Contribution of Physiotherapy

Physiotherapy is a rehabilitation profession concerned with identifying and maximising movement potential through education training and rehabilitation. It aims to promote the well being and autonomy of people with a physical dysfunction associated with mental and physical illness. Using a variety of evidence based therapeutic means, and by taking a holistic person centred approach we aim to influence the psychological health of individuals.

Physiotherapists in mental health are uniquely placed through their knowledge of mental health conditions and their expertise in the management of physical conditions to provide an extensive range of approaches to treatment aimed at relieving symptoms and improving quality of life. They are well placed to advise and support staff, service users and carers on both the physical manifestations of mental health conditions and on the management of physical conditions in mental health settings.

The number of physiotherapists, associated members and students in the UK now tops 42,000 with 19,139 qualified physiotherapists in employment in 2004 a rise of 6.8%. The profession is growing with more places being offered at universities for training in line with Chartered Society of Physiotherapy (CSP) target of 24,000 by 2009. It is difficult to identify the exact number of physiotherapists working in mental health at this present time, but anecdotal evidence suggests that there is an increasing demand for the role of physiotherapy in mental health as well as demand from students and staff grade physiotherapists for work placements in this area. The estimated figures are approximately 400 qualified staff and approx 500 assistants.

Universities are now also beginning to recognise the role of the physiotherapist in mental health with many delivering modules at undergraduate level as part of the core training but also extended specialist modules at postgraduate level allowing physiotherapists to enhance their skills within the field.

The development of the role of physiotherapy within mental health has been supported further by the emerging evidence related to physiotherapeutic interventions, one such key area is exercise. The publication of the consensus statements from Somerset Heath Authority following their academic symposium in January 1999, the NICE guidelines for depression (2004), Choosing Health (2004) and Health Body Health Mind (2004) have led to the recognition of exercise as an affective intervention in the management and treatment of mood disorders.

Physiotherapists working in mental health are members of the CSP. The CSP have now achieved protection of the title ‘Physiotherapist’ under the regulations of the Health Professionals Council (HPC). The HPC publishes standards of Conduct Performance & Ethics as well as Standards of Proficiency. Core standards of Physiotherapy Practice (2005), the Rules of professional Conduct (2002) and the Physiotherapy Assistants Code of Conduct are CPD advice is given by the CSP and re registration by the HPC in future will be subject to the appropriate CPD being undertaken.

Physiotherapy is provided by both qualified staff and technical instructors and assistants and is delivered across a wide range of services. These range from the traditional areas such as acute wards, community mental health teams, rehabilitation to newer areas which include early intervention psychosis teams, crisis and self harm services, eating disorder clinics, alcohol services, forensic services and assertive outreach teams as well as providing stand alone services addressing issues such as weight gain and healthy living in adult services. In old age psychiatry physiotherapists have a key role to play in falls prevention utilising physiotherapeutic interventions

but adapting programmes to meet the abilities of the clients. With dementia sufferers maintaining functional independence and newer developing roles in intermediate care and memory clinics.

The service will also provide physiotherapy treatment for clients whose mental health problems prevent them from accessing general physiotherapy services and where there is a need to understand the complexities of the sychological health in order to deliver patient centred care.

The development of new services emphasises the whole range of needs that the clients have which in turn highlights the potential role of the physiotherapist.

People with mental illness are a vulnerable and a health disadvantaged group. They often exist on low incomes and suffer from poor motivation both fitness and health limiting factors. They are at high risk of physical illness and three times more likely to die prematurely from ‘natural causes’ such as coronary heart disease, cancer and obesity. (Saving Lives- DOH Modernising Mental Health Services).

In addition prescribed medication for mental health problems, which can cause marked increased appetite and weight gain. The physiotherapists have a vital role in delivering healthy living and weight management programmes working alongside their dietetic colleagues.

Contact: Sharon Greensill - sharon.greensill@dsh.nhs.uk, or contact the Chartered Society of Physiotherapy on 0207 3066666 or visit www.csp.org.uk,

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