Lifestyle interventions in patients with a severe mental illness: Addressing self-management and living environment to improve health

The physical health of patients with a severe mental illness (SMI) is alarming and patients’ unhealthy lifestyle behaviors offer a window of opportunity to improve their health and well-being. In this thesis we studied how lifestyle behaviors in severe mentally ill patients could be improved in regular mental health care settings in order to improve their physical health. In the first pragmatic randomized controlled trial (ELIPS), lifestyle coaches trained residential staff members to target small changes in the obesogenic (obesity promoting) environment of residential patients with regard to diet and physical activity. We studied the effects on patients’ physical and mental health. The results showed that changing the obesogenic environment into a healthier environment could improve patients’ physical health and physical fitness. However, effects diminished when the lifestyle coaches left and staff members were responsible for the healthy environment. In the second trial (LION), we facilitated mental health nurses with training in motivational interviewing and a web tool to target lifestyle behaviors in SMI patients living at home. SMI patients, together with mental health nurses, screened their lifestyle behaviors and created a lifestyle plan with goals, which were biweekly discussed in regular care visits. This did not result in physical improvements, although patients’ motivation to change diet increased. The intervention was not cost-effective. Overall, this thesis indicates that lifestyle interventions for SMI patients are feasible in regular mental health care settings, but adaptations in mental healthcare routines are needed to enlarge and maintain outcomes