A multidisciplinary weight management intervention for adults with severe mental illness in forensic psychiatric inpatient services (Motiv8): a single blind cluster-randomised wait-list controlled feasibility trial

Rebekah Carney; Heather Law; Hany El-Metaal; Mark Hann; Gemma Shields; Siobhan Savage; Ingrid Small; Richard Jones; David Shiers; Gillian Macafee; Sophie Parker

doi:10.3389/fpsyt.2024.1457864

A multidisciplinary weight management intervention for adults with severe mental illness in forensic psychiatric inpatient services (Motiv8): a single blind cluster-randomised wait-list controlled feasibility trial

Front Psychiatry. 2024 Nov 18:15:1457864. doi: 10.3389/fpsyt.2024.1457864. eCollection 2024.

Authors

Rebekah Carney^{1

2}, Heather Law¹, Hany El-Metaal³, Mark Hann⁴, Gemma Shields⁴, Siobhan Savage³, Ingrid Small³, Richard Jones³, David Shiers^{2

5

6}, Gillian Macafee¹, Sophie Parker^{1

2}

Affiliations

¹ Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
² Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom.
³ Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
⁴ Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
⁵ Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom.
⁶ School of Medicine, University of Keele, Staffordshire, United Kingdom.

Abstract

Background: People with severe mental illness experience physical health inequalities and a 15-20-year premature mortality rate. Forensic inpatients are particularly affected by restrictions on movement, long admissions, and obesogenic/sedative psychotropic medication. We aimed to establish the feasibility and acceptability of Motiv8, a multidisciplinary weight management intervention co-produced with service users for forensic inpatients.

Methods: A randomised waitlist-controlled trial of Motiv8(+Treatment-As-Usual) vs.TAU was conducted in medium-secure forensic services in Greater Manchester. Motiv8 is a 9-week programme of exercise sessions, diet/cooking classes, psychology, physical health/sleep education, and peer support. Physical and mental health assessments were conducted at baseline/10-weeks/3-months. A nested qualitative study captured participant experiences. A staff sub-study explored ward environment.

Results: We aimed to recruit 32 participants (four cohorts). The trial met recruitment targets (n=29, 90.9%; 4 cohorts, 100%), participants were randomised to Motiv8+TAU (n=12) or waitlist (control) (n=17). Acceptable retention rates were observed (93.1%, 10-weeks; 72.4%, 3-months), and participants engaged well with the intervention. The blind was maintained, and no safety concerns raised. Assessment completion was high suggesting acceptability (>90% for people retained and engaged in the study). Participants reported high levels of satisfaction.

Conclusions: The trial was not powered to detect group differences. However, data suggests it is feasible to conduct a rigorous, methodologically robust study of Motiv8 vs.TAU for adults on forensic inpatient units. Motiv8 was acceptable with potential promise providing evidence to proceed to a definitive trial for males. A larger trial is needed to explore potential effectiveness and reduce physical health inequalities for people with SMI.

Clinical trial registration: https://doi.org/10.1186/ISRCTN13539285, identifier ISRCTN13539285.

Keywords: forensic; lifestyle intervention; multidisciplinary; physical health; randomised controlled trial; secure services.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. National Institute for Health and Care Research, Research for Patient Benefit (Reference Number NIHR201482).