Implementation of a system-wide health promotion intervention to reduce early mortality in high risk adults with serious mental illness and obesity

Overview Persons with serious mental illness (SMI) experience a high rate of medical comorbidity, resulting in reduced life expectancy of 7-30 years less than that of the general population largely due to cardiovascular disease. High rates of obesity and smoking are major factors contributing to early mortality, associated with sedentary behavior, poor diet, and prescription by physicians of high-weight-gain antipsychotic medications. This panel will describe a multicomponent approach to addressing one of the nation’s leading health disparities through a rigorous statewide implementation effort aimed at transforming mental health services by integrating health promotion and obesity prevention through organizational change, prescriber behavior change, and patient engagement in service design and implementation. The first presentation on organizational change describes how the results of an NIMH-funded RCT of the In SHAPE health promotion intervention were applied to a statewide implementation study including process outcomes of a learning collaborative, system level (organizational change) outcomes, and patient-level outcomes. The second presentation on prescriber behavior change will describe outcomes of a statewide academic detailing/ audit and feedback intervention to decrease prescribing of high weight gain propensity antipsychotic agents for individuals with SMI. The third presentation on patientpeer engagement describes the results of a pilot study designed by patients, providers and academic researchers with the goal of increasing uptake and reach of the professionally-led In SHAPE health coach fitness model by phasing out one-on-one fitness coach training sessions with individual and group-based peer support, motivational text messages, and physical activity sensors for monitoring and feedback. The discussion will consider how these findings may inform future systems change, national efforts, and implementation research to improve the health and longevity of high-risk adults with SMI and cardiovascular risk factors.