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Copyright © 2016 Marion Edwards
Mental health problems affect one in four of us at some time in our lives. Depression, post traumatic stress disorder, anxiety and other problems can be triggered by personal and lifestyle pressures, such as bereavement, relationship breakdown, or job loss. They can also be the result of drug or alcohol dependency, illness or long term physical disability.
Physiotherapy has an important role to play in helping those with mental health problems. Research shows that regular exercise affects mood and increases self-esteem. Physiotherapists are able to assess people and devise a safe, enjoyable exercise programme tailored to their needs, which will help to build their mental and physical well being. They can also alleviate back pain and other physical symptoms which often accompany mental health problems by teaching relaxation techniques or by using massage and other touch related therapies.
The Mental Health Charity
WHAT ARE THE ROLES OF A PHYCHOLOGIST IN
Recent research has demonstrated a correlation between physical exercise and the reduction of anxiety and depression especially in the mental health population. Having a mental condition does not exclude one from physical complaint or injury. A patient with a mental condition can suffer from a sore neck or back, as any other person in the community. Many patients with a mental condition will experience some sort of depression, lethargy, decrease in motivation and/or self-esteem at some stage of their condition either due to the mental condition itself or side effects of the medications. As a result, these patients are more prone to suffer from back and neck problems due to poor resting, sitting and or standing postures. If fact, one of the major tasks of Physiotherapist’s working in mental health is to correct and re-educate patients to maintain a better posture.
A physiotherapist working in mental health works as an effective member of a multi-disciplinary team of doctors, psychiatrists, psychologists, pharmacists, nurses, dieticians, social workers, occupational therapists and podiatrist etc. The physiotherapist brings a breadth of assessment and treatment expertise which complements prescribed medications and psychotherapy within the multi-disciplinary team.
Physiotherapists working in the mental health settings are well able to adopt a holistic approach, retaining some of the essential simplicity and values necessary for healing of a whole person. A listening ear and therapeutic touch plus educated insight and professional proficiency can do much to help those who are in need.
Physiotherapists working in mental health provide a comprehensive range of physical approaches to treatment aimed at relieving physical symptoms, maintaining and promoting the physical as well as mental well-being of patients.
Conventional physiotherapy interventions such as ultrasound, interferential, active/passive mobilisation are used in the mental health setting as in other health institutions or settings to treat the physical conditions of the patients. From time to time, physiotherapists in mental health are required to manage patients with physical injuries related to self-harm, falls, fractures or other problems sustained while the patients are acutely unwell.
And of course, other musculoskeletal injuries such as ligamentous strain, muscle strains, postural complaints, and fractures are treated with professional expertise.
In addition, the core skills to treat other physical conditions such as those of orthopaedic, cardiopulmonary, and neurological deficits are widely utilised as well in a mental health setting.
Physiotherapists working in mental health often deal with patients with complaints of pain, acute and chronic. The physiotherapist assesses factors contributing to pain, physical functional abilities, and deals with the problems accordingly. The intervention strategies include exercise, manual therapy, movement facilitation techniques, application of electro-physical agents and education.
Exercise therapy becomes one of the major interventions physiotherapists employ in a mental health setting. Patients’ physical fitness and exercise tolerance are assessed and monitored. Exercise can be done under supervision or can be self-directed with support from the physiotherapist.
There has been much research to show that physical exercise / activity is consistently associated with positive affect and mood. Positive psychological effects from physical activity are reported in patients with mental conditions.
In order to maintain the benefits of physical exercise, the exercise needs to be done with the appropriate dosage, intensity and duration. Compliance with rehabilitation or exercise programme can be a problem for patients with a mental condition. This can be due to poor concentration, paranoia, pre-occupation, low motivation, and side effects of medications. A physiotherapist working in mental health is an educator and motivator to assist patients to engage in physical activities and exercises.
WEIGHT REDUCTION &
Weight gain is often a result of side effects of some psychotropic medications, lethargy, decrease in motivation, lack of physical activity or poor diet.
A physiotherapist in mental health is well trained to assess physical fitness profiles and devise appropriate individual exercise programmes to achieve or maintain healthy weight ranges for patients. In many hospitals, group exercise classes conducted in a physically active environment on a regular basis assist patients in weight reduction or maintenance.
Physiotherapists can help link a client into community exercise program.
There is a potential role for exercise in the treatment of schizophrenia. Physical exercise can be used to alleviate the secondary symptoms of schizophrenia such as depression, low self-esteem and social withdrawal. Physical exercise might also be useful as a form of distraction for other symptoms such as auditory hallucinations. Other benefits of exercise include improved behaviour, self-esteem and physical self-perception.
Researchers have found that at least 30 minutes of moderate intensity physical activity on most days of the week can have positive benefits to mental health. Physical activity, used alone and in combination with other treatments, is effective in the treatment of patients with mild to moderate clinical depression. The effect can be as successful as psychotherapy or medication, particularly in the longer term.
Physical exercise can also reduce trait anxiety and is comparable in effect to other forms of psychotherapy in treating anxiety.
Physiotherapists working in some mental health settings offer regular outpatient exercise classes and healthy living groups aimed at promoting the physical health and well-being of patients in the community. Some services also include home visits providing physiotherapy care for those physically or mentally unable to access the hospital. Physiotherapists are involved in linking clients into community exercise and activity groups in order to promote independent ongoing health maintenance, integration into society as well as help form associations outside of the hospital setting.
Education about needs of clients with mental health problems is considered very important and some Physiotherapists provide this information for community groups, doctors and other Physiotherapy services.
The basic 4 years professional training lays a solid foundation to enable a physiotherapist to treat and promote the physical well-being of patients. However, physiotherapists working in a mental health setting warrant extra patience, effective communication skills and “leniency” to deal with the complex working environment. Being objective, flexible and creative to use Physio Balls, gymnasium equipment, hydrotherapy and other treatment strategies are indispensable in a mental health setting.
Professional support for physiotherapists working in mental health setting is scarce. A group of physiotherapists working in mental health across different hospitals and health services in Western Australia have recently initiated a forum to share and discuss ideas, programmes, development and problems with other physiotherapists working in the same speciality.
Mental health is an area where physiotherapy is under-utilised. Physiotherapists working in mental health have a lot to offer and there is a lot of potential to further develop the services. In a mental health setting, the physical well-being of patients are often overlooked or misdiagnosed. It is equally important for a mentally unwell person to enjoy a state of physical well-being as much as possible while being treated for their mental conditions. In fact, Physiotherapists are often the first contact person to diagnose and recognise the need to further investigate certain physical ailments in patients with mental conditions. Frequently physiotherapists working in mental health are the first contact clinicians to deal with the physical complaints of patients with mental conditions.
Physiotherapists working in mental health often educate patients about the importance of adopting better postures on the physical well-being, as well as promotion of a positive sense of self-esteem. The potential positive benefits of physical exercise on different mental conditions are explained to patients, and individual exercise routines and programmes are set up.
Carers are involved in the rehabilitation process to supervise and assist home exercise programme. Physiotherapists in mental health work closely with fellow multi-disciplinary team members to promote the physical as well as the mental well-being of patients. It is essential for other team members to understand what physiotherapists can offer to patients in mental health.