INTRODUCTION:School resilience focused programs have been identified as a possible method of improving health behaviours; however, few trials have been conducted to determine the effect of such comprehensive programs on adolescent physical activity and healthy eating practices. The aim of this trial was to determine the effect of a school-based resilience intervention on student physical activity levels and fruit and vegetable consumption. METHODS:A three-year exploratory cluster-randomised controlled trial of students in Australian secondary schools was conducted to determine the effectiveness of a pragmatic universal intervention targeting a range of student resilience protective factors grouped according to the Health Promoting Schools framework, in improving student physical activity and fruit and vegetable consumption. Data regarding physical activity, fruit and vegetable consumption, and resilience protective factors was collected. FINDINGS:No significant differences were found at follow-up between intervention and control students for any health risk physical activity: mean difference (MD) -40.7, 95% confidence interval (CI) -94.3,13.0, p = 0.14; fruit serves: MD 0.01, 95% CI -0.20, 0.22, p = 0.95; vegetable serves: MD -0.07, 95% CI -0.24, 0.11, p = 0.44; or resilience protective factor outcomes (individual: MD -0.01, 95% CI -0.07, 0.06, p = 0.87; environmental: MD -0.02, 95% CI -0.09, 0.06, p = 0.67). CONCLUSIONS:This resilience intervention was not effective in improving the physical activity, fruit and vegetable consumption, or resilience protective factors of students. SO WHAT?: Further research is warranted to determine the specific resilience protective factors that may be most effective for these outcomes, given the significant policy and practice potential this approach has. Trial Rregistration: ACTRN12611000606987.

The language used to describe and discuss mental ill-health continues to evolve and improve, driven by advocacy and commitment to reducing the harmful effects of stigma. However, from a lived experience perspective, room for improvement remains. This project aimed to explore the use of language and labels within the mental health sector and its impact on people with lived experience of mental ill-health. Interviews were conducted with mental health consumers and/or carers (n = 15), and co-researchers with lived experience of mental ill-health contributed researcher positionality to the research. Six themes were generated using reflexive thematic analysis; they accented how participants expressed complex and nuanced experiences of language and labels, and the overlapping themes highlight the ‘blurry edges’ when people with lived experience discuss language, with the individual at the centre. Responses reflected the nature of inclusive and exclusive language in the medical system and the community. Central to experiences of exclusion were times when people felt dismissed and misunderstood due to the language and labels others use and how the words are delivered. These negative experiences reflect the influence of stigma. Positive language provides validation, understanding and a sense of hope. Health professionals may have opportunities to apply more personalised communication approaches, which could improve outcomes for the people they support.

BACKGROUND:Mental health community managed organisations (CMOs) are well placed to provide preventive care, including behaviour change conversations to address smoking, nutrition, alcohol and physical activity (snap). This study evaluates the impact of co-developed preventive care implementation support strategies, including Healthy Conversation Skills (HCS) training on CMO staff attitudes and perceptions relating to preventive care for snap behaviours. METHODS:A non-randomised controlled pilot trial was undertaken (October 2021-May 2022) with two branches of a mental health CMO (n = 1 target; n = 1 control) in NSW, Australia. Target group staff received a three-month implementation support package co-developed by staff and researchers, including HCS training and educational materials. Staff from both groups completed an online survey at baseline and follow-up, reporting barriers and facilitators and perceived individual and organisational ability to provide preventive care for each behaviour. Pre and post HCS training, target staff completed surveys reporting barriers and facilitators to having behaviour change conversations, and competency of using 'open discovery questions' (a key HCS skill). RESULTS:Baseline (n = 27) and follow-up (n = 17) surveys showed mean scores increased for the target group and decreased for the control group for n = 4/8 barrier and facilitator outcomes, and n = 7/8 perceived individual and organisational ability of providing care outcomes. Sixteen target group staff participated in HCS training and surveys, with scores improving for skills (p = 0.0009), beliefs about capabilities (p = 0.0035), intentions (p = 0.0283), participant confidence (p = 0.0043), perceived usefulness (p = 0.004), and competence in using open discovery questions (p < 0.0001). CONCLUSIONS:This pilot trial demonstrates the feasibility and potential effectiveness of a co-developed implementation support package at increasing mental health CMO staff capacity to provide preventive care for multiple health behaviours. SO WHAT?: This evidence can inform future research trials and health policy aimed at supporting CMO staff in delivering comprehensive preventive care.

BackgroundTelephone support services are a viable means of providing population-level support to reduce health risk behaviours. While research exists on the effectiveness of Quitlines to reduce smoking, there is limited other research investigating whether telephone services can provide effective behaviour change support for people with a mental health condition for behaviours including physical activity, healthy eating, and weight management. The aims of this trial were to evaluate the effectiveness of referral of people with a mental health condition to a population-level telephone coaching service to improve health risk behaviours and increase attempts to do so.MethodsA parallel-group randomised controlled trial was conducted. Participants with a mental health condition (N = 681) were assigned to a control (health information pack) or intervention group (information pack and referral by the research team to a coaching program). Data were collected via telephone surveys at baseline and six months post-recruitment. Primary outcomes were: (1) weekly minutes of moderate-to-vigorous physical activity, (2) daily fruit serves, (3) daily vegetable serves, and (4) attempted behaviour change/weight loss (yes/no; composite measure). Secondary outcomes included weight, Body Mass Index (BMI), and attempts to change each health behaviour individually.ResultsIntention-to-treat analyses found no significant differential change between groups from baseline to six months for primary or secondary outcomes. By follow-up, 242/549 (44%) of intervention participants had enrolled in coaching and completed at least one call, with 16/242 having completed the program, 79 ongoing, and 147 withdrawn. Per-protocol analyses found attempting to improve at least one health behaviour/lose weight was significantly greater in enrolees (OR = 3.7, 95% CI 1.03-13.23) than the control group.ConclusionsReferral to the program did not improve risk behaviours or weight/BMI but did support behaviour change attempts. Contributing factors may include low program completion by follow-up and impact of COVID-19. Further research is required to better understand participation in and benefits of telephone coaching services for people with a mental health condition.Trial registrationRegistered retrospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12620000351910).

INTRODUCTION:PhysiCards have been co-designed to support an interactive, person-led approach to help people with mental health conditions identify and respond to cardiovascular disease and other physical health concerns. This study aimed to test the effectiveness of PhysiCards in assisting people accessing support from a community-managed mental health organization to identify and take action to address cardiovascular disease and other physical health concerns. METHODS:This study was a parallel-group RCT. Participants (aged ≥18 years; N=154) were people accessing Flourish Australia services in New South Wales, Australia. Participants were randomly allocated to a control (physical health concerns discussed in line with usual support) or intervention condition (usual care and offered PhysiCards) delivered in a single session. Main outcome measures were assessed through support worker records of allocation delivery and participant self-report telephone surveys at baseline and 1-week and 4-month follow-ups (September 2022 to January 2024). Analysis was conducted in 2025. Primary outcomes were identifying at least 1 concern participants wanted support for that was a physical health concern, cardiovascular disease prevention concern, new (i.e., not previously raised with a health professional) physical health concern, and new cardiovascular disease prevention concern. Secondary outcomes included discussing a concern with a health professional, confidence to raise concerns, and acceptability of PhysiCards. RESULTS:The intervention group participants were significantly more likely to identify that they wanted support for a physical health concern (OR=16.7; 95% CI=5.14, 54.24, p<0.001), cardiovascular disease-related concern (OR=7.89, 95% CI=2.91, 21.39, p<0.001), and new health concern (OR=7.40, 95% CI=2.28, 24.05, p<0.001). PhysiCards were rated as highly acceptable. There was no significant difference in discussing concerns with a health professional or confidence in raising concerns. CONCLUSIONS:PhysiCards were effective in supporting people to identify cardiovascular disease and other physical health concerns. Future research is needed to consider additional strategies to enhance their impact on care seeking.

Abstract Background Historically, researchers have been apt at conducting research on, rather than with, the people who are the focus of their efforts. Such approaches often fail to effectively support and benefit the populations they are intended to. This study aimed to explore the preferences of people with lived experience for engagement with research either as research participants within studies, or through active involvement in mental health research. Methods Data for this paper were collected in three separate lived experience agenda‐setting studies conducted over a 9‐year period from 2013 to 2022; two group discussions and an open‐ended online survey. Data were combined and thematic analysis undertaken. Results Participants described the inclusion of lived experience as a critical ingredient and the highest level of knowledge and expertise in mental health research that should lead to knowledge generation and research agendas. Participants discussed the importance and value of research that enables sharing experiences and stories, expressed a need for flexibility in research methods for choice and agency, and support for greater active involvement of people with lived experience across all stages of research. Participants also spoke to the need for perspective and knowledge generated from people with lived experience to have equal power in research, making space for lived experience voices across multiple aspects of research, and greater respect and recognition of the value of lived experience. Conclusion Lived experience in mental health research is coming of age, but dedicated, cocreated development is needed to get it right. People with lived experience increasingly understand the value their experiential knowledge brings to the mental health research effort, and describe a wide range of ways that researchers can support them to be research participants, and to get actively involved. Power‐sharing, respect and recognition of lived experience as central to effective mental health research are the keys to ‘keeping it real’. Patient or Public Contribution People with lived experience of mental health problems or distress either personally, and/or as carers, family and kinship group members, were involved in the coideation and codesign of this research. All authors identify as people with lived experience.

Meta-analyses of mindfulness-based interventions (MBIs) in schools consistently show small, positive effects, but the field remains dominated by studies with low methodological rigour. Recent large randomised controlled trials in adolescents demonstrate poor traction in this age group together with some adverse effects, creating a crossroads for their future. In their recent commentary on the null effects of the MYRIAD trial (Kuyken et al., 2022), Strohmaier and Bailey (2023) postulated that making mindfulness practice available within the school day may increase the dosage and benefits of MBIs for adolescents, and called for funders to direct efforts at developing and testing this approach. We agree that identifying ways to increase dose beyond weekly classroom lessons is important, but explore whether this suggestion is practical or developmentally appropriate for secondary school settings. Our commentary broadens to group together other large and moderately large RCTs that have also shown disappointing results in adolescents, and presents seven barriers that together may be compounding the lack of effect in this age group. We offer alternative suggestions for future school-based research and delivery of MBIs.

ObjectivesTo identify, characterise and broadly synthesise factors associated with child and adolescent electronic nicotine delivery systems (ENDS) and/or electronic non-nicotine delivery systems (ENNDS) ever-use and/or current use.MethodsFour electronic databases were searched from inception to 3rd June 2022. Non-experimental studies that provided quantitative factors associated with adolescent and/or child ENDS or ENNDS ever-use and/or current use were included. Factors associated with ever-use (any lifetime use) and/or current use (use in past 30 days) were included. All screening and data extraction was conducted independently by paired review authors. Frequencies for country, study design, sample size, measure of ENDS/ENNDS use and factors examined were calculated. Factors were categorised according to the Theory of Triadic Influence domains and sub-domains.ResultsThe search of electronic databases identified 4756 records, 240 of which were included. The majority of studies examined factors categorised within the Biology and Personality domain of the Theory of Triadic Influence (89.2%; 95%CI 84.6, 82.5), followed by the Social Context (50.8%; 95%CI 44.5, 57.2) and Broader Environment domains (30.4%; 95%CI 24.6, 36.3). The proportion of factors significantly associated with ENDS/ENNDS use was >75% for the Behavioural (78.0%; factors included use of tobacco, other drugs and alcohol), Peer Attitudes and Behaviours (80.0%; factors included peer use of ENDS/ENNDS and tobacco), and Legislation/Policy sub-domains (78.6%; factors included accessibility and advertising).ConclusionsThe evidence base on factors associated with ENDS/ENNDS use in children and adolescents is rapidly developing, predominately by research concentrated in high income regions and focused on behavioural- and personality-related factors.

ISSUE ADDRESSED People with a mental health condition are at risk of developing chronic physical disease due to smoking tobacco, inadequate nutrition, high alcohol consumption, low physical activity and poor sleep (SNAPS). Community managed organisations (CMOs) represent an opportune setting to support mental health consumers to improve their health behaviours through providing preventive care. Reporting of methods used to co-develop implementation strategies to assist CMO staff to deliver preventive care for SNAPS are scarce yet warranted. OBJECTIVES This study aims to: (1) describe a co-development workshop involving CMO staff and researchers to identify preferred implementation support strategies to help staff routinely provide preventive care; (2) describe the strategies that emerged from the workshop; and (3) report staff ratings of the workshop on four co-development principles. METHODS A three-hour co-development workshop was conducted on two occasions with staff of one CMO in New South Wales, Australia. Twenty staff participated in the workshops. RESULTS Participants generated and ranked a total of seven discrete implementation strategies within five categories (training, point of care prompts, guidelines, continuous quality improvement and consumer activation). Training for staff to have difficult conversations about behaviour change was ranked highest in both workshops. Participants rated the workshops positively across four co-development principles. CONCLUSIONS The co-development workshop enabled implementation strategies to be developed within the context in which they were to be delivered and tested, potentially increasing their feasibility, acceptability, appropriateness and impact. SO WHAT?: Implementation strategies selected from the workshops will inform a pilot implementation support trial to assist CMO staff to provide preventive care to people with mental health conditions.

Background There are significant challenges in ensuring sufficient clinician participation in quality improvement training. Clinician capability has been identified as a barrier to the delivery of evidence-based care. Clinician training is an effective strategy to address this barrier, however, there are significant challenges in ensuring adequate clinician participation in training. This study aimed to assess the extent of participation by antenatal clinicians in evidence-based training to address alcohol consumption during pregnancy, and to assess differences in participation by profession. Methods A 7-month training initiative based on six evidence-based principles was implemented in a maternity service in New South Wales, Australia. Descriptive statistics described participation in training (% attending: any training; six evidence-based principles of training; all principles). Regression analyses examined differences by profession. Results Almost all antenatal clinicians participated in some training (182/186; 98%); 69% participated in ≥1 h of training (μ = 88.2mins, SD:56.56). The proportion of clinicians participating in training that satisfied each of the six principles ranged from 35% (training from peers and experts) to 82% (training was educational and instructional). Only 7% participated in training that satisfied all principles. A significantly higher proportion of midwifery compared to medical clinicians participated in training satisfying five of the six training principles. Conclusions A training initiative based on evidence-based principles resulted in almost all clinicians receiving some training and 69% participating in at least 1 h of training. Variability between professions suggests training needs to be tailored to such groups. Further research is required to determine possible associations with care delivery outcomes. Trial registration Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017).

Background People with a mental health condition experience an elevated risk of chronic disease and greater prevalence of health and behaviours. Lifestyle interventions aim to reduce this risk by modifying health behaviours such as physical activity and diet. Previous reviews exploring the efficacy of such interventions for this group have typically limited inclusion to individuals with severe mental illness (SMI), with a focus of impact on weight. This review assessed the efficacy of lifestyle interventions delivered in community or outpatient settings to people with any mental health condition, on weight, physical activity and diet. Methods Eligible studies were randomised or cluster-randomised controlled trials published between January 1999 and February 2019 aiming to improve weight, physical activity or diet, for people with any mental health condition. Two reviewers independently completed study screening, data extraction and assessment of methodological quality. Primary outcome measures were weight, physical activity and diet. Secondary outcome measures were body mass index (BMI), waist circumference, sedentary behaviour and mental health. Where possible, meta-analyses were conducted. Narrative synthesis using vote counting based on direction of effect was used where studies were not amenable to meta-analysis. Results Fifty-seven studies were included (49 SMI only), with 46 contributing to meta-analyses. Meta-analyses revealed significant (< 0.05) effect of interventions on mean weight loss (−1.42 kg), achieving 5% weight loss ( OR 2.48), weight maintenance (−2.05 kg), physical activity (IPAQ MET minutes: 226.82) and daily vegetable serves (0.51), but not on fruit serves (0.01). Significant effects were also seen for secondary outcomes of BMI (−0.48 units) and waist circumference (−0.87cm), but not mental health (depression: SMD −0.03; anxiety: SMD −0.49; severity of psychological symptoms: SMD 0.72). Studies reporting sedentary behaviour were not able to be meta-analysed. Most trials had high risk of bias, quality of evidence for weight and physical activity were moderate, while quality of evidence for diet was low. Conclusion Lifestyle interventions delivered to people with a mental health condition made statistically significant improvements to weight, BMI, waist circumference, vegetable serves and physical activity. Further high-quality trials with greater consistency in measurement and reporting of outcomes are needed to better understand the impact of lifestyle interventions on physical activity, diet, sedentary behaviour and mental health and to understand impact on subgroups. Systematic review registration PROSPERO CRD42019137197

People living with mental health conditions experience a significantly reduced life expectancy compared to people without, largely linked to health risk behaviours and associated chronic disease. Community managed organisations (CMOs) represent an important setting in which to address health risk behaviours among people with mental health conditions. However, little is known about how these behaviours (smoking, poor nutrition, alcohol consumption, inadequate physical activity, poor sleep: SNAPS) are being addressed in this setting. One-on-one, semi-structured telephone interviews were conducted with a sample of 12 senior staff, representing 12 CMOs in New South Wales, Australia to: (1) explore types of support provided by CMOs to address the SNAPS behaviours of consumers living with a mental health condition; and (2) assess perceived organisational and staff level barriers and facilitators to providing such support. Transcribed interviews were analysed using inductive thematic analysis. This study found there was a range of supports offered by CMOs, and these differed by health risk behaviour. Findings suggest CMOs are well-placed to embed SNAPS supports as a part of their service provision; however, available funding, consistency of supports, workplace policies and culture, collaboration with other available supports, staff training and education, all impacted capacity.

Preventive care to address chronic disease risk behaviours is infrequently provided by community mental health services. In this cluster-randomised controlled trial, 12 community mental health services in 3 Local Health Districts in New South Wales, Australia, will be randomised to either an intervention group (implementing a new model of providing preventive care) or a control group (usual care). The model of care comprises three components: (1) a dedicated 'healthy choices' consultation offered by a 'healthy choices' clinician; (2) embedding information regarding risk factors into clients' care plans; and (3) the continuation of preventive care by mental health clinicians in ongoing consultations. Evidence-based implementation strategies will support the model implementation, which will be tailored by being co-developed with service managers and clinicians. The primary outcomes are client-reported receipt of: (1) an assessment of chronic disease risks (tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol use and physical inactivity); (2) brief advice regarding relevant risk behaviours; and (3) referral to at least one behaviour change support. Resources to develop and implement the intervention will be captured to enable an assessment of cost effectiveness and affordability. The findings will inform the development of future service delivery initiatives to achieve guideline- and policy-concordant preventive care delivery.

Background Clinical guideline recommendations for addressing modifiable risk factors are not routinely implemented into preconception and antenatal care. This review assessed the effectiveness of implementation strategies in improving health professional provision of preconception and antenatal care addressing tobacco smoking, weight management and alcohol consumption. Methods A systematic review of randomised and non-randomised studies with a parallel comparison group was conducted. Eligible studies used implementation strategy/ies targeted at health professionals to improve at least one element of preconception and/or antenatal care (smoking: ask, advise, assess, assist, arrange; weight/alcohol: assess, advise, refer) compared to usual practice/control or alternative strategies. Eligible studies were identified via CENTRAL, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL and other sources. Random-effects meta-analyses were conducted where appropriate, with other findings summarised using the direction of effect. The certainty of the pooled evidence was assessed using the GRADE approach. Results Fourteen studies were included in the review. Thirteen were in the antenatal period and 12 tested multiple implementation strategies (median: three). Meta-analyses of RCTs found that implementation strategies compared to usual practice/control probably increase asking (OR: 2.52; 95% CI: 1.13, 5.59; 3 studies; moderate-certainty evidence) and advising (OR: 4.32; 95% CI: 3.06, 6.11; 4 studies; moderate-certainty evidence) about smoking and assessing weight gain (OR: 57.56; 95% CI: 41.78, 79.29; 2 studies; moderate-certainty evidence), and may increase assessing (OR: 2.55; 95% CI: 0.24, 27.06; 2 studies; low-certainty evidence), assisting (OR: 6.34; 95% CI: 1.51, 26.63; 3 studies; low-certainty evidence) and arranging support (OR: 3.55; 95% CI: 0.50, 25.34; 2 studies; low-certainty evidence) for smoking. The true effect of implementation strategies in increasing advice about weight gain (OR: 3.37; 95% CI: 2.34, 4.84; 2 non-randomised studies; very low-certainty evidence) and alcohol consumption (OR: 10.36; 95% CI: 2.37, 41.20; 2 non-randomised studies; very low-certainty evidence) is uncertain due to the quality of evidence to date. Conclusions Review findings provide some evidence to support the effectiveness of implementation strategies in improving health professional delivery of antenatal care addressing smoking and weight management. Rigorous research is needed to build certainty in the evidence for improving alcohol and weight gain advice, and in preconception care. Trial registration PROSPERO-CRD42019131691.

Internationally, the mental health of children and adolescents is undoubtedly an important construct of theoretical, clinical, and policy level concern. Worldwide, five mental disorders (depression, alcohol misuse, bipolar affective disorder, schizophrenia, and obsessive-compulsive disorder) represent half of the 10 leading causes of disability and premature death; with mental disorders accounting for 15–30% of disability adjusted life years in the first three decades of life. This provides a solid rational founded in implications for population health as to why reducing and preventing mental health problems in children and adolescents deserves attention. Past research has indicated interventions focussed on building resilience through strengthening protective factors may offer the potential to address mental health problems in children and adolescents, and in particular aid in reducing such problems during times of increased risk or adversity. With childhood and adolescence being critical periods of development, there is a need to reflect on the strengths and limitations of resilience-focussed interventions and anticipated future needs of the world’s youth. This conceptual analysis identifies a number of future research directions that may meaningfully add to the evidence base and improve implementation, evaluation, and impact of resilience-focussed interventions. These largely relate to refining the understanding of how resilience protective factors relate to mental health problems in children and adolescents. Important issues and potential opportunities to improve the related research field include improved reporting of intervention content; improved measurement of resilience protective factors in intervention trials; continued reporting and review of evidence of association between protective factors and mental health outcomes; and incorporation of mediation analysis within intervention trials. There is a need for further intervention studies in this space to be conducted as rigorous trials of resilience-focussed approaches based on such evidence of association, with clearly posited mechanisms of change, and inclusive of analysis of differential intervention effects. The suggested implications for research made in this conceptual analysis will aid in improving the quality of the evidence base relevant to the fostering of resilience and prevention of mental health problems in children and adolescents.

There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of DHIs are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. The aim of this review is to describe the association between DHI engagement and dietary intake. A systematic search of four electronic databases and grey literature for records published before December 2019 was conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). From 10,653 citations, seven studies were included. Five studies included usage measures of engagement and two examined subjective experiences. Narrative synthesis, using vote counting, found mixed evidence of an association with usage measures (5 of 12 associations indicated a positive relationship, 7 were inconclusive) and no evidence regarding an association with subjective experience (both studies were inconclusive). The findings provide early evidence supporting an association between measures of usage and dietary intake; however, this was inconsistent. Further research examining the association between DHI engagement and dietary intake is warranted.

This Evidence Snapshot, commissioned by the Australian Commission on Safety and Quality in Health Care, identifies evaluated interventions targeting lifestyle risks and behaviours that reduce the risk of chronic disease for adults with disability. A range of intervention strategies were found, focusing on different risks. Of these, the reviewers found good evidence to support the following strategies: consumer education and resources, individualised goals and activities, practical support, involving family/unpaid carers, and staff training. The Snapshot is one of three rapid reviews funded by the NDIS Quality and Safeguards Commission examining effective strategies to improve the health of people with disabilities.

The COVID-19 pandemic has resulted in various challenges for child and adolescent mental health researchers, and particularly for those at the beginning of their career. We emphasise the challenges and opportunities from the individual perspective of trainee psychiatrists, psychologists, and doctoral or post-doctoral scholars in child and adolescent mental health from diverse settings across the globe.

This Evidence Check commissioned by NSW Ministry of Health aimed to evaluate delivery of physical health interventions for people living with a mental illness, delivered though community mental health programs. The review found that sufficient evidence exists to support a number of interventions, with further evaluation; and identified and describes key characteristics for effectiveness such as duration of the intervention and mode of delivery (e.g. face-to-face or telephone, group or individual). The supported interventions and/or actions included: multi-strategy lifestyle behaviour change interventions; care delivery models including peer-led self-management and staff delivered interventions; integration of new physical health care models or initiatives; referral to other services (e.g. telephone Quitline); assessing barriers and enablers prior to implementation; and the involvement of peer workers and consumers in design and delivery.

Clinical practice guidelines direct mental health services to provide preventive care to address client chronic disease risk behaviours, however, this care is not routinely provided. The aim of this systematic review was to synthesise evidence regarding the effectiveness of interventions to increase provision of preventive care by mental health services; by care element (ask, assess, advice, assist, arrange) and risk behaviour (tobacco smoking, poor nutrition, harmful alcohol consumption, physical inactivity). Electronic bibliographic databases, Google Scholar, relevant journals, and included study reference lists were searched. Eligible studies were of any design with a comparison group that reported the effectiveness of an intervention to increase the provision of at least one element of preventive care for at least one risk behaviour in a mental health setting. Twenty studies were included, most commonly examining smoking (n = 20) and 'ask' (n = 12). Meta-analysis found interventions involving task shifting were effective in increasing smoking 'advice' (n = 2 RCTs; p = 0.009) and physical activity 'advice' (n = 2 RCTs; p = 0.002). Overall, meta-analysis and narrative synthesis indicated that effective intervention strategies (categorised according to the Effective Practice and Organisation of Care taxonomy) were: task shifting, educational meetings, health information systems, local consensus processes, authority and accountability, and reminders. The most consistent findings across studies were with regard to preventive care for smoking, while conflicting or limited evidence was found regarding other risk behaviours. While further rigorous research examining key risk behaviours is recommended, the findings may inform the selection of strategies for future interventions and service delivery initiatives.