“Physiotherapy in mental health aims to optimise wellbeing and empower the individual by promoting functional movement, movement awareness, physical activity and exercises, bringing together physical and mental aspects.”

This is how the International Organisation for Physical Therapists in Mental Health (IOPTMH) describes the important role physiotherapy plays in promoting positive mental health.

According to John Feneley, NSW Mental Health Commissioner, the World Health Organisation dictum ‘no health without mental health’, also rings true when flipped around.

“No mental health without health -  I think those words still ring true,” Mr Feneley wrote in his comments in the NSW Mental Health Commission document, Physical health and mental wellbeing: evidence guide.

“It is very hard to stay psychologically healthy when our bodies let us down.

“Poor physical functioning may mean we cannot fully occupy the roles we choose for ourselves, or participate in the activities we would otherwise wish to. Poor physical health may prompt distress and lead to mental illness, directly or indirectly.

“While there have been gains made in physical health and life expectancy generally, the physical health of people who experience mental illness has traditionally received relatively little attention.”

Which is why Chair of the Australian Physiotherapy Association Mental Health Group, Associate Professor Joanne Connaughton, says the APA is calling for recognition and increased inclusion of physiotherapists as a valued member of any mental health team.

“The impact we can have on mental health conditions is related to the improvements in physical health that we can provide with treatment and the strong link between poor physical health and mental health problems,” says Associate Professor Connaughton.

“Throughout Australia and the world, physiotherapists can work with people who have mental illness either by providing services in a dedicated mental health facility or by treating people in the general health setting (hospitals, aged care facilities, disability services, private practice and more) who have a comorbid mental illness.”

Associate Professor Connaughton says while everyone with a mental illness can develop all physical health problems that a person without mental illness can develop, research has shown the person with mental illness has increased morbidity and mortality from preventable diseases, because they are not accessing appropriate treatment.

“People with serious mental health conditions often perceive insurmountable barriers to accessing appropriate treatment within the general health setting.  Providing services within mental health settings may improve access.

“I believe it is important for physiotherapists to be employed in this environment because ongoing and unmanaged poor physical health could result in further compromise to their mental health.”

Associate Professor Connaughton says the following points demonstrate why physiotherapists and their services should be accessible to people with mental illness, both within the dedicated mental health facilities/services and in the wider health community.

• A person’s mental illness may impact on their physical health. For example many antipsychotic medications have a side effect of weight gain. Obesity can lead to diabetes or metabolic syndrome and in mainstream health services physiotherapists are involved in the management of people with both of these conditions. Carrying extra weight can also put more strain on joints of the back and lower limbs increasing the risk of musculoskeletal problems such as knee and back pain. Physiotherapists are experts in management of joint problems. Physiotherapists should be part of the treating/rehabilitation team of people who may have sustained tendon and/or bone injuries during attempted suicide. 
• A person’s physical illness may be the catalyst for them developing a mental illness. For example a person with MS or Parkinson’s disease is at higher risk of developing depression. Physiotherapists are integral clinicians in the management of neurological conditions. The person with COPD (Chronic obstructive pulmonary disease) has a very high risk of developing anxiety disorder, as is an elderly person who is a falls risk because of deconditioning and muscle wasting. Physiotherapy is required to help people manage and often slow the progression of these conditions which in turn may reduce associated anxiety and have positive impact on other mental health conditions. 
• There may be no connection at all. For example a person who has schizophrenia may be involved in a motor vehicle accident and sustain injuries that require physiotherapy intervention, or a person with a mental illness may sustain a sporting injury or develop arthritis and require physiotherapy treatment. Without access to appropriate physiotherapy intervention there can be long term consequences for the person including chronic pain or disability.

Associate Professor Connaughton says while physiotherapists do not treat mental illness specifically, by helping a person maintain good physical health the physiotherapist also helps them maintain or achieve better mental health.

“Exercise has been shown to assist with treatment of mild depression, however, in isolation is not effective on moderate to severe depression. In this instance exercise can be used as an adjunct to other treatments including medications and psychological therapies.”

While awareness of the impact of physiotherapy on mental illness is increasing, there is still a long way to go, according to Associate Professor Connaughton, who says there are two key things the APA would like to see happen.

1. Recognition and increased inclusion of physiotherapists as a valued member of any mental health team. Physiotherapists need to be employed in mental health services.

“They need to be someone dedicated to the position, not a physio on a three month rotation as it is important to develop and maintain a therapeutic working relationship with both clients and clinicians,” says Associate Professor Connaughton.

“An holistic approach to treating a person cannot happen if their physical health is overlooked or disregarded or if the barriers to access appropriate services are insurmountable. Having a physiotherapist as a member of the team will address this.”

2. Education across the mental health sector as to the important role physiotherapists can play in recognising, assessing and treating many physical illnesses and conditions and the impact improving physical health can have on the person with mental health problems.

“I would like to point out, I do not advocate for employment of physiotherapists at exclusion of exercise physiologists. I firmly believe both professions play an important role in assisting people with mental illness.

“While exercise physiologists (EPs) and physiotherapists are both able to prescribe exercises, my ideal world would have physiotherapists working alongside EPs and dieticians.”