‘Mens sana in corpore sano’ (healthy mind in a healthy body). That’s how the old adage goes. Physiotherapy or physical therapy in a mental health setting aims to achieve a two-pronged effect, namely a direct therapeutic effect on the physical body and an indirect positive response on the psychological level.

It is a well-known fact that mental illness has a very negative impact on the physical body and inversely physical illness also has a negative effect on the person’s mental state. Today, the mind/body relationship is considered ever more important and physiotherapists in mental health care have an important role to play in this respect.

In the light of the above, it would therefore make a lot of sense to have physical therapeutic interventions where the mentally ill require rehabilitation. Hence, physiotherapy at Mount Carmel Hospital. There are currently three physiotherapists working in Malta’s psychiatric hospital.

Very often mental illness involves complex situations, with problems on a social, psychological, emotional and physical level. A multi-disciplinary team effort is required in order to achieve a good therapeutic response; including in the environment where the physiotherapist works alongside the other mental health care professionals. Compared to the other traditional or more established professions, physiotherapy in mental health care is a relative newcomer.

However, its importance is recognised especially at undergraduate level, where students are taught about mental health and physiotherapy students have clinical placements at Mount Carmel Hospital where they can experience mental illness at first hand. Physiotherapists working in mental health care must be aware of the fact that the patient’s mental state will influence the approach or outcome of physical rehabilitation. Also ingenuity, patience, commitment, empathy, good team player skills and a very positive attitude are all essential in getting the best out of a mentally ill person.

One of the aims of physiotherapy at Mount Carmel is to get the mentally ill person as fully physically functional as possible following physical trauma eg. stroke or a fracture. Falls are frequent in the elderly mentally ill and Mount Carmel, due to a large ageing population, has its fair share of older patients. Getting a patient as mobile/functional as possible following such a physical insult is important in order to keep the patient as independent as possible and not dependent on nursing staff. An independently mobile patient ascertains a better quality of life for that person and good mobility prevents certain medical complications from developing, eg. cardiovascular disease, pressure sores, etc. A positive physical outcome will also have a positive mental effect which is a win-win situation in a mental health setting. A patient’s mobility might also determine whether or not a patient can be discharged from the hospital.

Also, another important role of the physiotherapist is to maintain physical function/mobility in chronic institutionalised mentally ill patients. Such patients are all too often very lethargic, overweight and inactive both due to their mental illness and long-term psychiatric medication. Such patients benefit from physical exercises especially in groups where social interaction is facilitated.

Another useful role is delivering physical exercise regimes to patients with depression. Physical exercise is known to have a positive shift in mild to moderate depression. Regular exercise, whether aerobic or anaerobic, tends to elevate low moods. During exercise, the brain secretes endogenous opiates, like endorphins and enkephalins, which give the person exercising a high and good feeling. The regular exerciser loses excess weight and looks and feels healthier. Apart from the mental health benefits, there is a gamut of physical health benefits as well. Physical exercise is cost effective and can be delivered easily with minimal equipment.

The physiotherapist also has a good repertoire of relaxation tools in order to help alleviate anxiety, which is very useful as many mentally ill patients exhibit a lot of anxiety symptoms. Apart from worrisome and destructive thinking, the anxious patient usually exhibits a lot of unnecessary muscle tension. Very often this excess muscle tonus interferes with the patients’ day to day functioning, creating bad posture and pain, further increasing their anxiety. Using various muscular relaxation techniques, the physiotherapist is well-suited to help decrease such excess muscle tension. Another problem with anxious patients, is bad breathing patterns, eg. hyperventilation and shallow breathing. Here, the physiotherapist is well-trained in breathing techniques and can be very effective in managing ineffective breathing.

Advice and consultancy are two other important aspects. Physiotherapists are frequently consulted about what type of mobility aids, wheelchairs, seating etc. are required for mentally ill patients. Due to mental impairment, teaching a mentally ill patient how to manage a wheelchair or how to use a mobility aid could turn out to be a real challenge.

Mental illness is constantly increasing in society, making caring and treating affected persons a massive challenge to health care professionals, including physiotherapists.

Richard Abela is a physiotherapist at Mount Carmel Hospital