Fusing Fitness With Mental Health Treatment in Supportive Housing and Related Settings

by David F. Brand, MSW

     In 2011, I began working as a case manager at an East Harlem supportive housing site for adults with mental illness who have experienced homelessness. I had never worked with underserved adults, and I quickly noticed that the majority of tenants experienced obesity and related issues, such as hypertension, diabetes, asthma, and joint problems. Indeed, almost every client experienced a combination of those chronic, preventable health conditions.  

     A year later, I started working at another supportive housing site, where I observed the same health issues among tenants. I later learned that people with mental illness die, on average, 25 years earlier than the general population, primarily resulting from those same chronic health problems (Parks, Svendsen, Singer, & Foti, 2006).    

     With more experience, I frequently noted the connection between physical and mental health. For example, I worked with one woman whose intense knee pain typically confined her to her apartment. Her inactivity hastened weight gain, which placed more strain on her knees. Meanwhile, her pain and inactivity combined to exacerbate her depression and diminish her self-concept. I realized that to effectively treat and assist the whole person, we social service providers must seriously consider the relationship between physical and mental health.  

     In 2013, I began facilitating a weekly “Healthy Living” group to address chronic, preventable health problems among individuals who lacked nutrition education, exercise experience, and access to exercise opportunities. Group members and I shopped for healthy, low-cost groceries; set fitness-related goals; and toured local gyms. However, I saw the need to provide more comprehensive preventive health programs for people in supportive housing. A year later, I earned my certification as a personal trainer, so I could fuse fitness and mental health programs for individuals in supportive housing and similar settings. 

     While I was attending NYU for my MSW, Lantern Community Services hired me to facilitate fitness programs at two of the agency’s sites. Lantern operates several supportive housing sites throughout New York City and has demonstrated its commitment to preventive wellness programs for community members.  

     As a fitness consultant, I provide personal training for residents and lead exercise classes for clients and staff. I offer informal counseling and collaborate closely with the social service teams at each site to best serve clients. The individuals with whom I work have pursued exercise to support their substance use recovery goals, developed strong relationships with their neighbors, and achieved health goals, such as weight loss and stable blood pressure.

Four Attributes of an Effective Program

     During the past year, I have identified four core attributes of the programs that effectively foster an atmosphere of health within the community and that enable individuals to attain their physical health, mental health, and recovery goals. 

     First, the programs provide preventive, holistic healthcare by addressing chronic health problems proactively—a key to improving quality of life and reducing emergency room visits.   

     Second, the programs fuse fitness with mental health in a setting that contrasts the traditional seated, face-to-face counseling experience. The transference experience is quite different when a client and worker chat while pedaling stationary bicycles next to one another. Individuals often seem more comfortable talking while exercising and frequently share information with me that they have not yet talked about with their social workers or case managers. For example, a client recently disclosed to me how his family dynamics influence his substance use while he rested between sets of 10 push-ups. I am able to discuss such experiences with clients and encourage them to share these issues with their social workers.   

     Third, they pay attention to clinical evidence that indicates that exercise serves as an effective tool in the substance abuse intervention toolkit by affecting the brain’s reward system and serving as a positive, non-drug reinforcer (Smith & Lynch, 2012). In a practical sense, exercise provides a structured alternative to substance use during the period in which one prepares for and engages in it.  

     Fourth, exercise programs build community among staff and tenants and promote egalitarianism in the client-worker relationship. Typical barriers disintegrate when a case manager and client try to complete one last squat or shoulder press together.

Expanding Health Consciousness

     Fortunately, one need not be a certified personal trainer to integrate fitness initiatives at a supportive housing site, shelter, day program, or other social service setting. Here are a few ideas for organizations or individuals to promote fitness and nutrition:

Staff can seek client feedback about what types of fitness and wellness programs they would like to pursue at their sites.

• Social workers and other staff can provide counseling or case management while walking with clients. 
• Staff can integrate specific, measureable, attainable, relevant and time-bound (SMART) exercise and nutrition goals into service plans and document these goals. 
• Staff can obtain low-cost pedometers or encourage clients to download free step-counter apps on their phones to promote walking and movement
• .Staff can work with clients to enlist family members and other collateral contacts as a support system in attaining health goals. 
• Agencies can promote exercise initiatives shared by staff and clients. At Lantern, for example, I create a monthly “fitness challenge” calendar on which clients and staff members mark how many days they exercise. Staff and clients recognize and reward participants during monthly community meetings.
• Agencies can designate an exercise space and provide sample exercises for clients and staff. 
• Agencies can post ideas throughout their buildings for small behavioral adjustments, like taking the stairs instead of the elevator once a day or getting off the bus one stop earlier than usual.Agencies can host convenient nutrition and exercise trainings on-site for clients and staff.
• Agencies can connect with local gyms, especially large franchises, to provide free or discounted rates and training for clients.

     As we social service providers consider how to best assist individuals and improve their quality of life, we must overcome the notion that physical and mental health are separate domains. Instead, we must foster a teamwork approach among clients and staff as we promote opportunities to address physical and mental health needs. 

References

Parks, J., Svendsen, D., Singer, P., & Foti, M. (2006). Morbidity and mortality in people with serious mental illness. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council Technical Report (13). Retrieved from http://www.nasmhpd.org/sites/default/files/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf 

Smith, M., & Lynch, W. (2011). Exercise as a potential treatment for drug abuse: Evidence from preclinical studies. Frontiers in Psychology, 2 (82). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276339/ 

David F. Brand, MSW, is a social worker, writer, and certified personal trainer with several years of experience working in supportive housing. David collaborates with community members to facilitate programs that fuse fitness with counseling at supportive housing sites throughout New York City. He earned his Master of Social Work from New York University’s Silver School of Social Work in 2016.