Investigating the role of community managed organisations in addressing the health risk behaviours of people living with mental health conditions

People living with mental health conditions experience a significantly reduced life expectancy, largely due to physical chronic health conditions and associated modifiable health risk behaviours including tobacco smoking, poor nutrition, harmful alcohol consumption, physical inactivity, and poor sleep. While various international and national guidelines recommend the provision of preventive care to identify and address these health risk behaviours as part of routine mental health service provision, research identifying the effectiveness, prevalence, and type of preventive care provided among Community Managed Organisations (CMOs; non-government mental health services) is limited. Additionally, a limited number of studies have explored factors that may impact CMOs’ ability to provide preventive care to address the health risk behaviours of consumers. These research gaps were investigated utilising a mixed methodology approach, including one systematic review (Chapter 2), three cross-sectional quantitative studies (Chapter 3, 4 and 5), and one qualitative study (Chapter 6). Chapter 2 identified a small number of studies exploring the effectiveness of CMO-delivered health risk behaviour interventions (n=7), where interventions largely focused on multiple risk behaviours (physical activity and nutrition) and were of low methodological quality. Chapters 3 and 4 identified the prevalence of preventive care provision among staff from one CMO, indicating care to be highest for physical activity and lowest for alcohol consumption. A number of barriers relating to CMO staff providing such care were identified, including low confidence in providing preventive care and negative perceptions regarding consumers’ likelihood of taking up referrals for physical health care. Chapters 5 and 6 identified the prevalence, type, and factors potentially impacting the preventive care from an organisational perspective, through collecting data from organisational leaders (i.e., senior management staff) across a range of CMOs. Chapter 5 found that the prevalence of preventive care provision was highest for physical activity and lowest for smoking, and factors associated with providing care for all five health risk behaviours included the presence of guidelines for preventive care provision, and staff who had received preventive care training. Lastly, Chapter 6 identified the type of preventive care provided for health risk behaviours to include practical education and life skills, referral pathways and local connections, and staff encouragement and peer support. Factors reported to act as barriers to the provision of such care included lack of funding and a perceived limited ability to influence behaviours, while factors acting as facilitators to care provision included supportive workplace policies and culture, collaboration with available supports, and staff education and training. Together, these findings highlight variability in the way that health risk behaviours are being addressed by CMOs and highlight a number of factors that may assist or hinder the capacity of organisations and staff to provide preventive care in this setting. Areas for future research include identifying ways to support CMOs to address multiple health risk behaviours among consumers, exploring barriers to CMOs addressing certain clusters of health risk behaviours that co-occur, and further investigating the potential of organisational strategies (e.g., guidelines) for improving preventive care practices in CMOs. When conducting future research in this area, hybrid effectiveness-implementation trials should be considered, and co-design methods utilised, where researchers collaborate with CMOs to develop intervention content and implementation strategies with staff and consumers.