MENTAL HEALTH

‘In 1992/93 the provision of treatment and services to mental health patients cost the NHS £1.93 billion.’

improved self-esteem. It is therefore very important that realistic and achievable goals are set and ‘rewarded’. To begin with the intervention may simply start with two short 10-minute walks a week and then gently progress ● The exercise intervention should be fun and enjoyable. Again this means listening carefully to what the patient ‘wants’ to do and sometimes moderating what you think they ‘should’ do. Long-term adherence to exercise intervention is a problem and therefore it can be helpful to regularly review and restructure the exercise recom- mendation. Practitioners should be good

resource investigators and have a good up- to-date knowledge about what is going on in local leisure centres, conservation pro- jects and self-help groups. It is only by offering people a varied and changing menu of physical opportunities that we will promote life long activity

A word of caution Everyone has the right to make an informed choice not to exercise or be more active. When working with patients with mental health problems it is important to be sensitive to their right to choose and make decisions. It should also be noted

that while there is lot of research on the relationship between mental health and exercise, less has been published on the most effective types of exercise interven- tions for specific conditions or case studies exploring both the experience of the patient and the practitioner. While the new HEA guidelines for practice are a significant step forward more work is needed and is taking place.

Undoubtedly there are patients who, because of their conditions and current form of treatment, may be unsuitable for exercise interventions. For example, care needs to be taken that some patients do not become obsessive about their exercise patterns or that exercise becomes associ- ated with weight loss and concerns about calorie intake. These concerns highlight the importance of the needs analysis and the sharing of information between health and exercise practitioners.

Dr Andy Smith is the head of the School of Sports Science and Psychology at the College of Ripon and York St. John. He is also chairman of the British Association of Sport and Exercise Sciences (BASES).

References 1. Burdens of disease. NHS Executive 1996 2. Statistics of prescription dispensed in FSHA’s, England 1985-95. Department of Health 3. Biddle, SJH. Exercise and psychological health. Research Quarterly for Exercise and Sport 1995;66:292-297 4. Morgan, WP and O’Connor, PJ. Exercise and mental health. Exercise Adherence: Its Impact on Public Health, Dishman, R.K. (Ed). Champaign, IL: Human Kinetics 1988 5. Bird, SR Smith, A and James, K. Exercise Benefits and Prescription. Stanley Thornes 1988

Resources ● For more information on the consensus

statements contact Trudi Grant at the Somerset Health Authority on 01823 333491 ● For information on the HEA practition- er guide contact Gary Ward at the HEA on 0171 413 1991 ● Information on Accredited Sport and Exercise Scientists from the British Association of Sport and Exercise Sciences. Telephone 0113 289 1020

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