{"id":12308,"date":"2026-03-04T10:20:39","date_gmt":"2026-03-04T10:20:39","guid":{"rendered":"https:\/\/magazines.uthscsa.edu\/mission\/?p=12308"},"modified":"2026-03-10T18:21:10","modified_gmt":"2026-03-10T18:21:10","slug":"a-matter-of-mind-and-body","status":"publish","type":"post","link":"https:\/\/magazines.uthscsa.edu\/mission\/a-matter-of-mind-and-body\/","title":{"rendered":"A matter of mind and body: Managing mental illness and diabetes"},"content":{"rendered":"

Envisioning a future where individuals with serious mental illness and other chronic health conditions can gain the skills and support they need<\/span><\/em><\/h4>\n

 <\/p>\n

Just over 3% of occupational therapists in the U.S. specialize in behavioral health. Associate Professor Chinyu Wu, PhD, OTR<\/a>, is one of them.<\/p>\n

Occupational therapists work with people of all ages to help them achieve the activities, or occupations, of daily living that are important to them. When a person is living with serious mental illness, carrying out such everyday activities can be problematic. And that makes managing other chronic diseases even more challenging.<\/p>\n

\u201cWe have heard from clinicians as well when one condition is not addressed it is going to impact the other,\u201d Wu said.<\/p>\n

\"\"
\u201cWe see every client as an occupational being who has interests, who has values, who has preferences.\u201d \u2014 CHINYU WU, PHD, OTR<\/figcaption><\/figure>\n

Wu believes occupational therapy is the best-kept secret in behavioral health services today and noted that many people with serious mental illness who would benefit from occupational therapy services do not have access to them.<\/p>\n

\u201cWe see every client as [a unique individual] who has interests, who has values, who has preferences,\u201d Wu said. \u201cFor people with mental illness, their challenge is not related to mobility but to the impact of the mental illness that may make it not as easy to remember or to learn tasks. So, we have to consider the cognitive challenges that they acquire along with the illness.\u201d<\/p>\n

Wu envisions a future in which people with both serious mental illness and another major health condition are able to gain the skills and support they need to manage both. To help make that vision a reality, she is leading an interdisciplinary project to create Lifestyle MIND, or mental illness and diabetes \u2014 an evidence-based lifestyle intervention for people with Type 2 diabetes and a diagnosis of serious mental illness, such as major depression, bipolar disorder and schizophrenia.<\/p>\n

Type 2 diabetes has more than twice the prevalence in people with serious mental illness as in the general population, and people with serious mental health diagnoses are rarely included in research studies on diabetes \u2014 two reasons why Wu selected diabetes as the comorbid health condition on which to build the intervention.<\/p>\n

Wu wants to create an intervention that eventually can be adapted to work with serious mental illness and other chronic health conditions. Then she wants to make it available to occupational therapists near and far.<\/p>\n

The main reason Wu is working on Lifestyle MIND is that people with mental illness generally have a life expectancy from 10 to 20 years shorter than other people, and it\u2019s not because of their mental illness, Wu said.<\/p>\n

\u201cIt\u2019s because of their chronic diseases, including diabetes,\u201d she said. \u201cAnd that is not right.\u201d<\/p>\n

Lifestyle interventions <\/strong><\/span><\/h4>\n

Research shows that people with diabetes need physical activity and lifestyle change, but the comorbidity of serious mental illness adds layers of complexity.<\/p>\n

Lifestyle MIND is a 10-week, interdisciplinary in-person program featuring a weekly occupational therapy lifestyle class and a physical activity class designed to help participants build healthy habits. It incorporates trauma-informed care, motivational interviewing and cognitive adaptation training approaches so that clients are empowered to actively collaborate with occupational therapists and physical therapists to change their behaviors.<\/p>\n

With initial funding through a 2023 Community Service Learning grant from the institution\u2019s Center for Medical Humanities and Ethics, Lifestyle MIND grew out of a collaboration with Bexar County\u2019s Center for Health Care Services, which operates an integrated care clinic at Haven for Hope, a campus that offers services and care to homeless people in San Antonio.<\/p>\n

According to 2024 data from the U.S. Department of Housing and Urban Development, about 18% of people who are homeless have serious mental illness. Navigating the \u00a0healthcare system as a person with mental illness \u2014 and also as a person who is homeless \u2014 can be traumatic, explained Wu.<\/p>\n

\u201cIt requires highly skilled professionals to provide the services,\u201d said Wu. Trained professionals understand how to deliver trauma-informed care without passing judgment, she added.<\/p>\n

To date, the Lifestyle MIND program has been piloted with two cohorts of participants, all of whom have serious mental illness and diabetes and were receiving care at the integrated clinic.<\/p>\n

Wu and her research collaborators, including Department of Physical Therapy Chair and Associate Professor Bradley Tragord, PT, DPT, DSc<\/a>, are currently developing a Lifestyle MIND training manual for clinicians based on what they learned in the pilot testing of the Lifestyle MIND concept and from a mock training conducted in March 2025 led by occupational and physical therapy students from the School of Health Professions.<\/p>\n

Photovoice: A special lens <\/strong><\/p>\n

To learn more about what this population experiences and how standard diabetes education is not working for them, Wu and former student Laura Pavitt, now a Doctor of Occupational Therapy 2025 graduate, gave cameras to 10 participants with serious mental illness and Type 2 diabetes and asked them to take photos that represent their lived experience. Called photovoice, this qualitative research technique empowers participants to communicate feelings and experiences through images.<\/p>\n

\"\"
Pre-plated meals like the one below, which are often provided in a shelter setting, make it difficult to follow a healthy diet for managing diabetes.<\/figcaption><\/figure>\n

The group set about completing three photo assignments. After each assignment, they shared and discussed their photos. Their insights informed the design of Lifestyle MIND.<\/p>\n

\u201cOne thing we learned from the participants was the social determinants of health, like the pre-plated meals that they encounter on a daily basis,\u201d Wu said. She explained that pre-plated meals make it harder to stick to an ideal diet for managing diabetes.<\/p>\n

\u201cAnother thing we learned was that many of them could not afford a glucometer to monitor their blood glucose,\u201d said Wu. \u201cIf they are not monitoring, the control is not good.\u201d<\/p>\n

How it works<\/strong><\/span><\/h4>\n

Occupational therapists are trained to understand the challenges people with serious mental illness face, said Wu. The weekly occupational therapy classes in the Lifestyle MIND curriculum focus on health education, health literacy and understanding how diabetes and serious mental illness impact each other. The classes emphasize strategies for developing healthy lifestyle habits, including reading nutrition labels to inform better food choices.<\/p>\n

\u201cDuring Lifestyle MIND we worked with our clients to problem solve,\u201d Wu said. \u201cWe collaborate with our clients, [asking] \u2018What do you think would be a possible solution to the situation?\u2019\u201d<\/p>\n

One example of that problem-solving approach leads back to the plate method for diet. Wu noted that the standard diabetes education method of describing how to build a healthy plate of food doesn\u2019t work for people receiving pre-plated meals from a shelter or other organization.<\/p>\n

\"\"
The craft project of one study participant expressed the importance of staying sober in order to maintain mental wellness and manage their diabetes.<\/figcaption><\/figure>\n

\u201cWe have to do a translation,\u201d Wu said. \u201cHow does the plate method work when the person is homeless and doesn\u2019t have a choice? One solution is swap [food] with someone else.\u201d<\/p>\n

Another craft project for photovoice study participants represented the intersectionality of mental health and diabetes management. In addition to the likelihood of experiencing homelessness, this patient population is also likely to have a dual diagnosis of substance use disorder, resulting from attempts to self-medicate or counteract serious mental illness symptoms such as hallucinations.<\/p>\n

When they experienced a mental health crisis, study participants could not perform tasks for diabetes management. Similarly, the intersectionality could go the other way. When their diabetes was out of control, study participants experienced high levels of anxiety.<\/p>\n

The benefits of exercise <\/strong><\/span><\/h4>\n

For the physical activity piece of the program, Tragord and former student Kimberly Bristow, now a Doctor of Physical Therapy 2025 graduate, adapted guidelines from the American College of Sports Medicine to create 90-minute physical activity sessions tailored for a small group. Participants received a guidebook with illustrated exercises and a fitness tracker log to help monitor activities outside of class.<\/p>\n

\u201cParticipants reflected on how each week went,\u201d Tragord said of the classes. \u201cOur team of clinicians facilitated conversations highlighting successes and also some hurdles or challenges people faced.\u201d<\/p>\n

In a small group setting, individuals were able to share stories about how they would complete activities based on their environment or their own physical limitations. In class, the group worked on strength training for the upper and lower body, core exercises for the abdomen and back, balance and flexibility training and high-intensity interval training.<\/p>\n

\u201cSome of the most exciting things we looked at were not just step counts,\u201d Tragord said. \u201cWe have technology that measured the intensity of movement \u2014 so not just how many steps, but the overall vigor of that activity.\u201d<\/p>\n

The team was able to see changes in balance and speed of movement and assess other functional outcomes.<\/p>\n

\u201cThe neatest thing was to look at how much these individuals changed the amount of movement they were doing in terms of quantity and intensity,\u201d he said.<\/p>\n

The physical activity was intentionally designed to be achievable to avoid discouraging participants.<\/p>\n

\u201cWhen talking about doing exercise, that can scare away a lot of patients, including this target population of comorbid serious mental illness,\u201d Wu said. \u201cOur physical therapy faculty and students did a great job adapting and making the physical activity not as challenging, not as scary to our target population so that they are willing to come. And the physical activity portion turned out to be a component of Lifestyle MIND that our participants enjoyed so much.\u201d<\/p>\n

Looking forward <\/strong><\/span><\/h4>\n

With good attendance and retention rates among participants, Lifestyle MIND appears to be a good fit for the target population, Wu said. She, Tragord and the rest of the interdisciplinary research team, including an endocrinologist, trial scientist and statistician, are seeking additional funding to support the next phase of research, which will focus on gathering data to demonstrate the intervention\u2019s feasibility.<\/p>\n

A major focus of the next phase will be obtaining data using research-grade continuous glucose monitors, which would provide better data than the A1C readings used in the initial pilot cohorts. The continuous glucose monitors would remove one cognitive challenge faced by people with serious mental illness \u2014 remembering to test blood sugar and record readings on a regular schedule.<\/p>\n

\u201cMy vision is that people with mental illness would be able to manage their health just like other people,\u201d Wu said. \u201cWhen most people encounter a chronic disease, such as diabetes, [they] go about finding out information [and] getting to classes to learn how to manage diabetes. I\u2019m hoping people with mental illness can do exactly the same.\u201d<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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