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Physiotherapy support for mental illness: More than just an adjunct therapy

By Luke Spinks

The past 2 years have been extremely difficult for almost every Australian, with our communities experiencing sustained and profound hardships due to the COVID-19 pandemic. As a result, cases of major depressive disorder and anxiety disorders have increased by more than 25 per cent worldwide. But, as we settle into life with increasing stability and hope, healthcare professionals across all disciplines are well-positioned to play an important role in optimising mental health in Australia and across the world. 

I am a Team Leader and Senior Physiotherapist at KEO Care with a special interest and growing skillset in mental illness. I am extremely fortunate to be able to support participants living with psychosocial disabilities to achieve their goals by working within a multidisciplinary mental health care team.  

Physiotherapy promotes help-seeking in people experiencing mental illness

Worryingly, many people suffering from anxiety and depression disorders are reluctant to seek professional support for a range of reasons, with the two most prevalent barriers to help-seeking being stigma and distrust towards health professionals. In the context of mental health, stigma refers to when someone is marked or discredited somehow, or reduced from being a whole person to being a stereotype or labelled as a collection of symptoms or a diagnosis, and distrust towards health professionals can develop due to previous negative experiences within the healthcare system. We also know that trusted and strong relationships with healthcare professionals are known to be one of the strongest facilitators for people seeking professional support for their mental health.

By nature, physiotherapy assessments and interventions generally involve manual techniques requiring physical touch. Touch supports connectedness with others and participants indicate a deeper trust and stronger attachment with the therapist when touch is used in therapy. Participants attribute touch to creating a feeling of bond, closeness or a sense that the therapist really cares. A physiotherapist’s ability to break down barriers, establish rapport and build trust through physical touch is a unique attribute we can contribute to every mental health care team where distrust and hesitancy exist towards accessing services. Consequently, a physiotherapist’s capacity to establish a positive therapeutic relationship with individuals who have a   mental illness can promote help-seeking behaviours with other healthcare services, including psychology, social work, occupational therapy and more.

Through carefully establishing a positive therapeutic relationship with a foundation of trust and rapport, physiotherapists can proceed with supporting participants with individualised interventions to achieve their therapeutic goals.

A physiotherapist’s treatment toolkit is extensive, and in the mental health space, the following are some key examples of interventions that can be used to optimise an individual’s holistic health and wellbeing.

“Movement is a medicine for creating change in a person’s physical, emotional, and mental states.” – Carol Welch-Baril

Over the past 7+ years as a physiotherapist, I have enjoyed scripting movements and exercises to enable participants to achieve their goals. For a time, this was typically within rehabilitation programs for acute and chronic musculoskeletal injuries. Since joining KEO Care almost 3 years ago and working with participants who have a mental illness, the challenges may have changed but the goals remain largely consistent. To live a fulfilling and connected life.

When we exercise the brain releases chemicals that help to increase mood. As well as stimulating the release of these mood-enhancing chemicals, exercise also provides opportunities to access one’s local community in a meaningful way and provides an opportunity to reduce feelings of loneliness through socialisation.

As physiotherapists, we play a key role in supporting positive behaviour change, building confidence and motivation as well as improving health literacy. As educators, we use all these tools to improve participation in exercise to support optimal physical and mental health. Regular exercise helps to reduce stress, which is a major contributor not only to mental health but also impacts pain. Exercise helps to decrease symptoms of mental illness by reducing anxiety, depression, and negative mood by improving self-esteem and cognitive function.

The double-edged sword of chronic pain and mental illness

Major depression is the most common mental health condition associated with chronic pain, with 30-40% of people with a diagnosed mental illness also presenting for treatment for chronic pain.

Chronic pain is a complex sensory and emotional experience that varies widely between people depending on the context and meaning of the pain and the psychological state of the person. To put it simply, a complex interplay between cognitive/emotional factors and the brain explains why patients with long-term chronic pain may develop heightened anxiety and depression, and conversely, those with a mental illness are at increased risk of experiencing chronic pain and the amplification of pain. As physiotherapists, we are able to use our clinical, interpersonal and educational skills to meet our participants’ biopsychosocial needs to manage chronic pain and enable our participants to enjoy a vastly improved quality of life.

Let physiotherapy restore trust towards mental health support

It is well recognised that the prevalence of mental illness is on the rise in Australia, and our healthcare system is playing an important role in supporting millions of Australians, with 20% of Australians experiencing symptoms of mental illness each year. I am excited to see physiotherapists feature more prominently within multi-disciplinary care teams for people experiencing a mental illness through complex chronic pain management and exercise/movement-based therapy. And where there is a reluctance to seek professional help, physiotherapists can play a key role in re-establishing trust towards the medical system and linking people with mental illness back into the medical system when they are ready. Through advocacy and education, I look forward to raising awareness as to the benefits of physiotherapy for people experiencing mental illness, to ultimately broaden our impact as an industry and contribute to the support of Australians experiencing mental illness.

About the author

Luke Spinks is an Allied Health Team Leader and Senior Physiotherapist at KEO Care with 7+ years of experience. Luke has developed his skills across a variety of settings, including private practice (musculoskeletal focus), aged care, Indigenous health and now a community-based setting supporting NDIS participants.

Luke’s approach to physiotherapy is founded on developing a strong therapeutic relationship with participants, and his relaxed nature facilitates open and honest communication which supports holistic treatment plans to work towards collaborative, participation-based goals, and outcomes. Luke has developed a strong passion for working with marginalised communities and people experiencing hardship, leading him to establish himself as key support for NDIS participants with mental illness.