Fitness Program for Mentally Ill Expands in NH

Back when he was a self-described friendless recluse, Craig Carey spent hours sitting in a chair doing nothing or driving around in his car, alone. Then a fitness program for people with serious mental illness turned his life around.

"The In SHAPE program gave me something to grab onto. I came out of my shell, I went to other programs ... got a part time job," he said. "I started to say, 'OK, my life is getting back together.'"

Carey, 47, of Keene, was diagnosed with manic depression and obsessive-compulsive disorder 15 years ago. In 2003, he became one of the first clients at Monadnock Family Services to join In SHAPE, a program so successful that the state has won a $10 million federal grant to replicate it at the rest of the state's community mental health centers. The goal is to expand a program that now serves 150 people to 4,500 participants in the next five years.

The average life span for someone with a serious mental illness is 25 years shorter than someone in the general population, a gap that has been largely overlooked even though an estimated 10.4 million American adults - including about 43,000 in New Hampshire - fall into that category, said Dr. Stephen Bartels. He will supervise the program funded by the Centers for Medicare and Medicaid Services.

"It can legitimately be said that this is largest and most important health disparity in the nation that has been unappreciated," said Bartels, director of Dartmouth College's Centers for Health and Aging.

People with serious mental illnesses such as depression or schizophrenia are more likely to smoke and be obese, putting them at greater risk for diabetes, heart disease and other chronic disease. And medications used to treat their mental illnesses often cause weight gain or leave them feeling too lethargic to exercise.

Spending money on wellness efforts now will be less costly than expensive treatments for chronic diseases later, Bartels argues. According to the U.S. Centers for Disease Control and Prevention, a sustained 10 percent weight loss will reduce an overweight person's lifetime medical costs by $2,200-$5,300 by lowering costs associated with high blood pressure, type 2 diabetes, heart disease, stroke, and high cholesterol. A report released this month by the nonprofit, nonpartisan Trust for America's Health found that reducing the average body mass index by 5 percentage points in the United States could lead to more than $29 billion in health care savings in five years.

And there are societal benefits as well, said Ken Jue, who created the In SHAPE program in 2003. Some participants have gone back to work after decades of unemployment. Others have gone back to school.

"As people have become involved in the program and as they begin to improve their physical health, they develop a sense of self-confidence that really frees them up to do some incredible things," said Jue.

Jue, a consultant to Monadnock Family Services, was the agency's CEO in 2002 when he noticed a troubling trend.

"I was sitting in a funeral of a client of the agency ... and I realized in the middle of the funeral that I've been to a lot of these funerals, and people were pretty young. They were in their 50s or very early 60s," he said. "All of a sudden I said, 'This doesn't make sense why these folks would be dying.'"

The acronym in In SHAPE stands for "Self Help Action Plan for Empowerment." Participants are paired with trained health mentors to develop plans that include exercise, nutrition counseling and smoking cessation. Those who don't have a primary care doctor are assigned to physicians at Cheshire Medical Center, who know about the program and work to reinforce it. Students at nearby Keene State College help with the nutrition components, and the local YMCA provides the fitness facilities.

Those partnerships have been key to the program's success, Jue said, and have helped integrate participants into their communities in a way that would not have been possible had the mental health agency just set up its own fitness center.

"Someone with a serious mental illness can become isolated, and social isolation contributes to their poor health status," he said. "So I wanted this to be done in the community."

Participants generally spend about nine months in the program, and there is always a waiting list, Jue said. Research published by Bartels in 2010 found a dropout rate of 20 percent, compared to a 25-33 percent dropout rate for healthy adults enrolled in formal exercise programs.

The research also found that participation in the program was associated with a reduction in waist size, blood pressure and symptoms of depression and an increase in physical activity, readiness to eat healthier and overall confidence levels.

Diane Croteau, 49, of Keene said the confidence she's gained through the program has alleviated her depression and improved her health. She's lost 60 pounds in the last year and works out at the YMCA every week day.

"When I first started In SHAPE, I was a little wary about going and exercising in front of people. But once I started, it wasn't bad, and I got to meet a lot of people outside of In SHAPE," she said. "It's been basically life-changing for me."

She and other participants said the health mentors they've worked with know how to strike a balance between being supportive and challenging. If a participant isn't feeling up to going to the gym, mentors will go to their homes and take them out for walks. If someone is dealing with a medical issue, the mentors help contact doctors.

"It's a personal relationship," said Paula Wheeler, 68, of Keene, another longtime participant. "They offer you a lot of respect, and it doesn't matter where you are. You can be a very in-shape person or you can be a person who really has a lot of work to do, but they're accepting of who you are."

While several mental health agencies in other states have used In SHAPE as a model for similar programs, the New Hampshire expansion is the first time such a program will be implemented statewide, Bartels said.

Carey was glad to hear about those plans and said he hopes others will get just as much out of the program as he has.

"You've got to say to yourself, 'Do I want to be here in 10 years where I am now or do I want to do something with my life? Do I want to stay out of the hospital? Do I want to become productive?'" he said.

"That's what it comes down to. My life isn't perfect ... but it's a far cry from what it was 15 years ago, a far cry. And I'm very happy with it."