Care for people with severe and persistent mental illness


Robyn Fary, with input from Eleanor Andrews, elaborates on the mixed methods study exploring physiotherapists’ views about providing physiotherapy services to patients with severe and persistent mental illness.

Your research examined physiotherapy for people with ‘severe and persistent mental illness’. What conditions are generally included under that term?

Severe and persistent mental illnesses (SPMI) are conditions including schizophrenia, bipolar disorder and major depression that are recurrent and that severely affect a person’s lifestyle.

You recently published a related paper on this topic. Can you summarise that study?

To answer this question, it is first very important to understand that people with SPMI are more likely to die from poor physical health than from their mental illness. Consequently, it is critical for us to understand physiotherapy involvement in managing the physical health of people with SPMI.

Our first paper on this topic (Lee et al 2017) sought to determine how the role of physiotherapists in managing the physical health of people with SPMI was perceived by mental health professionals and people with SPMI. We found that these two groups of key stakeholders had a very limited understanding about how physiotherapists could contribute to managing the physical health of this population.

Additionally, mental health professionals questioned physiotherapists’ knowledge and skill in the mental health arena, while at the same time recognising limitations in the structure of the current health system that would facilitate physiotherapist involvement. People with SPMI also reported factors such as cost, appointment times and the ability to get to appointments as barriers to physiotherapy treatment.

How does the new study differ from the previous one?

This study adds to the previous one by surveying and interviewing physiotherapists to understand their perspective of managing the physical health of people with SPMI.

Does the new study progress our understanding of this topic?

Physiotherapists clearly recognised that managing the physical health of those with SPMI was an important part of their role. However, physiotherapists, while reporting being confident managing the physical health of those without SPMI, reported limited confidence in managing the physical health of those with SPMI. In particular, there was limited understanding of specific SPMI conditions and of how to communicate with and manage those with SPMI. Further, concerns about safety, funding, and inadequate models of service delivery were highlighted.

What about barriers and enablers? What needs to change to get physiotherapy services delivered to people with SPMI?

Fundamentally, limited education in how to deal with people with SPMI is a big barrier for physiotherapists to feel confident and competent working with this clinical group. A better understanding of the characteristics and behaviours of people with SPMI would go a long way to improving services. In addition though, the current health system does not seem to accommodate the special needs of this group, with strict appointment times and short duration of appointments limiting meaningful interaction. Clearly, inadequate funding of services plays a role here. Improved funding and subsequent improvement in how physiotherapy services are delivered would enable access to physical healthcare for this group of patients.

Where can training opportunities for physiotherapists who want to work in this area be found?

Currently, there are a number of generic training opportunities and resources available to physiotherapists through organisations such as Black Dog, Beyond Blue, Australian Red Cross and the APA Mental Health group. Development of training for physiotherapist- specific contexts would be invaluable for physiotherapists to work confidently and effectively to improve the physical health of people with SPMI.

Lee et al. Limited interface between physiotherapy primary care and people with severe mental illness: a qualitative study.Journal of Physiotherapy, Volume 63, Issue 3, July 2017

Click here to read this mixed methods study, published in the Journal of Physiotherapy.

Dr Robyn Fary, APAM, (left) is a senior lecturer and physiotherapy honours coordinator at Curtin University in Western Australia.
Eleanor Andrews, APAM, is a physiotherapist at Bunbury Hospital in Western Australia.

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