Mental illness can develop at any age and may be completely curable or require continuous treatment and support. At any one time, one in six adults suffer from the more common conditions, such as mild depression and one person in a hundred may be affected by more severe mental illness eg schizophrenia.

The most common types of mental illness that Dietitians working outside the mental health services are likely to encounter are:

Mood affective disorders
- Anxiety
- Depression
- Bipolar disorder ( manic depression )
Dementia
Schizophrenia

GP services now offer initial support to people with depression and anxiety through the practice based mental health workers and people with more severe mental illness are now treated by consultant psychiatrists and their teams in the community mental health services and social services. When people become unwell ( condition deteriorates) they may be referred to a crisis resolution team which offers intensive home based treatment or be admitted to an inpatient mental health unit.

Other services include Rehabilitation and Recovery which provides assessment and treatment programmes to enable service users to move to more independent living environment and Assertive Outreach teams which provide intensive treatment and support to people who have a history of disengagement with the main mental health services .

People with a diagnosis of severe and enduring mental illness such as schizophrenia and bipolar disorder are at an increased risk of developing and dying from a range of physical illness and conditions including coronary heart disease, diabetes, infections, respiratory disease and greater levels of obesity suffer more discrimination when compared to the general population .

Medication used to treat mental illness can have marked side effects including hyperglycaemia, hyperlipidaemia, diabetes, obesity and gastro intestinal disorders, which need long term dietary management. Self neglect and disorganised lifestyles may be a symptom of mental illness and may result in malnutrition.

In addition the above disorders may be exacerbated by food refusal and other disordered eating patterns, high caffeine intakes, polydypsia and food phobias.

Dietitians can help to reduce this additional burden both by direct intervention with service users who have complex therapeutic dietary requirements and by training other mental health care professionals.

Due to the small number of dietetic posts within the mental health trust , most people with a mental illness who need dietetic treatment are referred to primary or secondary care, who may not have the specific skills and links ( to mental health professional support) to provide the most appropriate care. Advice to these individuals needs to be given within a safe and supportive environment by mental health professionals involved in their care.

It is an interesting and opportune time for Dietitians working in the mental health services now that the poor physical health of our service users has been highlighted in many Department of Health reports. Great interest has been expressed by other organisations and individuals many of whom do not offer evidence based dietary advice.

Dietitians need to be proactive in their trusts and try to work at a strategic level

Advising on the implementation of relevant NICE guidelines
Influencing menu provision for inpatient units
Developing programmes and training mental health staff to deliver first line nutritional interventions whilst acting as a consultant for the more complex therapeutic dietary problems
Becoming involved in audits and participate in research relating to all nutritional issues and demonstrate the effectiveness of dietetic intervention.

A new vision for mental health FINAL1.pdf

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