A fitness movement: an innovative model pairing CMHC clients with personal trainers gains momentum.
Article Type: Report
Subject: Psychiatric services (Methods)
Mental illness (Care and treatment)
Wellness programs (Methods)
Author: Enos, Gary A.
Pub Date: 01/01/2012
Publication: Name: Behavioral Healthcare Publisher: Vendome Group LLC Audience: Academic; Trade Format: Magazine/Journal Subject: Health; Health care industry; Psychology and mental health Copyright: COPYRIGHT 2012 Vendome Group LLC ISSN: 1931-7093
Issue: Date: Jan-Feb, 2012 Source Volume: 32 Source Issue: 1
Product: Product Code: 8000186 Mental Health Care; 9105250 Mental Health Programs NAICS Code: 62142 Outpatient Mental Health and Substance Abuse Centers; 92312 Administration of Public Health Programs
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 282841915
Full Text: The CEO of Genesee County Community Mental Health in Flint, Mich., knew he was going against the grain in 2009 when he vowed to devote agency resources to pairing seriously mentally ill clients with personal trainers. Dan Russell would hear staffmembers wonder aloud what had convinced him to alter his thinking about treatment and recovery, hire "gym teachers" over mental health therapists, and allocate precious dollars from the agency's general fund for that purpose.

What convinced Russell was what he had seen while attending a New Hampshire training session organized by the agency that launched the InSHAPE program in 2003. Based on what he calls "amazing unscripted testimony" from clients at Monadnock Family Services in New Hampshire, Russell realized that he had an opportunity with InSHAPE not only to be of service to clients, but to transform their lives.

"This was something I couldn't ignore," says Russell. "This is going to keep people from dying."

Genesee County Community Mental Health two years ago joined a very small but highly committed group of community mental health centers (CMHCs) that have adopted the InSHAPE model established by former Monadnock Family Services CEO Ken Jue. The impetus for the effort iies in the well-known national data showing that individuals with serious mental illness on average die 20 to 25 years sooner than the general population, often from the effects of chronic illnesses exacerbated by a sedentary lifestyle.

The success of InSHAPE is founded on the relationship that is built between a client and a personal trainer. This relationship not only gives the client extra motivation to begin living healthier, but the partnership also helps combat the isolation experienced by many individuals with schizophrenia, bipolar disorder and other serious mental disorders.


For this population in general, "Classes and brochures don't help-you need personal interaction," says Shante Burke, who gave up working in fitness centers to work with the seriously mentally ill at the Michigan agency. Burke is Genesee County Community Mental Health's manager for health and wellness.

Burke, who has a degree in kinesiology, says in comparing her current job to working with the typical gym member population, "'This is definitely more beneficial; we can help add years to a person's life. Every individual has an opportunity for a better life."

Program history

Jue, who has remained a consultant to Monadnock Family Services since leaving the CEO role there two years ago, has said that the idea for InSHAPE stemmed from his attending one in what seemed like a never-endingseries of funerals for relatively young Monadnock clients around 2002. Because his staff was unable to find any examples of mental health centers that had adopted comprehensive fitness initiatives for clients, Jue decided to create a program from scratch.

At Monadnock Family Services, Jue set out to establish fitness options for clients in the community, rather than creating a "clients-only" fitness center that he believed would simply reinforce the isolation these individuals experience. Monadnock negotiated discounted memberships for its clients at a number of local health clubs. Along the way, Jue cemented other partnerships, such as when a Dartmouth-Hitchcock medical clinic agreed to offer primary care services to InSHAPE participants.

At several of the handful of CMHCs that have replicated the InSHAPE model, clients will begin working with trainers at an on-site fitness area in the agency, then will move to a fitness center in the community. At Genesee County Community Mental Health, many clients spend about four weeks in sessions at an on-site wellness center before moving to a recreation center on the University of Michigan's Flint campus.


The personal trainers generally are contract workers to the mental health agencies, with their fees representing most of these programs' costs. Before working with clients, Russell says that trainers for his agency receive two weeks instruction, based on the Mental Health First Aid curriculum, so that they better understand mental health symptoms and other issues associated with this population.

The Genesee County agency reters to the trainers as health mentors," reflecting its InSHAPE program's three focal points: physical activity, nutrition guidance, and management of chronic physical illness. Each health mentor works with about 30 clients.

Burke says the fitness level of consumers varies widely, from former athletes to individuals who "never have done a jumping jack." Clients may volunteer for the program or be referred by a case manager. There's no shortage of interest: Genesee County Community Mental Health recently had a waiting list of around 100 consumers and was looking to hire more health mentors.

Agencies that have adopted InSHAPE have been somewhat successful in billing Medicaid for a portion of their program costs, as some of the activities fall under accepted definitions for client symptom control. Russell says 56 percent of his agency's InSHAPE program costs fall under a Medicaid code. But funding support for the remainder of program expenses has been harder to find.

"It's not mental health counseling, so it's a little out of the box," says Russell, explaining the conventional thinking of some funders.

In New Hampshire, however, where six community mental health agencies either have implemented or are about to launch InSHAPE initiatives, funding has been bolstered by a five-year, $10 million commitment from the Centers for Medicare & Medicaid Services (CMS) to extend the model across the state.

Powerful effect

Russell says that while participants in Genesee County Community Mental Health's InSHAPE program have noted a weight loss of 10 pounds per person, on average, the program's impact goes beyond numbers.

Health mentors try to talk with clients as much about nutritional change as about exercise and can tailor their comments to the needs of individuals with chronic illnesses such as diabetes. Burke says that nutrition education often meets with more client resistance than does the physical fitness part of the program. Yet, she insists, "you can't have one without the other."

Russell adds that his organization has seen other benefits of the InSHAPE approach, including the sense that participating clients are becoming part of a community.

Dennis Johnson, 54, a peer specialist assigned to the Michigan agency's program, sees the enthusiasm many of the clients have for working out from a unique perspective. Once a multi-sport star athlete, the Flint native was later diagnosed with schizophrenia.

Jue believes strongly in the value of peers working in InSHAPE programs. Johnson says many of the clients with whom he works don't take long to embrace a fitness regimen, even if they've been sedentary for a time. "They say, 'This is the best hour of my day,'" Johnson says.

Brian Storm, 42 and diagnosed with bipolar disorder, has been participating in InSHAPE for more than six months, and now meets with his health mentor once a week at the University of Michigan fitness center. "When you've had something really rough happen in your life, this is another thing that helps you get your life together," says Storm. "The trainers teach you how to do the exercises properly, and how to repeat them in your home."

What participants exercise with isn't particularly important either, according to Burke. Access to expensive equipment is not required to help individuals improve fitness; an exercise ball can be as effective as a circuit of weight machines. When asked what constitutes the best workout regimen for this group, Burke replies, "Anything that they're willing to try."

Terry Peterson, the mother of a 33-year-old Genesee client with schizophrenia and developmental disabilities, is glad that she asked her son's case manager if a fitness program was available for him. Her son now sees his trainer twice a week at the mental health organization's wellness center, and his enthusiasm for the sessions has been a surprise. "This is going to be a program that's going to change his life," Peterson says.

Looking to the future

Jue believes that InSHAPE can help clients in service environments outside of typical CMHCs. For example, the model recently has been implemented by Mercy Behavioral Health in Pittsburgh for use at three group homes.

"The focus here is not just on physical activity but on people taking responsibility for their own diet," Jue says of the Mercy Behavioral Health adaptation. "That's challenging in a residential setting, because facilities end up dictating the residents' diet. But that doesn't teach people to take responsibility for what they eat."

InSHAPE supporters maintain that efforts to improve fitness and diet can reduce an individual's reliance on medications to manage chronic physical illnesses. Given the known, positive impact of exercise on mental well-being, it is no stretch to expect that improved exercise, diet, and fitness could affect the degree to which clients need medications for psychiatric symptom management.

New Hampshire's CMS grant to extend InSHAPE allows for an evaluation that will compare the model's trainer-based format to other, client-accessible exercise options. These results could well lead to further expansion of the model.

Despite the promise of InSHAPE or related initiatives in helping to address the physical fitness needs of mental health consumers, only a handful of CMHCs have taken steps to adopt it. Among those who have, the program has come to be seen as a moral imperative, leading its proponents to believe that ultimately, all CMHCs will have to make room for a fitness program. "This is going to become a competing priority," Jue vows.

Says Russell, "Within five years, every mental health center in the country should be doing some version of this." Then, he adds, "I hope it never comes down to [funding] InSHAPEorcase management at this agency. I don't know which way I'd go."

Shante Burke, Genesee County Community Mental Health's manager for health and wellness

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