The evidence

Equally Well is informed by an evidence review of published and unpublished literature to understand the extent of the problem, the drivers and the interventions which have been shown to be effective.

View an infographic showing an overview of the evidence.

Key findings

New Zealand’s situation is very similar to other relatively wealthy countries.

People with a mental illness and/or addiction die much earlier than their counterparts in the general population, with a two to three times greater risk of premature death (defined as dying before the age of 65). Two-thirds of this premature mortality is due to cardiovascular disease, cancer and other physical illnesses.

Rates of metabolic syndrome, viral and oral health problems, respiratory diseases, diabetes and cardiovascular disease are higher for this population group.

There’s a significant association between anti-psychotic use and risk of diabetes.

There are notable gaps in research, for example, in relation to effective interventions for Māori and Pacific populations.

Drivers

Drivers of relatively poor health outcomes include:

  • greater exposure to known risk factors – low socio-economic status, high rates of smoking, alcohol and other drug use, reduced physical activity and poor nutrition
  • psychotropic medication effects – their contribution to obesity, metabolic syndrome, cardiovascular disease and type 2 diabetes
  • reduced access to and quality of healthcare – due to financial and structural barriers, stigma and discrimination.

Solutions

Promising interventions include changes at a systems level and at the individual level (mainly trying to reduce exposure to known risk factors).

At a systems level, health care services need to increase integration between mental health and physical health care, and develop shared care arrangements between primary and secondary care.

Clinical guidelines need to clearly identify roles and responsibilities in relation to monitoring and managing physical health care.

Promising behaviour change interventions combine personalised support for smoking cessation, increasing physical activity, improving nutrition and general wellbeing. Interventions based on good evidence, which are service-user directed and work towards achieving long-term sustainable lifestyle changes, have been shown to be successful at an individual and small group level. However no simple or single approach has demonstrated long-term effectiveness.

Nutrition and exercise programmes that include the following characteristics are likely to have greater success.

  • Build on existing therapeutic alliance.
  • Incorporate cognitive and behavioural strategies.
  • Combine exercise, dietary counselling and health promotion.
  • Have realistic and/or modest outcome targets.
  • Are flexible in accommodating individual needs and differences.
  • Have a long-term approach and provide on-going support beyond the initial intervention
  • Include group and/or social components.
  • Acknowledge and take into account possible barriers to participating in such programmes.
  • Have a peer support component alongside staff support and active participation.