MENTAL HEALTH GROUP UPDATE – NOVEMBER 2024

If you would like to contribute in 2025, join our Mental Health committee by emailing Jenny Robertson.

Submitted by: Emily McIver 
APAM QLD committee member

We would like to acknowledge all the QLD Mental Health committee members who contributed in 2024. We look forward to continuing our valuable work in 2025. 

Committee members: 

• Antony Lung – returning member 
• Emily McIver APAM – returning member 
• Isabelle Kelly APAM – Incoming chair in 2025
• Isaac Bongaarts APAM – returning member 
• Richard Modderman APAM – returning member 
• Ellen Lake APAM (ex-officio, National Chair) 

Since our last communication, the QLD Mental Health committee has met three times this year, with the aim of meeting four times annually. The most recent meeting was held on 13 November 2024. 

A significant development this year was the passing of the Workers’ Compensation and Rehabilitation and Other Legislation Amendment Bill by the Queensland Parliament in August 2024. This legislation addresses the rise in psychological injury claims and introduces measures to reduce secondary psychological injuries following physical injuries. These measures ensure the provision of essential services and coverage of associated expenses to support affected workers. 

Workers with psychological injuries have been shown to take more time off work compared to those with other types of injuries. Mental health-related claims have been steadily increasing over time. In 2022–23, such claims accounted for 11 per cent of all serious claims. In 2024, 80 per cent of all serious claims involved body stressing, slips, trips, falls, being hit by moving objects, or mental stress. 

Furthermore, claims for mental stress had the highest median compensation paid, averaging $67,400, compared to $17,900 for the vehicle incidents and other injury category. If you would like to join the QLD Mental Health committee in 2025 and be part of the evolving landscape of physiotherapy in mental health, please contact the QLD Branch Manager Jody Hammel.

If you would like to contribute in 2025, join our Mental Health committee by emailing Casey Garnett.

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: 

1. Prevention and early intervention: early identification and referral to compassionate programs, services and supports. 
2. Aftercare and support: encouraging follow-up with the client’s general practitioner, mental health team or support programs. 
3. 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: 

• LivingWorks ASIST. 
• Black Dog Institute – Advanced Training in Suicide Prevention. 
• CALM Program. 

Trauma-informed care: 

• Phoenix Australia (self-paced, online, five hours). 
• Blue Knot Foundation. 
• TAFE (one-day online workshop). 
• Certificate of Trauma-Informed Care (self-paced, 30 hours). 

References 

• ‘LGBTQA+ mental health and suicidality state and territory-based briefing papers’. 
• APA Five facts about suicide prevention in physiotherapy. 
• APA Mental health resources page.

If you would like to contribute in 2025, join our Mental Health committee by emailing Rose Horvat.

Submitted by: Albert Tseng APAM
VIC Chair

Faulty thinking 

The renowned book Change Your Thinking by Sarah Edelmann PhD suggests that a key characteristic of happy individuals is their ability to adapt their thinking to life circumstances, rather than engaging in rigid or faulty thinking patterns when life inevitably does not go as planned. 

Below are five examples of faulty thinking as illustrated in the book: 

1. Irrational beliefs 
   Example: ‘I must be loved and approved of by everyone.’ Consequence: anxiety, unassertive (people-pleasing) behaviour, depression and poor self-esteem. 
2. Tyranny of the ‘shoulds’ 
   Example: ‘I should never make mistakes.’ Consequence: holding such beliefs can cause negative emotions because life often does not align with these expectations. However, reframing them as ‘preferences’ can make them less problematic. 
3. Awfulising (catastrophising) 
   Example: ‘I must find a partner – it is awful to be single.’ Consequence: negative language can be powerful in shaping thoughts because it assumes the consequences will be catastrophic. In reality, however, this is often not the case. 
4. Black-and-white thinking 
   Example: losing a mark on an otherwise high-achieving assignment and perceiving the entire assignment as a failure rather than a success. Consequence: these thinking patterns, common in perfectionists, can cause emotional distress by failing to recognise that other favourable outcomes may exist beyond the desired one. 
5. Overgeneralising 
   Example: Being treated poorly by someone at a party and assuming that all people at parties are out to make your experience unpleasant. Consequence: extrapolating from one situation to others without due consideration may limit opportunities for positive experiences. While such thoughts may serve as a protective mechanism to prevent further negative social encounters, they can also lead to avoiding socialising altogether, thereby missing out on potential positive experiences. 

Sarah Edelmann emphasises that recognising faulty thinking patterns is crucial because it helps identify cognitions worth challenging – an integral part of cognitive behavioural therapy, which is strongly supported by evidence.

Submitted by: Annelize Prinsloo APAM 
WA Chair

Reflections on professional development in 2024 

As 2024 comes to a close, we reflect on some of the outstanding professional development activities undertaken by the Mental Health national group. 

• Face-to-face session – ‘That makes me want to die, in my body: a brief on psychological trauma’ 
  Held on 21 August 2024, this session was presented by Dr Brian Lim, a psychologist with Fly2Health. It was very well received and sparked engaging discussions among participants. 
• Online Lecture – ‘Understanding eating disorders in physiotherapy practice’ 
  This online session, presented by Sally Partington APAM on 1 October 2024, provided valuable insights and left participants with much to consider. 
• World Congress on Menopause 
  I attended this international conference in Melbourne on 19–22 October 2024, where various presentations highlighted the intersection of mental health and menopause. Contributing factors influencing mental health during menopause, such as sleep disruptions, diet and exercise, were explored, with an emphasis on lifestyle changes to benefit women during this stage of life. Managing mental health issues such as anxiety, depression and low mood through hormone replacement therapy (HRT) remains the gold standard, rather than prescribing antidepressants. Menopause is gaining recognition as a vital area of research internationally, and we anticipate more robust evidence emerging in the near future. See my full review in the conference section of this update. 

Looking ahead 

Our committee is actively exploring new topics for discussion and presentation in 2025. Our goal is to deepen our understanding of the complex interactions and nuances in mental health, enhancing the support we provide to our clients and patients.