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Georgia Frydman: Hi, my name is Georgia Frydman. I’m a Senior Exercise Physiologist with Community Mental Health in Sydney Local Health District working with the Living Well, Living Longer program. Today I’ll be presenting on behalf of my colleague Katie Thorburn on our community-based Gym and Swim program.
[Project title slide: Gym and Swim Program: Improving mental health by building community, confidence and cardio-metabolic health | Prevention and Health Promotion | Georgia Frydman, senior exercise physiologist & Katie Thorburn, peer support worker | Sydney Local Health District]
So, before I begin, I’d like to acknowledge the traditional owners of the land that I’m presenting from today and the land of which this work takes place, the Gadigal people of the Eora Nation. I pay my respects to Elders past, present and emerging, and celebrate the diversity of Aboriginal peoples and their ongoing cultures and connection to the lands and waters of New South Wales. I’d also like to acknowledge the contributions and experiences of those with lived and living experience with mental health issues, as well as the people who are their carers, families and supporters.
[Slide 2: Case for Change]
So, before I begin on the case for change, I’ll start with a bit of context of where the Gym and Swim program fits into the broader suite of physical health initiatives delivered by Sydney Local Health District. Living Well, Living Longer is an integrated care initiative established in 2013 that was designed to provide care pathways to improve the physical health of people living with severe mental illness or people receiving care coordination from the Adult Community Mental Health Service in our District eligible to engage in this initiative.
And it’s been designed to provide a seamless comprehensive care pathway through the four stages of screening, detection, treatment initiation and ongoing management of any and all coexisting physical health conditions. Comprised of a number of physical health strategies which focus on supporting people building positive health behaviours, these include the Healthy Lifestyle Clinicians – so, exercise physiologists like myself and dietitians, health peer support workers like my colleague Katie who use lived experience to offer empathic support, empowerment and validation to inspire healthy lifestyle choices, the Collaborative Centre for Cardio Metabolic Health and Psychosis or CC-CHIP, which is an outpatient specialist MDT Clinic. We also have smoking cessation support – just to name a few of the initiatives that are relevant to what I’m speaking to today.
As clinicians we were frustrated by the barriers facing people due to the lack of accessible and suitable options that supported people to independently engage in exercise or physical activity to manage their own physical and mental health care once they were discharged from Community Mental Health Services. So, for example, people might have been engaging in programs offered by the Mental Health Service – the dietitians and the exercise physiologists – and then as part of discharge planning there was no appropriate long-term referral pathways for us that would support physical activity in the long term. So, filling in this gap meant creating a program where people could continue moving their bodies with a like-minded community or support network in a familiar environment, in an accessible setting, for the duration of their recovery journey.
[Slide 3: The Solution – Gym and Swim]
For us, the solution was a program that builds the confidence and skills for people to independently exercise that creates and supports a community in a community setting as opposed to a mental health setting and that improves cardio metabolic health and reduces risk of mortality and morbidity. We started the Gym and Swim program in 2018 and it is what it says on the box. It was a twice-weekly program that runs for two hours: the first hour being independent exercise in a gym setting and the second hour was using the pool and doing an aqua circuit. People could choose if they wanted to do just one or both depending on their preferences and their goals. In order to be successful, the program had to sit outside of the Health Service, but still be accessible. So, we proposed a partnership between Sydney Local Health District and a local aquatic and fitness centre. In this case, it was the Annette Kellerman Aquatic Centre in Enmore Park, Marrickville.
All of the sessions were co-facilitated by an SLHD health peer support worker and an exercise physiologist who used their shared experience in exercise, health behaviour change and lived experience to create a safe and supportive space for people to build skills, foster Independence and confidence in a gym environment. It was also important for us to resolve barriers to accessibility. And so, we were able to negotiate a reduced rate of entrance fees and membership features which addressed the issues we came across – of things like lock-in contracts and joining fees.
In terms of the New South Wales Health Physical Activity Guidelines, this program is being presented in the Health Promotion and Prevention chapter but like most programs it addresses a range of actions across each of the areas of the Guideline, such as Access and Intervention, Effective and Integrated Care and Values-Based Care.
[Slide 4: Implementation]
“Implementation” was an interesting slide for us to write and deliver because the Gym and Swim program was paused over the COVID-19 period due to shut-downs and redeployments of our services and since we’ve returned we’ve had to negotiate between, you know, various Amber and Yellow risk alert statuses for our Districts, seeking approvals to recommence groups. And then the management of the aquatic centre had actually changed and returned back to Council management, which was previously private. So, we’re actually back at this implementation stage, again, negotiating terms with Council.
So, it was our LHD that approached the centre proposing a collaboration to deliver the group in that proposal. We highlighted the alignment of both organisational strategies with explicit actions to partner with each other with the intention of supporting mental health and well-being and supporting integrated care and collaborative care. So, the LHD was offering our own staff to deliver and support the program. They were offering clientele in the gym in what would otherwise be a traditionally quieter time in the middle of the day, opportunities to have new members and we’re also offering training to upskill gym staff and Mental Health Training.
We were asking from the centre to use their centre at a discounted rate for program participants at an arranged day and time, access to gym and pool facilities for $4.50 for participants for the day, membership rates of $13/20-weekly with no minimum term contract and waive joining fee, and then free centre access to SLHD staff or facilitators during the program times.
So, right now we have signed an MOU and had a legal agreement for legal approval for a hiring agreement and we’re waiting for approval from our Chief Executive hoping to recommence soon.
[Slide 5: Outcomes]
During the COVID shutdown, we took the opportunity to run a qualitative study that looked at the experiences and attitudes of people who attended and did not attend the program – so people who were referred but never engaged or came along to any of the program. The major findings of the data from the participants who did attend was that they enjoyed exercising with their peers. They preferred the independent exercise within the group setting as opposed to a group exercise or exercising on their own. The majority of them experience the physical and mental health benefits of regular exercise. And those who did attend did not find the cost to be a major barrier.
In terms of successes, the “Godfather” is a great case study that really exemplifies the program’s objectives. So dubbed “The Godfather” by his peers, he became a pillar of the Gym and Swim community, attending over one hundred sessions. He would bring a big personality as well as a warm welcoming presence to the program. He would often offer to drive people to and from the gym and he’d also often coordinate people having lunch together afterwards. He independently entered and won a six-week cardiovascular health challenge run by the gym which made him also a well-known face to the entire Annette Kellerman gym community. He then used his prize winnings to put on a barbecue for all the Gym and Swim participants in the park which is next to the gym. The program inspired him to upskill to become a peer support worker and he’s been recently offered a position which is really lovely. The Godfather attributes Gym and Swim as helping him have more control over his mental health, reducing his anxiety and moving forward and helping him recover from his illness.
Although renegotiating with the Council has meant a delay in us being able to open the group back up again, it has meant that now we have an agreement with all the Council-managed aquatic centres rather than just the one in Marrickville. And so now what we will we have the opportunity to deliver at up to five sites across our District. This is really important to us to avoid a postcode lottery of inequity where people aren’t able to access the service just because of the postcode that they live in. It’s also going to assist us with one of our challenges – which we found from the people who didn’t attend the group – which was transport. So, having more sites that we can deliver services to means that people will be able to attend groups closer to home. I’ve also listed COVID as a challenge for obvious reasons and shutdowns resulting in an opportunity loss for people to attend the groups or new people joining the groups. But on the other hand, it’s given us an opportunity to pause, reflect on how we’re delivering the program in terms of our assessment data and make improvements for the future.
[Slide 6: Key Learnings & Take-Home Messages]
Key learnings and take-home messages. I think the three main components to recreating the success of the Gym and Swim group are community, confidence and cardio metabolic health. Community is probably the keystone to the success and here “community” I guess has two meanings. Firstly, setting up a program in the community rather than a mental health setting, so as to avoid institutionalising consumers into mental health programs and services, but also building a community that supports each other independent to the facilitators.
Confidence. The scaffolding of confidence is self-efficacy, knowledge and experience; providing the opportunity for people to build their confidence and independence by providing access and support for people to engage in positive lifestyle behaviour changes and building the confidence of the providers in the gym. So, helping to destigmatise mental health and also destigmatising some of the support providers who don’t think that people are interested in attending the gym. Confidence is also built through engaging with the community-based exercise services following discharge from Mental Health Service. So, to avoid consumers becoming entrapped by mental health-specific services.
In terms of cardio metabolic health, the program should be collaboratively designed and facilitated by traditional physical health disciplines, such as EPs as well as lived experienced experts. EPs provide expertise and the evidence-based practice to deliver either prescription or behaviour change, they ensure safe and effective participation both now and into the future by upskilling people to participate in independent tailored programs that are appropriate and progress safely with comorbid physical health concerns in mind. Evidence also suggests that participants prefer a person who is an expert to lead a program such as this.
Peer support workers utilise an internationally recognised framework in facilitating personal recovery called CHIME which stands for Connection, Hope, Identity, Meaning and Empowerment. They work with consumers to strengthen these areas of their lives and form a mutual relationship focused on common experience. When peer support workers facilitate Gym and Swim, they take this ethos and these practices with them on their journey of reconnecting people to joyful movement.
In the future… Well, we’ve recently been successful in applying for a HETI Grant Award for Mental Health Research and we’ve had Ethics approved and so we’re going to use the award to fund a research position, who’s also an exercise physiologist, to collect and evaluate the data with a goal of finding balance in data collection that aligns with the with a person’s personal goals so that we’re not overburdening people with paperwork that is meaningless to them. That’s all from us. Thank you.
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