When it comes to your eating habits, “small changes can have a big impact,” says CAMH Dietitian Kelly Matheson.
She’s seen too many mental health clients put their physical health on the backburner while they work towards recovery; and major changes in diet may not be realistic. So she’s a big believer in small but significant steps to better health.
“Our clients have even more complex needs. That’s because their mental health condition, or medications they are on, may cause cravings” says Kelly, one of six Registered Dietitians working at CAMH. She is responsible for providing dietary expertise to about 100 clients in the Complex Mental Illness (CMI) Program.
Cravings for sugar, and stimulants like caffeine, are common because they may temporarily counteract feelings of lethargy related to a client’s condition or meds, she says. At the same time, those craved foods may also contribute to chronic disease such as diabetes, high cholesterol and blood pressure, or weight issues.
Soda pop alternatives: CAMH Registered Dietitian Kelly Matheson helps clients make their own alternatives to sugar-rich soda pop with healthy ingredients such as spring water and fruit.
“My role is to work with clients to help them identify realistic changes that can improve their energy level, mood and overall health,” says Kelly, who is also a Certified Diabetes Educator. “I see this as a harm reduction approach.” She gives several examples:
- One woman Kelly assisted was living in a boarding house that served large portions of carb-heavy foods such as rice and potatoes. “We talked about options for a more balanced meal. She realized she could take a smaller serving of potatoes and add some vegetable portions by keeping baby carrots and cherry tomatoes in the fridge.”
- Kelly worked with a male client who agreed to step down a level on the “triple-sugar-triple-cream” coffees he was drinking several times a day. “I passed him in the park later. He had a coffee in his hand and he waved to me and shouted: “Double-Double!”
- Some of her clients have created substitutes for sugar- and caffeine-rich soda pop by adding their own favourite fruits, such as orange or lemon, to spring water. Kelly also helps clients take control over portions – for example by requesting a smaller portion, even for a fast food meal.
Kelly recently presented to a conference for Family Health Team (FHT) Dietitians across Ontario. Her focus was to increase their knowledge and comfort level when they assist patients with a mental illness or addiction.
Kelly told conference participants about some of the complexities faced by mental health clients when it comes to food. In addition to cravings for sugar and caffeine, these include food delusions or phobias, and food insecurity related to homelessness or unstable housing. As well, mental health clients may experience emotional eating related to stress. Co-existing conditions like addiction can also create challenges.
Three key factors in healthy eating
Kelly takes a three-pronged approach with her clients to look at:
1) Timing and frequency of meals -- the importance of eating every 4 to 6 hours, versus eating when Hungry, Angry, Lonely or Tired (the HALT principle)
2) What you eat – the importance of fibre and protein, prioritizing water for hydration, and reading the fine print on ingredients
3) How much you eat – emphasizing variety and portion sizes for heath.
Kelly says she sometimes has to challenge clients on a diet that they are trying – providing evidence-based advice about nutrition elements they may be missing. A gluten-free diet, for example, lacks fibre, exacerbating constipation that some clients may experience related to their meds. In this case, Kelly would look at ways to add fibre back to the person’s diet.
Finding the right balance: Kelly -- at right, with colleagues Danielle Clemmet, Behaviour Therapist (centre) and Kiera Marshall, Social Worker (left) -- uses plastic food models to speak with clients about food content and portion size.
Kelly also provides group sessions such as the Encore program, which equip CAMH clients with better knowledge about food, how to purchase and prepare it.
Addressing special needs for clients’ nutrition
She coordinates some special dietary needs, in teamwork with CAMH Dietary Services. These may be related to therapeutic diets for clients aimed at lowering cholesterol, as well as vegetarian diets and faith-based needs such as Halal and Kosher diets.
When a client leaves CAMH, Kelly aims to refer them to a community Family Health Team, Community Health Centre, or Diabetic Education Centre (DEC), to ensure continuity of care for their nutrition.
To keep up to date, she participates in an e-mail group of six CAMH Dietitians in the CAMH CMI and Addictions groups, to share practice questions, discuss referrals, and look at strategies.
When it comes to nutrition, it pays to sweat the small stuff, says Kelly.
“We know we won’t be perfect every day, but when we have a choice, small changes can make a big improvement in our health over the long term.”