The feasibility of a co-produced physical activity programme within a secure forensic unit to improve physical and mental health of those with severe mental illness

Abstract

The aim of this programme of research was to investigate the effects physical activity can have on individuals with Severe Mental Illness (SMI) within a secure forensic setting. Those with SMI are at higher risk of cardiovascular disease and early mortality. Physical activity can improve physical and mental health outcomes for those with SMI, yet recent evidence has shown that physical activity programmes in secure forensic settings are limited. The programme of research was made up of four studies to explore, implement and assess the feasibility of physical activity interventions within a secure forensic setting.

Study one presented a systematic review to review the effectiveness of physical activity programmes on mental and physical health and specifically on reducing symptoms of SMI in forensic settings. The review highlighted the lack of studies (n=4) within the area of research, the need for thorough research design as the results reported no theoretical underpinning within the four studies a range of outcome measure and a lack of follow up assessment. This information led to the second study.

Study two was a protocol use to (i) summarise the co-produced Flexible Interactive Training Together (FITT) programme that supports patients and staff physical activity levels in a secure forensic setting and, (ii) describe the trial protocol to be used to evaluate the FITT programmes effects on physical and mental health outcomes, through the self-determination theory (SDT) which lead to third study.

Study three was a qualitative study which aimed to determine (i) what the understanding of physical activity and health is to an individual in a secure setting, (ii) what patients and staff perceive as the barriers and facilitators to physical activity, and (iii) potential ways patients and staff can become more physically active. It was found that there was an inability to articulate a conventional definition of physical activity and mental health, with knowledge on activity and time to partake was based on previous experiences (i.e football before 4pm and after lunchtime). The results of study three and the use of co-production will aid in the development of study four, a physical activity intervention that would be implemented within a medium secure unit.

Study four was a co-produced intervention within a medium secure forensic clinic which examined the effect of the FITT programme on staff and patients' physical activity levels, mental health, well-being, motivation, and basic psychological needs. The FITT programme was devised via co-production and SDT and used tests of difference to assess the feasibility of FITT programme with participants within a secure forensic setting. The intervention results show a higher scoring of physical activity levels being reported, it also shows that there was a significant difference within motivation subscales for patients and staff.

In response to the FITT programme results showing significant differences through increased emotional and social constructs of mental health continuum, motivations and physical activity levels as well as decreasing anthropometric measurements in patients. The results suggest that it is feasible to run a large-scale trial to determine the effectiveness of the FITT programme using a larger sample to include a control group.

Date of Award	Nov 2023
Original language	English
Sponsors	Department for the Economy
Supervisor	Gavin Breslin (Supervisor), Mark Tully (Supervisor) & Stephen Shannon (Supervisor)