Submitted by: Tracey Clark APAM
NSW Chair
The NSW APA Mental Health committee continues to emphasise the importance of training physiotherapists to understand the awareness and impact of their clients’ mental health. Equally, the committee underscores the need to prioritise and support the mental and physical health of physiotherapists themselves.
With the updated APA Mental Health Resources page now available, physiotherapists can explore effective self-care strategies and access a range of useful websites and resources for clients.
Last month, Ellen Lake, Ryan McGrath and Sophie Shephard presented five discussion points on suicide prevention in a clinical context. Additionally, LGBTIQ+ Health Australia published state and territory-based briefing papers on LGBTQIA+ mental health and suicidality. Both initiatives highlighted the elevated mental health challenges and suicide risks among at-risk groups frequently encountered in physiotherapy practice.
Physiotherapists can actively improve client care by increasing their awareness of risk factors, using inclusive language, promoting protective factors, and leveraging available resources and referral pathways. By doing so, we can reduce client distress and discomfort while bolstering our own mental health.
According to the Australian Bureau of Statistics, three to four per cent of Australians experience suicidal thoughts each year.
Key risk factors
Physiotherapists should remain alert during assessments or as rapport develops with clients for the following risk factors:
- history of adverse childhood experiences and trauma
- mental health issues and/or alcohol and other drug use problems
- key life transitions or points of disconnection, such as leaving school, changes in foster care, retirement, exiting prison or entering aged care
- overlapping stressors and adverse life events
- discrimination, stigma and inequity
- a sense of lost value (individual, family, societal)
- loneliness and isolation
- hopelessness and emotional suffering during crises
- exposure to suicide or access to means
- persistent pain, particularly severe pain
- beginning or discontinuing opioid use.
Groups proportionately affected by suicide
Certain populations face higher suicide risks:
- Aboriginal and Torres Strait Islander peoples
- individuals with diverse sexualities and/or genders, including those who identify as LGBTIQ+
- people from culturally and linguistically diverse (CALD) communities who may experience greater exclusion, discrimination and isolation
- children and young people, particularly in foster care
- men, who may find it more challenging to seek support
- people in rural and regional communities with reduced access to services
- veterans and service members transitioning to civilian life.
Framework for suicide prevention
The NSW Mental Health Commission Framework underscores that everyone, in any setting, has a role to play in preventing suicide and providing early intervention, particularly for high-risk groups.
The framework defines suicide prevention as comprising three key components:
- Prevention and early intervention: early identification and referral to compassionate programs, services and supports.
- Aftercare and support: encouraging follow-up with the client’s general practitioner, mental health team or support programs.
- Post-suicide support: accessing 24-hour support services, such as the StandBy Support After Suicide program by calling 1300 727 247.
Supportive factors
Physiotherapists can help build protective factors for clients, such as the following:
- Encouraging meaningful work, leisure activities and future planning. Referral to occupational therapy (OT) may assist with leisure and work support.
- Facilitating access to effective mental health care. Referral to a general practitioner or specialised support groups may be appropriate.
- Strengthening community and cultural connections. Physiotherapists can support attendance at community events or help explore new opportunities.
- Promoting culturally safe and responsive services, such as ACON in NSW for the LGBTQI+ community.
- Supporting the development of life skills, including problem-solving, coping and adaptability. Referral to an occupational therapist, social worker or mental health practitioner may be beneficial.
Practical strategies for physiotherapists
- Listen actively and non-judgmentally, asking open-ended questions to assess risk levels.
- In high-risk or life-threatening situations, contact emergency services (000).
With client consent, connect them to crisis services, including:
- Lifeline: 13 11 14
- Beyond Blue: 1300 224 636
- Suicide Call Back Service: 1300 659 467
- 13YARN: 13 92 76 (for Aboriginal and Torres Strait Islander peoples).
- Support the client or their support person to follow up with a general practitioner for a mental health review or engage with their mental health practitioner.
Key actions for physiotherapists
- Radar: keep suicide risk on your radar and explore further if concerns arise.
- Resources: ensure you have critical resources and contacts readily available.
- Familiarity: familiarise yourself with services and referral pathways in your area.
- Training: consider further training, especially if you work with high-risk groups. The APA Mental Health Physiotherapy Level 1 course is an excellent resource for physiotherapists seeking to enhance their understanding of mental health issues.
Additionally, Jo Connaughton APAM and Ellen Lake have highlighted the blended learning Mental Health First Aid course, available multiple times annually. Check the APA’s website for more.
Further training opportunities
Suicide prevention:
Trauma-informed care:
References