Sign up for alerts

Autumn 2009 | Vol 13 No 1

Issues and trends

Nutrition plays growing role in mental health treatment

By Kim Goggins

When Michael Alzamora’s psychiatrist told him the results of his fasting blood test in February 2008, he knew he had to take immediate action. His triglyceride level was high, and he knew that as someone with schizophrenia taking one of the newer antipsychotic medications, he was at risk for substantial weight gain, high cholesterol and diabetes.

Alzamora immediately started doing some research and took steps to live healthier. “My first six weeks of changing my diet were ‘do or die,’” he recalls. “I noticed that I was highly addicted to sugar, as well as fatty foods. I used to sit for many hours watching television, drinking a litre of cola with sweet pastries. Other times, I would eat enormous amounts of ice cream, also while watching television. For breakfast and lunch, I would have coffee with a lot of sugar and donuts.”

Alzamora enlisted the help of a registered dietitian who counselled him on nutrition and provided moral support. She was able to direct him to the right path and help him stay the course – and it worked. During the first two months, he dropped nine pounds and two waist sizes. “I looked and felt healthier. Mentally, I felt strong and confident, and I lost a lot of fat in my abdomen,” says Alzamora, who also began to exercise regularly and take nutritional supplements.

Seven months after Alzamora began to make healthy changes with the help of his dietitian, his blood levels were within normal range and he was running 10 km, three days a week. In May, he completed a half-marathon, running on behalf of the Schizophrenia Society of Ontario. “Physical fitness in combination with good nutrition is crucial to a healthy lifestyle,” he says. “I chose running because it makes me physically fit and the long training runs make me mentally strong.”

Through nutritional advice and counselling, nutritional screening and assessment, health promotion and disease prevention strategies, dietitians play an important role at psychiatric facilities and on primary health care teams, which are seeing a growing number of people with mental health issues.

When clients embrace the healthy changes she suggests, registered dietitian Monique Sonier (not Alzamora’s dietitian) says it’s very rewarding. At the Restigouche Hospital Care Center in Campbellton, New Brunswick, she helps clients by encouraging the use of a pedometer to tally physical activity and to make healthier food choices as part of the psychiatric hospital’s 12-week NutriAction Program. “We are very proud of our clients. It’s very rewarding to see their motivation,” she says. “Even if some of them don’t lose weight immediately, we hope they will be more motivated to do some activities and take care of their health. In the long run, they will lose weight and have good eating habits.”

Advocacy for clients with medical conditions to receive more social assistance funding to purchase healthy food is also an important role of the dietitian. “They might be able to get a little more funding than if they just completed the required form through their family physician because dietitians may be able to go through the form more thoroughly than a GP could, because of time constraints,” says Elke Sengmueller, a clinical dietitian at the Centre for Addiction and Mental Health (CAMH) in Toronto. “Often clients aren’t aware that the funding exists so I’m in a position to let them know and to get that form.”

To highlight this important role and provide guidance to dietitians, Dietitians of Canada has created a toolkit, in conjunction with the Canadian Collaborative Mental Health Initiative (CCMHI), to be used by dietitians who work with mental health clients in a general practice setting. The Role of Dietitians in Collaborative Primary Health Care Mental Health Programs (PDF) is also a resource for other members of the primary health care team to help them understand the importance of dietitians to the care of clients with mental illness.

“Dietitians now working in primary health care settings, as well as family physicians, are starting to identify more patients who may have mental health issues,” explains Linda Dietrich, executive director with Dietitians of Canada for central and southern Ontario. “This toolkit is a resource they can use to see the kinds of nutritional issues that may come up, and they can even go further in the therapies they might provide as part of the team.”

Since the toolkit was released in 2006, the number of dietitians in primary health care settings across Canada has grown, especially in Ontario where there has been a move to the family health team model, notes Dietrich. “Most family health teams in Ontario employ a dietitian, but it’s based on community needs. It’s not a given that every family health team will have a dietitian, but if the community requires that kind of counselling and prevention, very often dietitians are employed.”

However, lack of health care funding and a shortage of registered dietitians make it difficult for dietitians to spend the time needed with clients. Many areas face waiting lists and accessibility issues. “It would be ideal if every community mental health team had access to a dietitian on site,” says Jan Palmer, a clinical dietitian who says there is only a 1.5 full-time equivalent registered dietitian position for the entire Capital

District Health Authority in Nova Scotia, which includes several facilities that provide mental health programs. “Right now, due to the lack of resources, the community health teams in our district refer clients to us. So accessibility can be an issue because travel is a barrier for many clients. It would be great for community teams to have a dietitian on site to be more accessible for clients. We’re working towards that.”

It’s a goal shared by the Dietitians of Canada, which has become more involved in mental health issues. Along with its collaboration on the CCMHI toolkit, the association has developed the Addiction, Mental Health and Eating Disorder Network (AMHED) as a way for member dietitians to share information and resources. The Dietitians of Canada also contributes to the field of nutrition in mental health through speakers, seminars and literature. “We would have always done those things, but as a result of the CCMHI project it’s become an important issue for the association,” says Dietrich. “We have directed funding to make sure we have representation at national meetings and to ensure we contribute to the Mental Health Commission of Canada.”