Promoting Healthy Eating within a Forensic Mental Health Setting

1
Promoting Healthy Eating within a Forensic
Mental Health Setting Frances Waddell (Lead
Dietitian), Joy Farquharson (Nutrition
Champion), Martin Henry (Facilities Manager)
Lois Collins (Catering Analysis Dietitian). The
State Hospital, Carstairs, Lanark

• Background
• The State Hospital is a high secure forensic
  mental health hospital situated half way between
  Edinburgh and Glasgow. All patients are male and
  detained under the Mental Health (Care and
  Treatment) Scotland Act 2003 or other associated
  legislation.
• The average age of patients is 41 years (range 18
  - 69) and they stay approximately 8 years (range
  3 month - 40 years).
• Obesity rates are rising in Scotland with over
  60 of the population being overweight or obese
  in 2008 (1). At the State Hospital (TSH) in 2008
  over 80 of patients were overweight or obese. In
  preparation for the QIS Food, Fluid and Nutrition
  review a targeted approach was implemented to
  improve patients nutritional status.
• The challenges around physical health are multi
  factorial and relate to
• Overweight and obesity
• Poor dietary choices
• Diabetes
• Metabolic syndrome
• Hyperlipideamia
• Lack of physical activity
• Smoking
• Anti psychotic medication.

• Ward/nursing based interventions
• Development, validation and role out of a unique
  nutritional screening tool.
• Generic care plans for nutritional care
• Identification and training for Nutrition Link
  Nurses (NLN) on all wards
• Observations of care meal specific.
• A tiered approach to staff training around Food,
  Fluid and nutrition.

• Catering
• Implementation of standard recipes
• A review of patient menus to comply with Food in
  Hospitals (2) including nutritional analysis.
• Implementation of 2 x three week menu cycles ,
  incorporating the FSA traffic light coding.
• Update Patient and Staff Guides to Catering
• Production of photographic menus
• Revision of meal ordering system.

Aim To review, develop and implement changes in
practice (dietetics, catering and nursing/ward
based initiatives) to improve healthy eating in a
high secure forensic mental health setting for
patients during 2009.
Outcomes and Results Patients have supported the
revised menus and have been actively involved in
the menu development process. There is an
ongoing monthly catering patient partnership
group which provides an opportunity for feedback
and discussion on all patient related food
matters. An annual catering audit commencing in
2006 has demonstrated an increase in patient
satisfaction with the meals provided. Over 40 of
staff have undertaken nutritional screening
training and since August 2009, all patients have
been nutritionally screened on admission, and 75
of patients have been screened at their annual
review. Dietitians completed 85 of annual
reviews during 2009 Obesity rates decreased to
77 in December 2009
Methodology In order to fulfil an integrated
hospital wide approach to improving healthy
eating, programmes were developed and implemented
under three broad services.

• Dietetics
• Proactive Dietetic assessments and instigation of
  annual reviews (from April 2008) in line with CPA
  approach
• Biannual anthropometric collection (June and
  December)
• Input to discharge planning
• Patients weekly slim and trim group
• Patients Healthy Living Group a dietetics,
  psychology and physical activity intervention
  group.

Conclusions A multidisciplinary approach to
improving nutrition has been demonstrated across
the Hospital with internal and external
recognition. Services have worked well together
and the priority for improving nutrition and
tackling obesity is on route to being achieved.
This healthy eating approach has resulted in the
hospital receiving the NHS Health Facilities
Scotland Innovations award in 2009.
References 1. The Scottish Government (2008) The
Scottish Health Survey, Edinburgh. 2.Scottish
Government (2008) Food in Hospitals National
Catering and Nutritional Specification .