Weight management in secure mental health services: a mixed methods study in Northern England

Abstract Background Excess weight and associated morbidity and mortality are major challenges for people with severe mental illness (SMI, including schizophrenia and bipolar disorder), particularly in secure mental healthcare (patients who have committed a crime or have threatening behaviour). This research explored: what are the barriers and opportunities for weight management in such settings? Methods Four integrated cross-sectional workstreams were undertaken in National Health Service (NHS) mental health secure services in Northern England. Firstly, all staff were surveyed to explore their views and experiences of weight management. Secondly, ethnographic in-person observations were undertaken on an inpatient ward over six months. Thirdly, focus groups were conducted with current and former service users, carers and multidisciplinary staff, and semi-structured interviews were undertaken with multidisciplinary staff at a second, complementary, NHS trust. Fourthly, empirical findings were integrated by a diverse stakeholder group. Results Seven key themes were identified through results drawn from 79 staff survey responses (16.2% response rate), in-person observations, nine focus groups and 11 interviews. Antipsychotic medication was identified as an initial precipitator of weight gain, subsequently perpetuated by insufficient staffing to facilitate physical activity and health promotion. Sedentary lifestyle, poor perception of hospital food and low patient motivation to eat well and exercise were highlighted. Ward culture was perceived to centre around unhealthy food, with limited staff authority to mandate healthier choices. Conclusions Factors driving excess weight amongst patients living with SMI in secure services are multifaceted and embedded into current approaches to SMI management and healthcare culture. Although further study is required in other hospital trusts, long-term complex interventions involving wide ranging stakeholders are likely to be required. Key messages • The majority of patients with severe mental illness in secure hospitals experience unhealthy weight. This has multiple causes, linked to healthcare culture and approaches to managing mental illness. • Effectively addressing the challenges around excess weight is expected to require complex, multi-faceted interventions, engaging key diverse stakeholders, including experts with lived experience.