)
Wellness 10x10 Tools features information and resources to help stakeholders collaborate to achieve and maintain wellness and realize the vision of the campaign—to increase life the expectancy and quality of life of individuals with mental health problems.
Please disseminate this resource widely and share your ideas with us—what you are doing, what you are planning to do, and what we can collectively do to promote wellness and achieve the vision of the 10x10 Wellness Campaign—at 10x10@samhsa.hhs.gov.
About the SAMHSA 10x10 Wellness Campaign
People with mental health problems deserve to live as long and as healthily as other Americans. Yet data show that mental health consumers are likely to die decades earlier than their counterparts in the general population.1 According to the National Association of State Mental Health Program Directors Medical Directors' Council, the "increased morbidity and mortality [among people with mental health problems] are largely due to treatable medical conditions that are caused by modifiable risk factors such as smoking, obesity, substance abuse, and inadequate access to medical care." Among the causative factors are: higher rates of cardiovascular disease, diabetes, respiratory disease, and infectious disease; high rates of smoking, substance abuse, and obesity; increased vulnerability due to poverty, social isolation, trauma, and incarceration; a lack of coordination between mental and primary health care; stigma and discrimination; side effects from psychotropic medications; and an overall lack of access to health care—particularly preventative care.
This disparity in life expectancy is unacceptable.
The Substance Abuse and Mental Health Services Administration (SAMHSA)/Center for Mental Health Services (CMHS) 10x10 Wellness Campaign seeks to reduce early mortality of individuals with mental health problems by 10 years over the next 10 years.
We envision...
A future in which people with mental health problems pursue optimal health, happiness, recovery, and a full and satisfying life in the community via access to a range of effective services, supports, and resources.
We pledge...
To promote wellness for people with mental health problems by taking action to prevent and reduce early mortality by 10 years over the next 10 years.
More than 2,000 organizations and individuals have signed the Pledge for Wellness, thereby expressing their commitment to promoting wellness and reducing the disproportionate impact of preventable morbidity and mortality on people with mental health problems. Sign the pledge online at http://www.10x10.samhsa.gov.
The Campaign Steering Committee, comprising leaders from various perspectives in the mental health field, serves as an important advisory group, helping guide the project's focus, activities, and programs. Steering Committee members include:
- Meghan Caughey, Peer Wellness Coordinator, Benton County Health Services
- Benjamin G. Druss, M.D., M.P.H., Rosalynn Carter Chair in Mental Health, Emory University
- Anita Everett, M.D., The Johns Hopkins Hospital, Bayview Campus
- Laura Galbreath, M.P.P., Director of Health Integration and Wellness Promotion, National Council for Community Behavioral Healthcare
- Dori Stauss Hutchinson, Sc.D., L.R.C., Director of Services, Center for Psychiatric Rehabilitation
- Ron Manderscheid, Ph.D., Executive Director, National Association of County Behavioral Health and Developmental Disability Directors
- Joseph Parks, M.D., Medical Director, Missouri Department of Mental Health
- Marc A. Safran, M.D., F.A.C.P.M., M.P.A., D.F.A.P.A., Captain, U.S. Public Health Service, Senior Medical Officer/Senior Psychiatrist Chair, CDC Mental Health Work Group
- Sherry Jenkins Tucker, Executive Director, Georgia Mental Health Consumer Network
- Betty Vreeland, APN.C, PMHCNS-BC, ANP-BC, Advanced Practice Nurse, UMDNJ-University Behavioral HealthCare
- Jane Winterling, Recovery Education Coordinator, Vermont Psychiatric Survivors
- Carlton Whitmore, Assistant Director—Office of Consumer Affairs, Division of Mental Hygiene, New York City Department of Health and Mental Hygiene
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Wellness Basics
Wellness is a concept that embraces a way of living that helps all people enjoy a more satisfying, productive, and happy life. It is, by definition, a conscious, deliberate process that requires a person to become aware of and make choices for a more satisfying lifestyle. A wellness lifestyle is balanced; it includes cultivating healthy habits that contribute to a better quality of life.
The dimensions of wellness are outlined in Figure 1.2 Additional resources defining the various dimensions of wellness are found at http://www.definitionofwellness.com.
Physical: Recognizing the need for physical activity, diet, sleep, and nutrition while discouraging the use of tobacco, drugs, and excessive alcohol consumption
Occupational: Deriving personal satisfaction and enrichment from participating in work, volunteering, and other activities that that reflect personal values, interests, and beliefs
Spiritual: Exploring, respecting, and incorporating personal values, beliefs, and the awareness of a being or force that transcends the material life
Social: Developing a sense of connection and a well-developed support system, which can be a tremendous resource for wellness
Environmental: Fostering good health by occupying pleasant, stimulating environments that support our well-being
Intellectual: Recognizing creative abilities and finding ways to expand knowledge and skills
Financial: Feeling satisfied with current and foreseeable future financial situation
Emotional: Developing skills and strategies for being able to cope effectively with stress, challenges, and conflict
Figure 1: DIMENSIONS OF WELLNESS
Moving Toward Wellness: Helping Yourself and Others
- Eat well. Some prescribed medications make it difficult to lose weight. Here are some simple steps you can take to improve your diet:
- Follow the Dietary Guidelines for Americans (available at: http://www.mypyramid.gov/guidelines/index.html), which emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products; includes lean meats, poultry, fish, beans, eggs, and nuts; and is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
- Find new recipes and tools from trusted online resources such as the American Heart Association: http://www.americanheart.org and Mayo Clinic: http://www.mayoclinic.com/health/healthy-recipes/RecipeIndex.
- Get active—and make it fun. Physical activity is a great way to lose weight, improve overall health, and prevent diseases. Find a hobby (e.g., hiking, bike riding, kayaking), play an indoor or outdoor sport (e.g., soccer, volleyball, basketball), or join a local health club or community center.
- Take time for yourself. It is important to reflect on personal goals and life ambitions, as well as to allow time for recreational activities. Develop your intellectual wellness by reading, or relax by using deep breathing exercises and yoga.
- Find a wellness partner. It is easier to make lifestyle changes if you have someone else with you on your journey. Consider talking with friends, family members, and consider joining a self-help group. Social encouragement can be an important factor in sustaining health-promoting behavior change.
- Quit smoking. There are many new programs specifically designed to help people stop smoking. Consider using a nicotine replacement therapy and/or joining a smoking cessation self-help group. (Please see the resources included in the article, "Tobacco Cessation Can Improve Life Expectancy," in this issue of Wellness 10x10 Tools.)
Be mindful and pay attention to your body. Notice your sleep and awake cycles, your personal energy cycles, and how your routines fit together.
From eating a nutrient-rich diet to getting adequate amounts of exercise to practicing mindfulness, wellness encompasses all realms of a positive, healthy lifestyle. And nurturing a positive, healthy lifestyle can lead to a greater quality of life, not to mention longevity.
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Tobacco Cessation Can Improve Life Expectancy
Reducing the prevalence and intensity of peers smoking may be the single most effective way to improve life expectancy among people with mental health problems. In fact, three-quarters of individuals with either mental health problems or addictions smoke cigarettes as compared to 23 percent of the general population.3 Smoking negatively affects the health of the smoker and his or her family, employment, finances, and quality of life.
In addition to generally applicable barriers to smoking cessation, such as reduced social opportunities and real or perceived lack of support, people with mental health problems may find it more difficult to quit smoking than others. Some of the reasons include:
- temporary relief from symptoms, including anxiety and auditory hallucinations, provided by nicotine (which helps to explain the 60—80 percent prevalence of smoking among people with schizophrenia,4,5 and major depressive and bipolar disorder6);
- real and perceived fears that smoking cessation will lead to symptom exacerbation, which in turn will impact quality of life, employment, community, and freedom;
- perceived impact of loss of social networks on social inclusion and integration; and
- economic barriers (e.g., cost of nicotine replacement) and lack of health coverage.
FREE tools and supports are available. There are various tools to help people with mental health problems quit smoking.
Resources for Consumers
Resources for Providers
Self-help groups and programs can apply existing models to help people quit smoking, develop and pilot their own self-help structures, and help members choose from existing resources in the community. It is important for both professional and self-help mental health programs to foster a culture of supporting tobacco use reduction/cessation.
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People with mental health problems, particularly schizophrenia and mood disorders, have shown a higher prevalence of metabolic syndrome—a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes—compared with the general population.7 Second-generation atypical antipsychotic medications are linked to the development of the metabolic syndrome and may contribute to the disparity in life expectancies between people with mental health problems and the general public. These drugs have an effect on the process of metabolism, promote cravings for carbohydrates, and tend to cause an altered resting metabolic rate.8 People may get into patterns of inactivity and burn fewer calories from the foods they ingest. The excess calories get stored as body fat. Over time, this effect becomes cumulative, if all the other factors—calories ingested, lifestyle choices, and exercise—remain the same.
Three or more of the following symptoms may indicate metabolic syndrome.9
- High blood pressure—blood pressure of 130/85 or higher
- High glucose levels or insulin resistance
- Blood fat disorders that tend to clog up the arteries and prevent easy blood flow
- A waistline of more than 35 inches in women and 40 inches in men
- High levels of particular activator inhibitors and/or proteins in the blood
People who are severely overweight, have a very large waist measurement, use antipsychotic medications or mood stabilizers, or have a family history involving stroke or heart attack should consider himself/herself to have an elevated risk for metabolic syndrome and discuss the condition with a health care professional. Healthy habits may prevent or manage metabolic syndrome. Future editions of Wellness 10x10 Tools will feature promising and best practices addressing metabolic syndrome.
Check out the free resources available from the U.S. Department of Health and Human Services Weight-control Information Network at http://win.niddk.nih.gov/publications/choosing.htm.
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Peer Support Whole Health
Peers are taking a lead role in moving toward the 10x10 Wellness Campaign vision. In Georgia and Michigan, for example, SAMHSA-funded and NASMHPD-coordinated Peer Support Whole Health projects have been developed, implemented, and evaluated. In these models, a peer specialist helps another peer choose and work toward a health goal. Both projects are based on an adaptation of the Chronic Disease Self-Management Program developed by Kate Lorig at Stanford University (see http://patienteducation.stanford.edu/programs/cdsmp.html).
With a SAMHSA grant, New Jersey developed a training program for peer wellness coaches who can help a peer to set and achieve a wellness or health goal by offering support, and encouragement. A coach helps the person define what is important and set a plan to accomplish a personal goal. The positive, supportive connection between a coach and another peer empowers the person seeking change to draw upon his or her own abilities and potential to achieve lasting lifestyle changes.
A critical aspect of coaching is self-responsibility. A person seeking coaching should accept responsibility for where s/he is in his/her own life, including where he or she is relative to health. Through coaching a person can determine what s/he is responsible for and become empowered to take the action to improve his/her wellness status, in terms of the many dimensions of wellness: spiritual, emotional, physical, occupational, financial, environmental, intellectual, and social.
The peer wellness coaches and peer support whole health specialist roles have significant potential to assist many people in living longer and living a better quality of life. For more information, visit: http://www.gmhcn.org/files/TTI_PSWH_Nat._Council_article_on_peer_support _whole_health.doc.
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Build Your Health Literacy
Improving health literacy—being able to understand what doctors, nurses, and pharmacists are saying—is important to achieving and maintaining wellness and enhancing life expectancy. Health literacy is the ability to find, understand, and use health information and services to make appropriate health decisions and to act on that information. At the same time, it is equally important for health care professionals to enhance their ability to deliver information in terms that consumers can readily understand.
Low health literacy and poor provider-consumer communication can have profound impacts on healthcare costs and health outcomes as, for example, complex paperwork, misunderstanding of benefits information, the management of chronic conditions, and the proper use of medications is compromised.
The Health Resources and Services Administration of the U.S. Department of Health and Human Services provides an excellent health literacy resource for healthcare providers and consumers at http://www.hrsa.gov/healthliteracy. The Web site includes a free online course that can help healthcare providers:
- acknowledge cultural diversity and deal sensitively with cultural differences that affect the way patients navigate the health care system;
- address low health literacy and bridge knowledge gaps that can prevent patients from adhering to prevention and treatment protocols; and
- accommodate limited English proficiency.
By improving health literacy, mental health consumers and providers can:
- improve understanding of health conditions, allergies, sensitivities, and histories;
- advocate for and obtain better health care;
- research complex health decisions and medications in order to make more informed and empowered choices; and
- understand the health impacts of modifiable (lifestyle) factors, and thereby make more appropriate positive choices.
Grants are Available to Address Health Literacy
The National Institutes of Health and the Agency for Health Research and Quality have released the following funding opportunity announcements:
Understanding and Promoting Health Literacy (R01) (PAR-10-133) http://grants.nih.gov/grants/guide/pa-files/PAR-10-133.html
Understanding and Promoting Health Literacy (R03) (PAR-10-134) http://grants.nih.gov/grants/guide/pa-files/PAR-10-134.html
Understanding and Promoting Health Literacy (R21) (PAR-10-135) http://grants.nih.gov/grants/guide/pa-files/PAR-10-135.html
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Resources
Campaign Resources
Now Available—Training Teleconference Archive: Focus on Wellness to Increase Life Expectancy and Healthy Living of Individuals with Mental Health Problems. Visit http://www.promoteacceptance.samhsa.gov/10by10/ archives/default.aspx.
National Organizations
Mental Health America (MHA) Live Your Life Well http://www.liveyourlifewell.org/
National Alliance on Mental Illness (NAMI) Hearts and Mind: A Roadmap to Wellness http://www.nami.org/Content/NavigationMenu/Hearts_and_Minds/ FINALfinalRoadmaptoWellness.pdf [PDF Format - 653 Kb]
1 Parks, J., Svendsen, D., Singer, P., & Foti, M.E. eds. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA: National Association of State Mental Health Program Directors Medical Directors? Council. Read the report at http://www.nasmhpd.org/general_files/publications/med_directors_pubs/ Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf [PDF Format - 1108 Kb].
2 Adapted from 'Words of Wellness,' the newsletter of the Collaborative Support Programs of New Jersey Institute for Wellness and Recovery Initiatives, Volume 3, Number 7, January 19, 2010, available at http://www.cspnj.org.
3 Parks, J., Svendsen, D., Singer, P., and Foti, M.E. eds. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA: National Association of State Mental Health Program Directors Medical Directors? Council. Read the report at http://www.nasmhpd.org/general_files/publications/med_directors_pubs/ Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf [PDF Format - 1108 Kb].
4 Winterer, G. (2010). Why do patients with schizophrenia smoke? Current Opinions in Psychiatry, 23(2):112-9.
5 Sagud, M., Mihaljevic-Peles, A., Mück-Seler, D., Pivac, N., Vuksan-Cusa, B., Brataljenovic, T. and Jakovljevic, M. (2009). Smoking and schizophrenia. Psychiatria Danubina, 21(3):371-5.
6 Diaz. F.J., James, D., Botts, S., Maw, L., Susce, M.T., and de Leon, J. (2009). Tobacco smoking behaviors in bipolar disorder: A comparison of the general population, schizophrenia, and major depression. Bipolar Disorders, 11(2):154-65.
7 Toalson, R., Saeeduddin, A., Hardy, T., & Kabinoff, G. (2004). The metabolic syndrome in patients with severe mental illnesses. Primary Care Companion Journal of Clinical Psychiatry, 6(4): 152-158.
8 Ruetsch, O., Viala, A., Bardou, H., Martin, P. & Vacheron, M.N. (2005). Psychotropic drugs induced weight gain: a review of the literature concerning epidemiological data, mechanisms and management. Encephale, 31 (4 Pt 1). Retrieved April 9, 2010 from http://www.ncbi.nlm.nih.gov/pubmed/16389718?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Results Panel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=related reviews&logdbfrom=pubmed.
9 Medicinenet.com. 'Metabolic Syndrome.' Retrieved April 9, 2010 from http://www.medicinenet.com/metabolic_syndrome/article.htm.
