InSHAPE: A Health Promotion Program for People with Serious Mental Illness
Researchers at Dartmouth are addressing one of the greatest health disparities in our nation. We collaborate with community mental health centers, community based organizations, and fitness centers to provide InSHAPE®, an evidence-based health promotion program for individuals with serious mental illness (SMI). SMI includes: schizophrenia and schizoaffective disorder, major depression, and bipolar disorder.
National Impact of Serious Mental Illness
Approximately 1 in 25 adults in the US — 9.8 million, or 4.0% —experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities (1).
Impact of Serious Mental Illness in New Hampshire
- In New Hampshire, about 49,000 adults aged 18 or older (4.7%) experience a serious mental illness in a given year (2).
- About 50% of NH Medicaid eligible adults have a mental health diagnosis, compared to about 17% in the private sector (3).
Burden of Disease in persons with SMI
- Smoking and obesity continue to affect 50 to 80% of persons with serious mental illness (4-6).
- More than 68% of adults with a mental disorder have at least one general medical disorder (7).
- Persons with comorbid mental and medical conditions cost employers twice as much as those with either condition alone (7).
The InSHAPE Program
This program provides fitness and nutrition coaching, gym memberships, and smoking cessation counseling to improve cardiovascular health in people with serious mental illness.
- Half of InShape participants achieve reduced cardiovascular risk by achieving clinically significant weight loss or improved fitness (8).
- The improvements are sustained over and 18-month follow-up.
- Includes a component to enhance motivation to quit smoking using an novel electronic decision support system.
Reach of InSHAPE
- InSHAPE is being implemented in 74 agencies across 28 states.
- This includes all 10 community mental health centers in New Hampshire.
1. National Alliance on Mental Illness (2017). Mental Health By The Numbers. Available from https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
2. Substance Abuse and mental Health Services Administration. Behavioral Health Barometer: New Hampshire, 2015. HHS Publication No. SMA-16-Baro-2015-NH. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015. Available from https://www.samhsa.gov/data/sites/default/files/2015_New-Hampshire_BHBarometer.pdf
3. New Hampshire Center for Public Policy Studies (2007). Adults and Mental Health in New Hampshire. available from http://www.nhpolicy.org/UploadedFiles/Reports/amh_prevalence_august_2007.pdf
4. Diaz FJ, James D, Botts S, Maw L, Susce MT, De Leon J. Tobacco smoking behaviors in bipolar disorder: a comparison of the general population, schizophrenia, and major depression. Bipolar disorders. 2009;11(2): 154-165.
5. Ziedonis D, Williams JM, Smelson D. Serious mental illness and tobacco addiction: a model program to address this common but neglected issues. The American journal of the medical sciences. 2003;326(4):223-230.
6. Compton MT, Daumit GL, Druss BG. Cigarette smoking and overweight/obesity among individuals with serious mental illness: a preventive perspective. Harvard Review of Psychiatry. 2006;14(4):212-222.
7. The Probert Wood Johnson Foundation. Research Synthesis Report No. 21. Mental disorders and medical comorbidity. (2011). Available from https://www.integration.samhsa.gov/workforce/mental_disorders_and_medical_comorbidity.pdf .
8. Bartels SJ, Pratt SI, Aschbrenner KA, Barre LK, Naslund JA, Wolfe R, Xie H, McHugo GJ, Jimenez DE, Jue K, Feldman J, Bird BL. Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes. Am J Psychiatry. 2015 Apr; 172(4): 344-352.