Health Physicals: A health physical is the physical evaluation of an individual, including an age and gender appropriate history, examination and the ordering of laboratory/diagnostic procedures as appropriate. This service is provided by a physician, nurse practitioner or other medical professional acting within scope of practice. (NYS OMH 14 NYCRR Part 599).
Health Screening: Initial gathering and assessing of information concerning the individual’s medical history and current physical health status (including physical examination and determination of substance use) for purposes of informing an assessment and determination of its potential impact on a individual’s mental health diagnosis and treatment and the need for additional health services or referral. (NYS OMH 14 NYCRR Part 599).
Health Monitoring: Health monitoring is the continued measuring of specific health indicators associated with increased risk of medical illness and early death. For adults, these indicators include, but are not limited to, blood pressure, body mass index (BMI), and smoking status. This service is provided by a physician, nurse or other medical professional acting within scope of practice. (NYS OMH 14 NYCRR Part 599).
Increased morbidity and mortality for individuals with serious mental illness is largely due to risk factors including:
1. Medications; especially a-typical anti-psychotic medication
Selected side effects of commonly used antipsychotic medications: http://www.psychiatryonline.com/popup.aspx?aID=46267
2. Tobacco Use/History
3. Substance Use/History
4. Obesity
5. Sedentary Lifestyle
6. Poor Nutrition
7. High Blood Pressure
8. High Blood Glucose or HbA1C
9. Poor Lipid Profile
10. Personal History of Diabetes, Hypertension, Cardiovascular Disease
11. Family History of Diabetes, Hypertension, Cardiovascular Disease
12. Inadequate access to primary care
13. Lack of social supports
The following are best practice guidelines. If an individual falls outside the recommended guidelines, it is recommended that they follow up with their medical provider to determine the appropriate action plan. It is also strongly encouraged that behavioral health providers educate and encourage individuals to self-monitor these indicators. Those indicators with an asterisk * are required by NYS OMH 14 NYCRR Part 599 (Clinic Treatment Programs).
Heart Health Indicators
Monitor Frequency
Goal/ Recommendation
Resources
Body Mass Index (BMI)*
BMI should be evaluated at baseline & every 3 months thereafter
Individual may need to be monitored more frequently if they are taking antipsychotic medications; especially when medication is initiated, changed and/or when an individual
experiences significant
weight gain
BMI grid (see toolkit):
Desired range between 18.5 and 25
BMI should be evaluated at baseline & every 3 months thereafter
Individual may need to be monitored more frequently if they are taking antipsychotic medications; especially when medication is initiated, changed and/or when an individual experiences significant weight gain
Desired range:
Women:less than 35 inches
Men: less than 40 inches
Counseling Points: A 3 part series focused on Breaking Barriers & Implementing
Changes when working with those who are tobacco dependent and mentally ill
(published by the American Psychiatric Nurses Association, 2010) http://www.apna.org/i4a/pages/index.cfm?pageid=3578
Testing should include baseline, at 12 weeks and annually.
Individuals taking antipsychotics and/or have glucose elevation, frequency of monitoring may vary. Important to coordinate with primary care physician.
Individuals with diabetes should have their A1C tested every three months. After consultation with their doctor, they may choose to have A1C tested less frequently if levels are consistently in the desired range, but not less often than twice a year.
A1C:
Under 5.7%- normal
5.7%-6.4%- pre-diabetes
Over 6.5%- diabetes
Fasting Blood Glucose:
Under 100mg/dl- normal
100mg/dl-126/mg/dl- pre-diabetes
Over 126mg/dl-diabetes
Oral Glucose Tolerance Test: Under 140mg/dl-normal
140mg/dl-200mg/dl-pre-diabetes
Over 200mg/dl- diabetes
Baseline, every 3 months and annually. If this is a current goal, monitor more frequently.
For those under
age 65:
Moderate intense cardio 30 minutes daily, 5 days a week
OR
Vigorous intense cardio 20 minutes daily, 3 days a week
AND
8-10 strength-training exercises, 8-12 repetitions of each exercise twice a week
