April 12, 2017

Life Goals: A Strategy for Wellness for Persons With Serious Mental Illness

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Amy M. Kilbourne, PhD, MPH

VA Center for Clinical Management Research and University of Michigan Medical School, Ann Arbor​​​


Tom is 52 years old, single, and has cycled through a number of construction jobs since being hospitalized for chronic major depressive disorder and suicidal ideation 3 months ago. His primary mode of treatment has been pharmacologic, including some psychotropic medications that also help him cope with pain and insomnia. He jokes with his psychiatrist that the 6-pack of beer he enjoys each day has been his major form of therapy since his discharge from the Army several years ago and, more recently, his divorce from his wife of 15 years. Since Tom’s last psychiatric hospitalization, he has gained 35 pounds, taking a toll on his knees and other joints and making it even more difficult for him to find a job in construction.

Tom’s psychiatrist has every reason to worry—studies suggest that persons with chronic mental disorders, including major depression, bipolar disorder, and schizophrenia, die from natural causes 3–26 years younger than the general population and, from unnatural causes, 8–41 years younger. The primary causes of mortality among these individuals are natural causes, many of which are preventable—the most common being cardiovascular disease, which can be exacerbated by unhealthy behaviors including smoking, poor nutrition, and sedentary lifestyle. These risk factors cannot be reduced through medication alone and require a deeper connection between clinicians and those suffering from mental disorders.

In our recent article in The Journal of Clinical Psychiatry, my colleagues and I showed that the Life Goals program—a relatively brief, manualized intervention based on the collaborative care model—improved physical health and decreased cardiovascular disease risk factors compared with usual care among patients with chronic mental disorders. Developed more than 20 years ago, Life Goals was originally designed to improve psychiatric outcomes for persons with bipolar disorder. The program was updated to include health behavior change strategies that also improved physical health and decreased cardiovascular disease risk for individuals with a wide range of chronic mental disorders including depression, bipolar disorder, and schizophrenia. Delivered in group sessions or individual contacts, Life Goals focuses on stigma reduction through personal goal-setting. Patients learn achievable health behavior change strategies focused on physical activity, sleep, smoking cessation, and healthy eating that have also helped individuals manage their psychiatric symptoms. Ultimately, Life Goals helps people maintain a vision toward achieving their personal goals and provides practical day-to-day support on wellness goals over time.

Life Goals is evidence-based; multiple randomized trials have demonstrated its effectiveness, and Life Goals is listed on the Substance Use and Mental Health Services Administration (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP). The active ingredient in Life Goals is unique—it helps individuals match their personal goals (eg, improve personal relationships, get a job, do better in school) to individualized health behavior change strategies that also help them cope with their mental health symptoms. In essence, Life Goals helps individuals get beyond the patient role by promoting achievement of personal goals through collaborative care and self-management; the individual may take on the role of the “athlete” and the Life Goals provider the “coach.” With this scalable, flexible program that is suitable across different treatment settings and populations, our next step is to increase access to Life Goals through development of state-of-the-art information technology for consumers and providers as well as through inclusion in health care reimbursement models that support collaborative care and patient-centered health home models.

At his next routine follow-up visit, Tom’s psychiatrist encouraged him to consider participating in the Life Goals program. When he attended his first group session, Tom was delighted to discover that the group included veterans like himself who also had chronic mental disorders and were facing similar personal struggles. The leader of the group helped Tom not only learn about his condition but also reflect on how he might better manage his mental and physical health to lose weight and avoid severe mood relapses. At the end of the group sessions, Tom completed a wellness plan to improve his health, setting a goal of healthier eating as his primary area of focus. Each month, Tom checked in with his Life Goals coach by phone and internet and worked through the challenges of changing his eating habits. After 3 months, Tom had lost 10 pounds and had more energy. Encouraged, Tom worked with his VA health care providers to develop a plan to reduce hazardous drinking, and he has scheduled several job interviews.

Financial disclosure:Dr Kilbourne is the co-author of the workbook Overcoming Bipolar Disorder: A Comprehensive Workbook for Managing Your Symptoms & Achieving Your Life Goals (New Harbinger Publications, Inc, 2008) and receives publication royalties.​​

Category: Bipolar Disorder , Depression , Medical Conditions , Schizophrenia
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