January 2009

Dear Mental Health Care Provider:

We at the Bureau of Behavioral Health are focusing on improving the physical health of people with serious mental illness in 2009. We are responding to growing research that suggests that people with serious mental illness have more medical problems and die younger by 10-25 years than people without serious mental illness. Research also suggests that mental health care providers can intervene to improve this situation. Our efforts are consistent with a national effort to improve community mental health practices to promote wellness in people with serious mental illness.
Based on the current state of knowledge, we recommend the following:

1. Engage and support patients in proactive healthy diet and exercise behaviors.
2. Address smoking status on a regular basis. Offer support, referral and treatment for smoking cessation.
3. Discuss and weigh potential health risks and mental health benefits of each medication treatment option with patients (and their family/support person if desired).
4. When prescribing antipsychotic medication, systematically monitor patients for cardiometabolic status at APA-recommended intervals.
5. Utilize antipsychotic monotherapy (one antipsychotic medication rather than combination treatment with two or more agents) unless psychosis symptoms do not respond to evidence based treatment strategies (including clozapine) and the combination confers clear benefits that outweigh the potential risks (including cardiometabolic risks).

Follow the accompanying links to a review and recommendations regarding health behaviors and antipsychotic medications for prescribes with references for more information, an information sheet for consumers and families, and a health tips sheet for consumers and families. You will also find a copy of the ADA/APA guidelines for monitoring cardiometabolic side effects of antipsychotic medication. Please incorporate these recommendations into your current practice, read the linked documents, and discuss/distribute the information sheet and tips sheet with consumers and families with whom you work.

Best wishes for a healthy 2009!

Mary Brunette, M.D.
Medical Director
Bureau of Behavioral Health
New Hampshire Department of Health and Human Services