Wellness Defined

"Wellness is a conscious, deliberate process that requires a person to become aware of and make choices for a more satisfying lifestyle. A wellness lifestyle includes a self defined balance of health habits such as adequate sleep and rest, productivity, exercise, participation in meaningful activity, nutrition, productivity, social contact, and supportive relationships. It is important to note self defined because everyone has individual needs and preferences, and the balance of activity, social contact, and sleep varies from person to person.Wellness is the process of creating and adapting patterns of behavior that lead to improved health in the wellness dimensions (Physical, Spiritual, Social, Intellectual, Emotional/Mental, Occupational, Environmental, Financial)." To read the full article click here.  

Wellness Factsheets

National Council ABC Wellness Factsheets

Primary care and behavioral health providers are responsible for ensuring the people they serve have quality health and wellness information. These factsheets are a practical and effective way to increase individuals' understanding of their health and how to make decisions that reflect their values. 

Staying well, it's as simple as your ABCs...and D & E
A of wellness know your A1c
B of wellness know your blood pressure
C of wellness know your cholesterol
ABC's of wellness personal health screening form

SAMHSA 10X10 Wellness Campaign  

The SAMHSA 10x10 Wellness Campaign is dedicated to promoting the importance of addressing all parts of a person's life in hopes of increasing life expectancy for persons with mental health problems by 10 years over the next 10 years. 

Go to the Campaign for SAMHSA Wellness Summit Resources to receive new free posters and to pledge your commitment to promoting wellness and reducing the disproportionate impact of preventable morbidity and mortality on people with mental health problems.  

Living Well

Healthy Eating
Leading Health Indicators for Healthy People 2010
For the past three decades, the Department of Health and Human Services (HHS) has issued a national agenda aimed at improving the health of all Americans over each 10-year span. The report recommends 12 topics, 12 indicators, and 24 objectives that that can be used to create a focus on major health concerns for the U.S. population.

Food Education for People with Serious Psychiatric Disabilities is designed to guide rehabilitation practitioners in helping people with psychiatric disabilities to learn good nutrition and healthy eating practices and to empower people with serious psychiatric disabilities to achieve nutritional health as a resource for recovery.  NOTE: The Food Education curriculum includes an instructor's copy of the student handouts. Citation: Books, A. (2009). Food education for people with serious psychiatric disabilities: An evidence-based recovery curriculum. Boston: Boston University Center for Psychiatric Rehabilitation.

National Center on Physical Activity and Disability created a fact sheet entitled, “Food and your Mood: Nutrition and Mental Health.” 

Food Education, A Curriculum to Assist people with Psychiatric Disabilities to eat well,  Boston University, nutrition and fitness center and center for psychiatric rehabilitation. 

Stress Management   
The Relaxation Response
The founder of the Benson-Henry Institute (BHI) is Dr. Herbert Benson, a Harvard Medical School trained cardiologist. His work pioneered mind/body medicine by linking stress to physical health. Dr. Benson’s research found that by changing thought patterns, subjects experienced decreases in their metabolism, rate of breathing and heart rate, and had slower brain waves. These changes appeared to be the opposite of the commonly known “fight-or-flight,” or “stress response”, and Dr. Benson labeled it the “relaxation response” which is the foundation of mind/body medicine practiced at BHI. Dr. Benson is the author or co-author of more than 175 scientific publications and 11 books. How does one elicit the relaxation response?
To elicit the relaxation response there are two essential steps:

• Repetition of a word, sound, phrase, or muscular activity.
• Passive disregard of everyday thoughts that inevitably come to mind and the return to your repetition.

For more information Dr. Herbert Benson's " The Relaxation Response" please use this link.

Physical activity
Physical Activity Guidelines for Americans
The Federal Government has issued its first-ever Physical Activity Guidelines for Americans. They describe the types and amounts of physical activity that offer substantial health benefits to Americans.

The Center for Disease Control reports, "Regular physical activity helps improve your overall health and fitness, and reduces your risk for many chronic diseases. Fitting regular exercise into your daily schedule may seem difficult at first, but the 2008 Physical Activity Guidelines for Americans are more flexible than ever, giving you the freedom to reach your physical activity goals through different types and amounts of activities each week."

Physical Activity and Physical Disability
Access the National Center on Physical Activity and Disability for the latest information, resources, and research.

National Center for Complementary and Alternative Medicine
The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on the diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. View the website and their evidence based information on complementary and alternative medicine.
 
Recovery

Availability of Asian language substance abuse treatment counselors varies by region.
The number of substance abuse treatment services tailored to various Asian cultures are not distributed evenly in the United States. Click here to read the full fact sheet.

SAMHSA Blog: Recovery Defined – A Unified Working Definition and Set of Principles
In August 2010, leaders in the behavioral health field, including people in recovery from mental health and addiction problems and SAMHSA met to explore the development of a common, unified definition of recovery.   “Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.” Click here to check out the full blog posting and the guiding principles of Recovery.

Tobacco Cessation

Smoking: The Shocking Statistics
The average life span of people with serious mental illness is 25 years less than that of the general population—smoking is a major contributing factor to early morbidity and mortality.

• Approximately 50% of persons with serious mental illness smoke, compared to 23% of all other persons. 
• Persons with mental illness smoke half of all cigarettes produced and are only half as likely as other smokers to quit.
• Half of all deaths among people with mental illness are due to smoking related illnesses.
• 30–35% of treatment staff in mental health and substance abuse facilities smoke (compared to 1.7% primary care physicians).  

Leadership Academy
The Leadership Academy in Oklahoma was held in Oklahoma City on April 20-21, 2011.  The two goals are to significantly reduce smoking prevalence among both adult behavioral health consumers and staff by 2015.

Smoking and Mental Illness- Breaking the Link
An article from the New England Journal of Medicine, “Smoking and Mental Illness- Breaking the Link” addresses the, “Five prevailing myths have contributed to continuing tobacco use among people with mental illness.” Additionally, the article discusses ways to address smoking cessation with patients. 

Tobacco Free Press
Click here to access to valuable tobacco-related news and resources. This publication is sponsored in partnership with the Tobacco Technical Assistance Consortium (TTAC) and the CDC's National Center for Chronic Disease Prevention and Health Promotion.

Smoking Cessation Leadership Center
A national program office of the Robert Wood Johnson Foundation with research, information, and tips for clinicians. 

Peer to Peer Tobacco Recovery Program Description
To assist individuals to lead meaningful lives, treatment settings need to promote behaviors that lead to health and wellness. The Peer-to-Peer Tobacco Dependence Recovery Program does so by filling a critical gap in behavioral healthcare settings- tobacco dependence services for persons with substance abuse or mental health disorders.

Mental Health Tobacco Cessation Toolkit
To assist people to lead meaningful lives, mental health providers need to promote behaviors that lead to health. Individuals with mental illness must be alive to “recover” from their illnesses, and tobacco use is potentially the
most modifiable risk factor for decreasing excess mortality and morbidity. Tobacco cessation is a key component of many individuals’ recovery, and is a priority issue for every health provider.

Smokefree
The federal government has an interactive website to help with smoking cessation. Visit for free phone counseling (1-800-784-8669) assistance, and instant messaging from specially trained Quit Coaches.

Reimbursement for Tobacco Cessation Counseling
The attached reimbursement code chart highlights HCPCS, CPT, & ICD-9 Codes Related to Tobacco Cessation Counseling under Medicare and private payors.

Association for the Treatment of Tobacco Use and Dependence Position Paper
The Association for the Treatment of Tobacco Use and Dependence (ATTUD) recently released a position paper, Integrating Tobacco Treatment Within Behavioral Health. ATTUD's Disparate Populations Committee Chair, Alice Dalla Palu, noted: "The committee reviewed literature for behavioral health populations and tobacco use in preparing the paper and found that most behavioral health clients want to quit tobacco use.  It is time to alter our approach to this issue, actively intervene, and not accept tobacco addiction as unapproachable with behavioral health patients. Our hope is that the paper will provide guidance and encouragement to practitioners to offer tobacco services to their patients." 

Increasing Access to Tobacco Cessation in States: ActionToQuit Case Studies
Partnership for Prevention published a case study guide entitled “Increasing Access to Tobacco Cessation in States: ActionToQuit Case Studies.”

"News You Can Use" Widget
The FDA Center for Tobacco Products (CTP) has made two widgets available to help stakeholders share FDA information easily. Click here to see the Widgets and learn how to place them on a webpage or blog.

Helping Latinos quit smoking: Miriam Hospital studies offers new insight Latinos looking to quit smoking are more successful when they have a significant other and partner support, say researchers from The Miriam Hospital's Centers for Behavioral and Preventive Medicine. Click here to read the full article. 

Smoking cessation during substance abuse treatment
This article, “Smoking cessation during substance abuse treatment: What you need to know” provides a thoughtful literature review and successful cessation interventions.

Centers for Medicare & Medicaid Letter
A State Medicaid Director’s letter was released that provided information to assist States as they work to reduce tobacco utilization. The letter includes guidance on implementation of section 4107 of the Affordable Care Act, and provides guidance on “tobacco telephone quitline” activities. Click here to read the letter.

State Smoking Cessation Quitlines May Be Reimbursed For Medicaid Patients Working To Quit from  Medical News Today 
The Center for Medicare and Medicaid announced historic expanded coverage options that States may offer for tobacco cessation services. Americans could now have tools from tobacco control programs for help to tackle and overcome smoking and addiction to nicotine. Click here to read the article.

Other Resources: 
Behavioral Health and Wellness Program
National Quitline, 1-877-44U-QUIT (1-877-448-7848)
 

Media

Words of Wellness Newsletter
The Institute for Wellness and Recovery Initiatives at Collaborative Support Programs of New Jersey offers, Words of Wellness, a publication that features valuable information and resources, including details about educational events, to help people to achieve and maintain wellness.   

Webinars

Motivational Interviewing for Better Health Outcomes
Motivational Interviewing helps persons with mental and addiction disorders and other chronic conditions such as diabetes, cardiovascular conditions, and asthma make positive behavioral changes to support better health. View the recording and presentation from the Motivational Interviewing webinar.

Chronic Medical Conditions in People with Serious Mental Illness 
This Webcast recording includes an overview of the causes of physical illness in people with severe mental illness-cardiovascular disease, diabetes, substance abuse, and smoking; and operational modes for integrating physical care with mental healthcare delivery, with an emphasis on the community mental health care setting.  

Wellness Informed Care

Tools

InShape
InShape is a wellness program for individuals with mental illness. The goal of In SHAPE is to improve physical health and quality of life, reduce the risk of preventable diseases, and enhance the life expectancy of individuals with serious mental illness. Studies show that individuals with severe and persistent mental illness such as schizophrenia and bi-polar disorder are at increased risk of chronic diseases including diabetes, hypertension, cardio-vascular disease, and nicotine dependence; and they have a lifespan that is 10-20 years shorter than the general population. In SHAPE participants work with a trained health mentor to create a Self Health Action Plan for Employment that includes physical activity, healthy eating goals, and attention to medical needs.

Wellness Self Management
Wellness Self-Management is a curriculum-based clinical practice designed to assist adults to effectively manage serious mental health problems. The WSM program is based on Illness Management and Recovery (IMR), a nationally recognized evidence-based practice for adults with serious mental health problems. In addition to IMR-related topics such as recovery, mental health wellness, and relapse prevention, the WSM approach includes lessons emphasizing the connection between physical and mental health. It may be helpful to think of WSM as a comprehensive curriculum that covers many topics providing information, knowledge, and skills that help people to make decisions that support recovery. The curriculum is organized into a 57-lesson personal workbook that includes topics such as:

• Understanding what helps and what hinders recovery
• Understanding the connection between physical and mental health

For more information on the Wellness Self Management workbook that was developed by The New York State Office of Mental Health (NYSOMH)and The Urban Institute for Behavioral Health (UBH) check out this site.

Patient Activation Measures
The Patient Activation Measure™ (PAM™) survey assesses the knowledge, skills and confidence integral to managing one's own health and healthcare. With the ability to measure activation and uncover related insights into consumer self-management abilities, care support and education can be more effectively tailored to help individuals become better self managers. 

The Behavioral Health and Wellness Program offers training and consultation to healthcare providers, administrators, and clients. Over the last five years we have worked with over 20 states and have also provided services internationally.

Life Goals Collaborative Care
Life Goals Collaborative Care (LGCC) is an evidence-based, consumer-centered program shown to improve health outcomes for persons with bipolar disorder in three separate randomized controlled trials. A central tenet of the program is reducing the separation between physical and mental health through integrated psychotherapy and collaborative care management. LGCC has been recently expanded to other chronic mental disorders (e.g., mood disorders), and found to be effective for those with co-occurring substance use and general medical disorders. View the Life Goals Collaborative Care description here.
 

Diabetes Management

The American Diabetes Association Standards of Medical Care in Diabetes. "Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long term complications. A large body of evidence exist that supports a range of interventions to improve diabetes outcomes."
Read the full position statement at Standards of Medical Care in Diabetes-2009.  

Diabetes Education Services, Reimbursement Tips for Primary Care Practice
Diabetes self-management education/training is cost effective and improves health outcomes as patients maintain better control of their A1C. Physicians will benefit by establishing a relationship with a diabetes educator who can provide their services for patients with diabetes. This document serves as a guide for reimbursement for diabetes education services. This document document serves as a guide for reimbursement for diabetes education services.

Treating Mind And Body: Integrating Mental Health And Primary Care Cuts Costs
An article in INFORUM speaks to the importance of integrating mental health and primary care when a patient at Stanford clinic was diagnosed with diabetes. The patient realized she turned to food as an unhealthy form of self-medication for depression, but over the course of her diabetes treatment, she felt strong enough to begin therapy for her depression.  In a normal primary care clinic, there is a one- in-five-chance treatment will result in a decrease of depression symptoms. However, embedding mental health professionals in primary care settings has yielded far better results, with a decrease of symptoms in half the cases on average. Click here to read more about integrating mental health and primary care to cut costs.  

Health Literacy

The following sites are excellent resources for guidance on developing health education materials that support health literacy:

• UNC  
• UNC-toolkit developed and tested specifically for office practices
• Iowa Department of Public Health
   

Environment and Policy

Position Statements
Mental Health America has several important position statements related to Mental Wellness. Check out Position Statement 17: Promotion of Mental Wellness and Position Statement 16: Health and Wellness for People with Serious Mental Illnesses.

Coverage of Annual Wellness Visit Providing A Personalized Prevention Plan: The Affordable Care Act extends the preventative focus of Medicare coverage, which pays for a one-time only initial preventive physical examination (IPPE or the “Welcome to Medicare Examination”) , to provide coverage for annual wellness visits where beneficiaries receive personalized prevention plan services (PPPS). The law required the annual wellness visit to include at least the following six elements:

• Establish or update the individual’s medical and family history.
• List individual’s current medical providers and suppliers and all prescribed medications.
• Record measurement of height, weight, body mass index, blood pressure and other routine measurements. 
• Detect any cognitive impairment.
• Establish a screening schedule for the next 5 to 10 years including screening appropriate for the general population, and any additional screenings that may be appropriate because of their individual patient’s risk factors.
• Furnish personal health advice and coordinate appropriate referrals and health education. 
     

Research 

Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29, (4) 311-314. There is a significant paradigm in the field of public mental health practice that encompasses a wellness approach. This paper will present a wellness approach by comparing it to the traditional medical model. A personal  application of the wellness approach will be discussed. 

The effects of physical activity on psychological well-being for those with schizophrenia: A systematic review was published in The British Journal of Clinical Psychology (2011), 50, 84-105.
 
Wellness Coaching: A new Role for Peers, Published by Psychiatric Rehabilitation Journal, M. Swarbrick, et al. This report brief highlights how wellness coaching represents an intervention that can help individuals persist in the pursuit of individually chosen health and wellness goals.