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Re-shaping the status quo

March 1, 2009
by Erin L. George
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A mental health agency motivates consumers to take charge of their health

Mental health workers across the nation are no strangers to funerals. In fact, it is hard to find people in the field who haven't attended a client's funeral. Some even have accepted this as a “normal” part of working in mental healthcare.

But for Ken Jue, CEO of Monadnock Family Services (MFS) in Keene, New Hampshire, “normal” and the status quo were not good enough. Jue decided when attending a client's funeral that something needed to be done to make more of a difference in the lives of the mentally ill.

People with severe mental illness in the public system die an average 25 years earlier than the general population because of “lifestyle-related” chronic conditions. “For mental healthcare providers, it is morally indefensible to accept the status quo and do nothing to alter this situation,” Jue says.

Jue and MFS staffers put their heads together a few years ago to develop an innovative program called In SHAPE that is now receiving national attention and, more importantly, seeing results.

In SHAPE is designed to reverse or remove the factors that can contribute to early death among the mentally ill. The program brings together a broad range of community organizations concerned with health, exercise, and nutrition to teach participants that physical health is central to their overall quality of life.

In SHAPE now serves more than 150 participants and offers individuals with mental illness:

  • personal health mentors to accompany them up to three times a week to activities within the community and at the local gym;

  • access to fitness activities provided by program partners;

  • nutrition education;

  • smoking-cessation support;

  • medical liaison support; and

  • encouragement and support for receiving regular medical checkups and actively managing chronic health conditions.

A comprehensive research component affiliated with Dartmouth College rounds out the program's design, allowing In SHAPE's effectiveness to be evaluated and potentially replicated in other communities.

Strong local support

In SHAPE was established with support from the local community and matching funding from the Robert Wood Johnson Foundation (RWJF). According to Polly Seitz, director of RWJF's Local Initiative Funding Partners program, MFS's strong backing from funders, partners, and community leaders from the onset gave the program proposal a lot of credibility. These partners include community foundations, businesses, and organizations that provide resources, services, and expertise to the program, including the Monadnock United Way; the Keene Family YMCA, where participants workout; and the Dartmouth-Hitchcock Psychiatric Research Center.

This collaboration has helped people with mental illness integrate into the community and feel valued, welcomed, and accepted, according to program staff. The natural peer network that developed among participants reinforces this integration.

While the concept seems relatively simple, it has had its share of challenges, such as finding funding initially as well as developing partners' interest in the project and helping them understand the crossover in their respective missions. Surprisingly, we had anticipated getting consumers to sign up for the program would be a challenge, but it wasn't.

In SHAPE's commitment and attention to subtle details create the magic to make this program effective, says In SHAPE Director Gail Williams. Key to the program's success are its essential elements (sidebar), she explains.

“Providers of mental health services around the United States and in other countries are watching the clients they work with gain weight, become diabetic, develop cardiovascular disease and other chronic conditions,” Williams notes. “In SHAPE provides a solution to this dire problem. It is a model for incorporating health promotion into mental health treatment.”


To gauge the program's success, In SHAPE participants are interviewed six times during the program, whose length is determined on a case-by-case basis (most are in the program for about three years). The first interview gives evaluators a baseline measure of the participant's mental and physical status and readiness-to-change behaviors. Following that initial interview, participants are interviewed at 3-, 6-, 9-, 12-, and 18-month intervals.

Results from a pilot research study1 conducted by the Dartmouth Psychiatric Research Center suggest that In SHAPE has strong promise, and it has attracted funding from the Centers for Disease Control and Prevention and the National Institute of Mental Health for further research.

The preliminary research shows that people with severe mental illness participating in In SHAPE are experiencing improved physical and mental health. After nine months in the program, participants:

  • significantly increased the number of hours they reported exercising per week;

  • significantly increased their overall activity and their participation in vigorous activities;

  • were significantly more satisfied with their physical fitness; and

  • reported having significantly greater self-efficacy, or confidence, in social situations.

In addition:

  • Approximately 20% of participants reduced their waist circumference by 10 cm or more or lowered their weight by 10 lbs or more.

  • 33% with hypertension reduced their systolic blood pressure by 10 mmHg or more.

  • Approximately 25% with depression showed a 50% or greater symptom reduction.