Weight management in adult secure care mental health settings
Research type
Research Study
Full title
Mixed methods study to generate evidence to inform weight management interventions in adult secure care mental health inpatient settings
IRAS ID
307058
Contact name
Susanna Mills
Contact email
Sponsor organisation
Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust
Duration of Study in the UK
1 years, 5 months, 28 days
Research summary
Overweight and obesity are very common in the UK population, leading to avoidable illnesses such as heart disease, diabetes and certain cancers. Unhealthy weight is even more widespread among patients with serious mental illness (including schizophrenia and bipolar disorder), reaching about 80% in secure care hospitals (patients who have offended or have violent behaviour). Many challenges make it more difficult for patients in secure care to maintain a healthy weight. These include restricted opportunities to exercise and eat well, low patient motivation, limited knowledge and understanding amongst staff, and medication that tends to lead to weight gain. Our research aims to address these problems by using different methods to explore first-hand with adult patients, staff and carers their priorities for tackling unhealthy weight, and what would make this easier and harder to achieve. Firstly, we will survey all staff with different roles working in secure services within Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust (CNTW) to investigate their views. Next, we will observe food and exercise behaviours on different occasions on a secure CNTW ward. This will include events over the whole day, such as meal- and snack-times, buying food from the tuck shop and ordering takeaways, therapy activities and exercise opportunities. We will then use these findings to inform focus groups with patients, carers and staff at CNTW, and interviews with multidisciplinary staff at Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). Finally, we will draw this learning together and compare the different findings, so they can be used in future to guide the development of weight management programmes, to be trialled amongst patients and staff in adult secure care.
Summary of results
It can be difficult for people living with severe mental illness in secure mental health hospitals to become and stay a healthy weight. We used four linked approaches in an NHS Trust in Northern England to understand more about this problem. We surveyed staff in secure settings and received a range of responses from across different parts of the service. These findings informed in-person observations undertaken in a low-secure ward over a six month period. Next we held focus groups with current service users, former service users, carers and a range of staff, and semi-structured interviews with different staff in another NHS Trust, to explore everyone’s views and experiences. We then combined all our finding through discussion groups, involving former service users and a range of staff. Overall, we found that service users in secure care live in an environment which makes it much easier to be overweight or obese, rather than a healthy weight. Particular problems are around medication, being inactive for most of the time, low motivation to change, dislike of hospital food and choosing unhealthy alternatives, understaffing, ward culture and trying to balance service user preferences with making healthy choices. In future, rather than focusing on one small issue, we are likely to need plans and activities that address the whole range of current issues causing unhealthy weight across the service, and include everyone involved in secure care.REC name
London - Bromley Research Ethics Committee
REC reference
22/PR/0100
Date of REC Opinion
13 Mar 2022
REC opinion
Further Information Favourable Opinion