Title: Improving Physical Health and Decreasing Cannabis Abuse in People With Severe Mental Illness
Funder: Department of Health (England)

Abstract: SECTION 8 AIMS: To develop culturally appropriate, innovative, and effective programmes to achieve better physical and mental health in people with severe mental illness (SMI), by improving lifestyle choices and decreasing illicit drug use. SECTION 9 BACKGROUND The physical health of people with SMI is very poor, resulting in markedly increased mortality rates. The metabolic syndrome, a constellation of cardiovascular (CVD) risk factors including central obesity, dyslipidaemia, hyperglycaemia and hypertension, increases long-term morbidity and death and is highly prevalent in people with SMI. Additionally, while there is a 3-fold excess of diabetes in schizophrenia, the management of metabolic syndrome and diabetes is poor in those with SMI. The huge implications of this, in terms of morbidity, mortality, quality of life and cost make improving physical health in SMI a national priority. Cannabis is the most commonly used illicit drug in the UK, and the concentration of the active compound is rising. Regular cannabis increases the risk of schizophrenia up to 6-fold, and on-going use leads to more relapses, poor compliance, and longer duration of illness. Unfortunately, there are no established practical treatment programmes to reduce substance use in SMI. Newly developed programmes are promising, but lengthy, complex and expensive. A more practical alternative is needed. ; SECTION 10 RESEARCH PLANS Study 1 A prospective one-year study of physical health and substance use outcomes in 300 people with a first episode psychosis. The main hypotheses are:- 1. People with first episode psychosis with less healthy lifestyle habits are at greater risk for metabolic syndrome at 1 year. 2. People with first episode psychosis who take cannabis will have more psychotic symptoms 1 year later than non-users. Study 2 Development, validation and manualisation of a health promotion intervention (HPI). The aim of the HPI is to modify lifestyle factors which impact negatively on health in SMI: substance use, smoking, obesity, poor nutrition and lack of exercise. Study 3 Randomised Controlled Trial assessing the cost-effectiveness of the above intervention (HPI), tailored to individual needs, in promoting mental and physical health. We propose a two-arm RCT comparing the cost-effectiveness of combining usual CMHT care with a one-year HPI as described above vs. usual CMHT care alone in improving health at 1-year. The main hypothesis is: People with established psychosis who receive the HPI plus usual care will have greater quality of life and more quality-adjusted life years compared to usual care alone. Study 4 A feasibility study of an assertive intervention to improve diabetes control in people with diabetes mellitus and severe mental illness (SMI). We plan to test an assertive and intensive multidisciplinary diabetes care outreach service to help people with SMI and diabetes reduce their glycosylated haemoglobin (HbA1c), a standard marker of glycaemic control, by at least 0.5% over 12 months. 11 RESEARCH TEAM The team has a spread of expertise in research, development and health promotion across psychosis, drug abuse, and medical disorders. It includes the internationally most widely cited schizophrenia researcher, a service user, a manager, and experts in physical health; diabetes; health economics; psychological interventions and health promotion. 12 RESEARCH ENVIRONMENT South London and Maudsley NHS Trust and the Institute of Psychiatry (IoP) together comprise the largest concentration of expertise in psychiatric research and development in Europe. The IoP received a 6* rating in the RAE. The IoP Psychosis Interdisciplinary Research Group is the most cited group in schizophrenia research outside the USA and has considerable experience in trials of novel interventions and in rolling them out to become part of routine care. 13 ANTICIPATED OUTPUTS This proposal will produce a better understanding of the frequency and development of metabolic syndrome in SMI and the role of cannabis in the onset and relapse of psychosis. It will develop new, practical, evidence-based interventions to maximise physical health and minimise substance use in SMI. It will facilitate wider provision of health promotion, illness prevention and optimal disease management, thus improving health outcomes and reducing illness burden. It will allow us to develop a brief screening tool to assess risk of physical morbidity in people with SMI, and will provide guidelines on screening for emergence of modifiable CVD risk factors in SMI. We will publish our findings in high impact clinical journals; present results to senior clinicians, managers and users and disseminate them widely. 14 -16 PUBLIC INVOLVEMENT Service Users have been closely involved in the preparation of this proposal. One investigators is a service user and will lead in establishing collaborative User and Carers’ groups to help plan both in the interventions and their evaluation.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH;METABOLIC AND ENDOCRINE;CARDIOVASCULAR