TODAY’S AGENDA

Background: diet and mental health connections

Project overview: “Setting the Research Agenda”

Research priorities

Stakeholder perspectives

Next steps: Moving the research agenda forward

Questions / discussion

Webinar participants

Are you currently involved in any research projects around nutrition and/or mental health?

Yes: 1%

No: 99%

“No, but I’m interested ingetting involved…”

Job title?

Dietitian/Nutritionist Nurse Program Manager Researcher Health Promoter Psychiatrist Student Other…

Background

What’s the connection between diet and mental health?

Healthy diet for prevention Reduced risk of developing chronic physical and mental health conditions (e.g., depression, anxiety)

Nutrition as therapyImproved cognition, better self-management of mental health condition, and improved overall occupational, social, and psychological function, as an adjunct to psychiatric medications

Collaborative mental health promotion programsBenefits: enhanced social inclusion, self-reliance, food security, and healthy body image; reduced health and social inequities

Mental health continuum1

Optimal Mental Health

Thriving (without

condition)

Surviving (with

condition)

No Condition Mental Health Condition

Poor Mental Health1Keyes CLM (2002). Journal of Health and Social Research, 43: 207-222.

1 2

3 4

Thriving (with

condition)

Surviving (without

condition)

Nutrition Strategies for Optimal: • Cognition• Behaviour• Emotions

Nutrition Strategies for: • Symptom control• Remission• Functional recovery

Nutrition and mental health: The evidence

Historical Evidence

All nutrients indirectly or directly affect mental health

Nutrient deficiencies mental health effects

Biochemical and Physiological Research

Genetics, inflammation, gut microbiota, oxidative/nitrosative damage, mitochondria

Nutrients and bioactive compounds

Epidemiology Studies

Cross-sectional: diet patterns, nutrients, food security

Longitudinal: diet patterns and depression, childhood hunger and late adolescent/early adulthood depression/suicide ideation, prenatal nutrition and mental health outcomes of children

Interventions

Diet, natural health products, intuitive eating

Community and Practice Based Research?

Sample studies: Sánchez-Villegas A et al.: Arch Gen Psychiatry 2009; 66:1090; PLoS One 2011;6:e16268; Public Health Nutr 2012;15:424. Jacka FN et al.: Am J Psychiatry 2010; 167:305; Psychother Psychosom 2012;81:196; PLoS ONE 2014 9(1): e87657. Davison KM et al.: Can J Psychiatry 2012; 57(2):85-92; DC Nutrition & Mental Health Role Paper

Poll

What type of research is of interest to you?

Mental health and nutrition programming

Canadian Community Mental Health System

Common Features:1. Mix of institution-based services

2. Universal coverage: hospital, physician and voluntary sector

3. Regionalization differentiation of services

Concepts: 1. Team-based care: access, continuity, and integration

2. Recovery movements: peer support, self-determination, respectful, collaborative, consumer-operated programs

3. Rehabilitation: recognition of historical neglect, individualized supports and strengths case management

4. Best practices: ongoing training and high quality services

5. Participatory

Programming considerations

Draw upon established theories and frameworksSocial Cognitive Theory, Transtheoretical Model, Chronic Condition Self Management

Nutrition and food educationMindful eating, motivational interviewing, nutrition/food literacy, cognitive adaptive training

Determinants of healthSocial and economic environment (e.g., life stage, food insecurity)Physical environment (e.g., built food environment, food system policies)Person’s health practices and coping skills

Engaging diverse stakeholders in programming and evaluationNutrition and mental health professionalsIndividuals with experiential knowledge

History: CMHA Ontario and DC connection

Minding Our Bodies (2008-2013) www.mindingourbodies.ca

CMHA Ontario capacity-building project

Dietitians not integrated into community mental health services

Need for further evidence on the relationships between mental health, food security, social inclusion, and community-based healthy eating programs

Dietitians of Canada role paper (2012)www.dietitians.ca/mentalhealth

“Promoting Mental Health through Healthy Eating and Nutritional Care: The Role of Dietitians”

Identified gaps in knowledge and areas needing further research relevant to dietetics and community mental health

Project overview

Critical Research in Health and Healthcare Inequities (CRiHHI) Research Unit

Dietitians and Community Mental Health:

Setting the Research Agenda (2013-2014)

GOAL: To develop a Canadian research agenda for nutrition and community mental health with input from a broad range of stakeholders

Why a research agenda?

1. Guide health research investments and knowledge exchange activity

2. Facilitate partnerships and collaborations between dietitians and the community mental health sector for research, knowledge exchange and program delivery

3. Increase community access to quality nutrition services for people with mental health conditions

Stakeholder engagement

The best predictor of research use is early and continued involvement of relevant decision-makers and stakeholders*

We intentionally consulted a broad array of stakeholders:

anyone living with a mental health condition(s)

family members of someone living with a mental health condition(s)

service providers (e.g., case managers, support workers, nurses,occupational therapists, dietitians, social workers, psychiatrists)

program developers (nutrition and/or mental health)

public policy decision-makers

researchers

advocates

*Caplan 1979; Huberman 1994; Landry, Amara, and Lamari 2001; Lavis et al. 2002; Lomas et al. 2003; Rich 1991; Weiss 1997; Wingens 1990

Collaborative multi-step consultation process

Priority-Setting Workshop February 2014 n = 16 participants

Key-Informant Interviews and QuestionnaireDecember 2013-January 2014 n = 9 / n = 63 (questionnaire)

National Stakeholder SurveySeptember-October 2013 n = 811 respondents

Expert Advisory CommitteeJune 2013-March 2014 n = 9 members

Scoping Review: Research and InitiativesJuly 2013

CO

NSE

NSU

S B

UIL

DIN

G

Survey respondents (n = 811)

STAKEHOLDER CATEGORY n (%)

Service Provider 433 (54)

Family Member 344 (43)

Registered Dietitian 299 (37)

Lived Experience 244 (30)

Advocacy 135 (17)

Volunteer 120 (15)

Researcher 109 (14)

Manager/Director 70 (9)

Public Policy 48 (6)

Student (post‐secondary) 37 (5)

Respondents could self-identify as belonging to more than one stakeholder category

Key informant interviews / questionnaire

Key informants were asked to:

Identify gaps in current nutrition and mental health research

Suggest criteria for establishing nutrition and mental healthresearch priorities

Point out barriers that may prevent project recommendationsfrom moving forward

Identify researchers, research teams, institutions, communitypartners to engage in research, as well as possible funders

Tell us who needs to know about project results and how to disseminate that information

Research questions: categories and examples

1. Improve the health of people living with mental health conditions

What food-related policies would help people living with mental health conditions?

2. Improve community nutrition and mental health programs and services

What are the roles of non-dietitian service providers for providing nutrition information or support to clients who are living with mental health conditions?

3. Promote mental health and/or prevent or delay the onset of mental health conditions

How does a healthy diet and/or access to healthy food promote mental health?

Setting research priorities

So, how do you decide?

Prioritizing the research questions

* Adapted from: David Okello, Pisonthi Chongtrakul and the COHRED Working Group on Priority Setting, A Manual for Research Priority Setting using the ENHR Strategy, Geneva: Council on Health Research for Development, March 2000.

Face-to-face workshop with invited experts to review findings and consider 8 criteria* grouped under 4 categories:

1. Appropriateness: Should we do it?

2. Relevancy: Why should we do it?

3. Chance of Success: Can we do it?

4. Impact of the Research Outcome: What do the stakeholders get out of it?

1. Appropriateness: Should we do it?

Is the research: Ethically, morally, culturally appropriate?

Not reliant on the food industry?

Do we need more research? Avoid duplication

2. Relevancy: Why should we do it?

Will the research: Contribute to better equity in health?

Serve community concern/demand?

Be broad in scope? Reduce the burden of illness?

Address the social determinants of health (poverty, food insecurity, housing)?

3. Chance of success: Can we do it?

Does our system have the capacity to undertake the research?

Do we have the competency, infrastructure, mechanisms, support system, resources?

Can we justify the cost of the research?

Likelihood of partnership building

Funding potential

Political acceptability

4. Impact of the research outcome:

What do the stakeholders get out of it?

Likelihood of implementation of research recommendations

Applicability to current practice

Forward/upstream thinking

Reduction of burden, including costs and quality of life

Impact of research on mental health and quality of life within the population

Economic impact

Four priority areas for research

Community nutrition and mental health

programs and services

Service provider roles in the provision of

nutrition care

Informing policy: determinants of

healthKnowledge translation

Research Priorities

Community nutrition and mental health

programs and services

Research Priority

Identify nutrition program/service needs, gaps, and barriers for people living with mental health conditions with respect to

healthy diet, food access and skills development

Research Use

Develop effective models of care to address these issues in community settings

Service provider roles in the provision of

nutrition care

Research Priority

Explore roles and responsibilities of mental health service providers, including dietitians, in the effective provision

of nutrition care to clients living with mental health conditions in the community

Research Use

Enhance collaboration and cross-training among service providers, and improve access to dietitians at the most

effective points of intervention

Informing policy: determinants of health

Research Priority

Investigate the impact of social determinants(housing, income, education, employment, etc.)

on diet, food security and mental health

Research Use

Advocate for and establish effective systems-level policies to benefit people living with mental health conditions

Stakeholder views

“I am a researcher who is interested in determinants of mental illness. Nutrition is particularly interesting because it is a modifiable risk factor.”

“As a service provider serving marginalized populations, the link is essential for those trying to achieve mental wellness. Food insecurity and poverty overlap with many of those that we serve, and research in multiple areas sets the stage for overall improvement in health care outcomes, program design, and policy change for people with lived experience.”

Knowledge translation

Research Priority

Explore methods of knowledge translation and exchangefor nutrition and community mental health research

Research Use

Improve dissemination and uptake of new and existing knowledge to strengthen the impact of community services,

inform policy and program decision-makers, and increase food literacy in target population

Poll 2

What research priority areas are of

interest to you?

Perspectives of different stakeholders

1. Researchers (n=109)

Identified as academic or clinical researchers or working as research consultants

33% identified as having lived experience

2. Service Providers (n = 433)

Roles included nurse (RN, LPN, NP), support/peer support worker, counsellor, psychologist, psychometrist, social worker

32% identified as having lived experience

Both groups had same priorities:

How food and/or nutrient intake affect specific mental health conditions

What programs or services do people living with mental health conditions need with respect to food access, nutrition, and/or cooking skills

How life situations affect the type and amount of food that people eat and what impact does that have on their mental health

Perspectives of different stakeholders

3. Individuals with Lived Experience or Who Had Family Members with Lived Experience of a Mental Health Condition

Those with lived experience in all stakeholder groups

6% identified themselves in the lived experience category only

About 20% of sample had family members with lived experience of a mental health condition

Some priorities similar to other stakeholders:

How food and/or nutrient intake affect specific mental health conditions

What programs or services do people living with mental health conditions need with respect to food access, nutrition, and/or cooking skills

But priorities were also..

How healthy diet and/or access to healthy food promotes mental health

How intakes of certain foods and/or nutrients prevent or delay the onset of mental health conditions

4. Dietitians (n=299)

0 to > 30 years of practice

Across diverse stakeholder groups

Key findings by stakeholder group

Early stages of practice: neurocognitive conditions, disordered eating, depression, autism

4 to 10 years of practice: older adults and those living in group settings

All years of practice: depression

Lived experience or service providers: schizophrenia spectrum conditions

Voluntary role: trauma and stress-related conditions

Perspectives of different stakeholders

Article: D'Andreamatteo C, Davison KM, Vanderkooy P. Defining Research Priorities for Nutrition and Mental Health: Insights from Dietetics Practice. Can J Diet Pract Res. 2016 Mar;77(1):55-6.

Next steps

Raise awareness of research priorities

Engage with researchers and other stakeholders to move the research agenda forward…

Project report: www.dietitians.ca/mentalhealth

Fostering collaborative research

Practice-Based Community-Based

Where to start?Partnerships?

Funding?Knowledge dissemination?

Moving the research agenda forward

Perceived barriers

Lack of fundingLess funding available for community-based and qualitative research approaches versus clinical, nutrient-specific quantitative research

Trouble finding participants and partnersThere may be difficulty:

1. recruiting research participants with lived experience2. locating dietitians with training in mental health nutrition3. finding motivated partners to engage in research

Low interestSkepticism about benefits, low priority for government and funders, competing interests (e.g., pharmaceutical approach), stigma around mental illness

Complexity of following through with research resultsPolicy support may be lacking, social determinants too overwhelming

Poll:

What are the next steps you would like to take in nutrition and mental health research?

Bridging the Divide project (2016-2017)

Renewed funding from CIHR

Key elements:• Advisory Committee to guide the project• Knowledge broker to develop, implement and

evaluate a knowledge exchange strategy• Knowledge products (e.g., infographic, evidence summaries)• Webinars to raise awareness• Stakeholder bridge-building workshops• Online hub: nutritionandmentalhealth.ca• Other opportunities…?

Next webinar

Questions?

For more information

Bridging the Dividehttp://nutritionandmentalhealth.ca

Project ManagerLisa Petermannlisa@exep.ca