Promoting Healthy Eating within a Forensic Mental Health Setting

1. Promoting Healthy Eating within a Forensic Mental Health Setting Frances Waddell (Lead Dietitian), Joy Farquharson (Nutrition Champion), Martin Henry (Facilities Manager) & Lois Collins (Catering Analysis Dietitian). The State Hospital, Carstairs, Lanark • Background • The State Hospital is a high secure forensic mental health hospital situated half way between Edinburgh and Glasgow. All patients are male and detained under the Mental Health (Care and Treatment) Scotland Act 2003 or other associated legislation. • The average age of patients is 41 years (range 18 - 69) and they stay approximately 8 years (range 3 month - 40 years). • Obesity rates are rising in Scotland with over 60% of the population being overweight or obese in 2008 (1). At the State Hospital (TSH) in 2008 over 80% of patients were overweight or obese. In preparation for the QIS Food, Fluid and Nutrition review a targeted approach was implemented to improve patients nutritional status. • The challenges around physical health are multi factorial and relate to; • Overweight and obesity • Poor dietary choices • Diabetes • Metabolic syndrome • Hyperlipideamia • Lack of physical activity • Smoking • Anti psychotic medication. • Ward/nursing based interventions • Development, validation and role out of a unique nutritional screening tool. • Generic care plans for nutritional care • Identification and training for Nutrition Link Nurses (NLN) on all wards • Observations of care – meal specific. • A tiered approach to staff training around Food, Fluid and nutrition. • Catering • Implementation of standard recipes • A review of patient menus to comply with “Food in Hospitals” (2)including nutritional analysis. • Implementation of 2 x three week menu cycles , incorporating the FSA traffic light coding. • Update Patient and Staff Guides to Catering • Production of photographic menus • Revision of meal ordering system. Aim To review, develop and implement changes in practice (dietetics, catering and nursing/ward based initiatives) to improve healthy eating in a high secure forensic mental health setting for patients during 2009. Outcomes and Results Patients have supported the revised menus and have been actively involved in the menu development process. There is an ongoing monthly catering patient partnership group which provides an opportunity for feedback and discussion on all patient related food matters. An annual catering audit commencing in 2006 has demonstrated an increase in patient satisfaction with the meals provided. Over 40% of staff have undertaken nutritional screening training and since August 2009, all patients have been nutritionally screened on admission, and 75% of patients have been screened at their annual review. Dietitians completed 85% of annual reviews during 2009 Obesity rates decreased to 77% in December 2009 Methodology In order to fulfil an integrated hospital wide approach to improving healthy eating, programmes were developed and implemented under three broad services. • Dietetics • Proactive Dietetic assessments and instigation of annual reviews (from April 2008) in line with CPA approach • Biannual anthropometric collection (June and December) • Input to discharge planning • Patients weekly “slim and trim” group • Patients Healthy Living Group – a dietetics, psychology and physical activity intervention group. Conclusions A multidisciplinary approach to improving nutrition has been demonstrated across the Hospital with internal and external recognition. Services have worked well together and the priority for improving nutrition and tackling obesity is on route to being achieved. This healthy eating approach has resulted in the hospital receiving the NHS Health Facilities Scotland Innovations award in 2009. References 1. The Scottish Government (2008) The Scottish Health Survey, Edinburgh. 2.Scottish Government (2008) Food in Hospitals National Catering and Nutritional Specification .