Professional Documents
Culture Documents
Acknowledgements 4
Carer’s statement 7
Executive Summary 8
Introduction 9
Rationale 10
References 21
3
Acknowledgements
Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
Foreword by CSP President
Jeremy Chaplin
psychological disorders across a wide range of diagnoses
from depression and anxiety to dementia. Many patients
will be cared for in generic health services as mental
health teams will be managing complex disorders.
Physiotherapists need to feel confident to respond to
this changing clinical environment, whether working
specifically in mental health or taking a person – centred
approach in any arena of health.
David Tombs
Service User
Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
Carers’ statement
7
Executive summary
This document identifies how developing the role Key messages have been drawn from across the four
of physiotherapy within mental health can support building blocks and action is summarised in a table
the delivery of integrated care that is focused on the at the end.
individual. Service users and carers have contributed
to its development. This information should support The key messages are
commissioners, managers, physiotherapists, educators, • The views of service users and carers are central
service users and carers in their respective roles. to the development of services and education
The focus of the document is England and further • New Ways of Working offers opportunities for
consideration will be given on how to take this work physiotherapists to demonstrate and develop
forward in Wales, Scotland and Northern Ireland. their role and the contribution they can make
to services
The table below identifies the key aims of the work. • Working with other Allied Health Professions
To achieve these ambitions four building blocks have (AHPs) and healthcare professionals will enable
The physiotherapy workforce will be equipped to deliver services New ways of working
tailored to individual needs that recognise and support wellness Learning and development
in any service setting
Services will be delivered across a range of providers to support Leadership
person centred care in mental health
Physiotherapy will be commissioned as part of multi-disciplinary New ways of working
care pathways relating to mental health Leadership
Physiotherapists will continue to base their practice on best Developing the evidence base
available evidence
Physiotherapists will be employed in a range of roles that support New ways of working
the delivery of innovative and person centred care Learning and development
been identified – New ways of working, leadership, efficient use of resources and maximise
learning and development and developing the learning and leadership
evidence base. Key issues and action points are • Developing the knowledge and skills of the
identified under each of these headings. workforce, both expert and generic, will support
the development of service user led services
Within the document the role of the physiotherapist • The Chartered Society of Physiotherapy
now and in the future is described. Examples and Chartered Physiotherapists in Mental
of liaison, leadership, multidisciplinary team Healthcare should collaborate to increase the
management and service user involvement are given production, dissemination and implementation
which are reproducible in other settings. of research and evidence-based practice in
mental health
The importance of pre and post qualifying education
which includes mental health as a speciality and Full references are given and this document
as an integral part of physiotherapy is identified. should be read in conjunction with ‘Commissioning
Collection and dissemination of evidence to inform Mental Health Services: the contribution of
practice is clearly identified as a priority and specific physiotherapy to integrated services for health
actions identified. and wellbeing’
Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
x x
Introduction
This framework places the needs of service users This framework identifies where we want to be by
and carers at its heart. Their contribution has 2013 and the building blocks needed to support
been invaluable in framing how physiotherapy this. Five years was identified as the timescale
can continue to develop to meet the needs of to reflect the need to review progress in light of
individuals and deliver integrated care. health care developments. Our aim is that
by 2013:
“We want a knowledgeable ‘doer’ who can • The physiotherapy workforce will be equipped
treat our physical needs and ailments but to deliver services tailored to individual needs
who knows how these affect and are affected that recognise and support wellbeing in any
by our mental health...how we feel that day. service setting
And if they don’t know they will find out... • Services will be delivered across a range of
it is no more than anyone wants” providers to support client centred care in
(Answer from service user to ‘Mind the Gap’ mental health
questionnaire Northampton PCT 2005). • Physiotherapy will be commissioned as part
of multi-disciplinary care pathways relating to
This document should be read in conjunction mental health
with ‘Commissioning Mental Health services: the • Physiotherapists will deliver care based on best
contribution of physiotherapy’. The information possible evidence
in this document is intended to be of value to • Physiotherapists will be employed in a range
commissioners, managers, physiotherapists, of roles that support the delivery of innovative
educators, service users and carers. and client centred care
The key underpinning principles are: The development of this document has taken
• Service users and carers should be central place during a period of substantial change to the
to care planning delivery of health care across the four countries.
• Services should be designed around the In recognition of the differences developing
needs of individuals within the countries further consideration will be
• Services should incorporate all aspects of given on how best to take this forward in Wales,
the individual and empower a wellbeing Northern Ireland and Scotland. The focus of this
and recovery model of care document is primarily England.
• There is recognition of the interdependency
between physical and mental health
x
9
Rationale
At a time of unprecedented change within the work by identifying building blocks for delivery.
delivery of health and well being services there These are:
are both opportunities and challenges. The • New ways of working: the changing role of
delivery of services will be increasingly focused physiotherapy in mental health
on the well being of the nation, prevention, • Leadership
empowering the individual and social inclusion. • Learning and Development
Access to physiotherapy within a multidisciplinary • Developing the evidence base
mental health team is fundamental to delivering
this agenda. The main points related to each of these building
blocks are described and actions identified at the
Developing and maintaining physical health has end of each section. Key messages are summarised
a major contribution to make to mental health at the end of the document along with a table
and wellbeing. One in four people experience a outlining the key action points and how they will
mental health disorder at some point in their lives, be taken forward.
and the risk is particularly high for those who
have chronic physical disability or illness. Failure The document only provides an over view within
to recognise and help a person’s mental health each section. Inclusion of all of the material
problem is likely to delay their physical recovery collated during the development of this resource
(Rose 2003). Working together commissioners, is impossible. The Chartered Physiotherapists in
providers, physiotherapists, educationalists, service Mental Healthcare [CPMH] will be utilising this
users and carers can ensure that access to services information to develop supplementary documents.
is increased and appropriate training is provided to This also supports the intention that this is a living
ensure that there is a skilled workforce in place. document which recognises the pace of change
within health and social care and will therefore
The purpose of this framework is to support this continue to be developed.
Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
Building blocks for delivery
1 New Ways of Working
1.1 The role of physiotherapists For service users suffering from both physical
working in Mental Health and mental health problems, where the physical
need is acute, the pathway of choice would be to
Physiotherapists have an extensive wealth of skills access mainstream services. To deliver this, services
and knowledge in the physical health field and may need to develop more flexibility. They may
this, combined with their skills in mental health, require more sessions for a full assessment to be
means they are uniquely placed to meet the needs completed to take account of issues with personal
of service users who have both physical and mental trust, or they may require more one to one sessions
health needs. Key skills include: due to problems with self-motivation or memory. In
• Understanding of the impact of mental health these situations mental health physiotherapists can
on ability to function at home and work work alongside generic services or provide advice
• Experts in motivation and support to the primary care physiotherapists.
• Development and delivery of lifestyle
and weight management programmes Continuing to develop all physiotherapists’
• Experts in prescribing exercise knowledge of the psychosocial dimensions of
• Management of falls health and wellbeing and deploying this in practice
• Treatment of pain with all patients will support the delivery of person
• Liaison between mental and physical health centred care. Access to specialist services and
services/voluntary agencies relevant training will support this.
11
1 New Ways of Working continued
1.4 Action
Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
Building blocks for delivery
2 Leadership
It is recognised that the delivery of integrated should seek to meet these needs to deliver quality
care requires the development of leadership assured services.
capability and capacity. New Ways of Working
(2007) describes the ability to provide effective The development of effective teams requires
leadership at different levels in different settings. relevant competencies to be identified to support
Appropriate leadership and supervision for identification of the skill mix required to deliver
physiotherapists in mental health trusts can care. Appropriate supervision and support models
be provided through the development of a are required to support this, for example a newly
variety of approaches. For example, thinking qualified physiotherapist could be supported by a
creatively about different models of supervision senior from another team.
can allow more flexible career pathways to be
supported. Physiotherapists who have taken
on multi-disciplinary team manager roles have
demonstrated their ability to manage staff from
other disciplines in addition to physiotherapy, and
in these roles been able to promote physiotherapy
as part of a whole service. Consider this good
practice example...
There are benefits in linking with other allied
health professionals to provide strategic • In Nottinghamshire Healthcare NHS Trust
leadership and professional support. Positive there is an AHP professional lead providing
multi-disciplinary line management can prevent a single point of contact, and giving
professional isolation and encourage the professional leadership and advice to AHPs,
recognition and sharing of expertise, whichever other staff, managers and clinical directors
service structure is utilised. • The post is at Associate Director Level
reporting directly to the Executive Director
An effective leadership model for Nursing and AHPs who sits on the Trust
• Ensures service users and carers can access Board
services • This post allows for the development of a
• Demonstrates how Physiotherapy contributes corporate AHP strategy and direct access to
to clinical services the Executive Team
• Ensures physiotherapists have appropriate • AHP issues remain on the Trust’s agenda
supervision/mentorship that includes access to and their unique contribution is recognised
managerial, clinical and professional support • AHPs including physiotherapists are line
• Engages with relevant decision making fora, managed within directorates, some within
for example in directorates, at the Trust Board, multi-disciplinary teams and others within
with commissioners, in education and training therapy teams
• Supports access to career opportunities for • No physiotherapists are now exclusively
physiotherapists both as clinicians and in managed within a profession specific team
management. • There are professional leads within each
directorate who are all additionally
To ensure continued access to the diversity of supervised by the Associate Director AHPs,
skills physiotherapists provide, practitioners need who also inputs into their appraisals.
to be supported, both in maintaining those skills, Within the directorates these leads are part
their professional identity and registration to of the management team, thus ensuring
practice. Commissioners and service managers representation at a local level
13
2 Leadership continued
Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
Building blocks for delivery
3 Learning and development
The Ten Essential Capabilities (DH 2004a) which In many trusts service users and carers are involved
were developed in consultation with service users, in delivering training such as the Wellness Recovery
carers and practitioners provide, in one overarching Action Plan (WRAP) programmes, however, few
statement, the headline capabilities required to physiotherapy services include service users and
achieve best practice for education and training carers in their training delivery. Incorporating
of all staff who work in mental health services. service users and carers into training at both
It recommends their inclusion in the curricula of pre- and post-qualifying allows practitioners to
all pre-registration training for professionally gain first hand experience of the needs, experience
affiliated staff as well as being embedded in and difficulties encountered, all of which can
induction, continuing professional development influence practice and service delivery.
(CPD) and life long learning.
15
3 Learning and development continued
As part of their CPD physiotherapists may need to • Promote appropriate mental health development
further develop their understanding of mental health opportunities by mapping current provision and
in order to deliver person centred care. a gap analysis
With appropriately identified learning outcomes CPD • Promote engagement with the CSP
may be provided in a variety of ways for example: • Influence physiotherapy mental health education
• Provision of band 5 rotational and static posts and service user and carer involvement in
• Provision of in-service education, lectures, courses its provision
and conferences
Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
Building blocks for delivery
4 Developing the evidence base
There is a growing evidence base available to With many physiotherapists now working as
support the role of physiotherapy in mental members of multi disciplinary teams there is
health. Work by Biddle et al (2002) on exercise, value in linking to multi professional research and
and Donaghy and Mutrie (1999) on the effect audits, as clinical results are rarely attributable to
of exercise in continuation of sobriety have both uniprofessional intervention, and large scale multi-
directly impacted on practice and the recognition disciplinary research projects are more likely to
of physiotherapy in mental health. Research by attract funding.
other professionals on the use of exercise to delay
the onset of cognitive impairment (Boutcher
2002, Tanne 2004), relaxation for people with 4.1 Action
anxiety (Eppley et al 1991), and of massage for the
reduction of anxiety and depression (Sunshine et • CPMH will work with its members and the
al 1997), and muscle tension and pain (Andrade CSP to identify how the evidence base
and Clifford 2001) also provide an evidence base can be developed
for physiotherapy interventions. The CSP and • CPMH will continue to support the
CPMH continue to support and promote the use of dissemination of evidence and its
evidenced based interventions. implementation in practice
17
Mental health physiotherapy development pathway
The diagram below demonstrates the development pathway described in building blocks3 and 4,
learning and development and delivering the evidence base.
Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
Summary
The development of integrated care will require • New Ways of working offers opportunities for
commitment, a willingness to change, openness to physiotherapists to demonstrate and develop
innovation and most importantly engagement with their role and the contribution they can make
service users and carers. Physiotherapists are willing to services
and able to engage with this agenda. • Working with other AHP’s and healthcare
professionals will enable efficient use of
It is hoped that the identification of four building resources and maximise learning and leadership
blocks, and action identified under each of these, • Developing the knowledge and skills of the
will support managers, physiotherapists and workforce, both expert and generic, will support
commissioners alike in taking mental health the development of service user led services
services forward. • The Chartered Society of Physiotherapy and
Chartered Physiotherapists in Mental Healthcare
For the benefit of the reader key messages have should collaborate to increase the production,
been drawn from across the four building blocks dissemination and implementation of research
and the action points have been summarised in and evidence-based practice in mental health
a table.
The work identified in the table below will be
Key Messages discussed by the members of the CPMH. Timescales
• The views of service users and carers are central and action leaders will be identified to take the
to the development of services and education work forward.
19
Recovering mind and body action plan 2008-2013
ACTION HOW
Strengthen the contribution that physiotherapists can make within Sharing information and good practice through Chartered
the multi-disciplinary team by developing skills as care co-ordinators; Physiotherapists in Mental Healthcare (CPMH), publication
promoting health and well-being; acting as a resource for the team and conferences
Ensure the needs of service users inform the development Patient Reported Outcome Measure (PROMS)
of the physiotherapists role Audit of Service
Service users as teachers
Sharing of good practice and service delivery examples
Engagement with Service Users
Identify competences required and therefore relevant skill Use AHP Career Framework & Skills for Health Competence
mix to deliver services and input to workforce planning Framework, KSF Development Reviews
Input to local workforce planning committees
Advise on the training needs of specialist and mainstream staff Appraisal/KSF Development Reviews, use of latest evidence/research
Leadership
CPMH and senior mental health physiotherapists should be Continue to seek every opportunity to represent physiotherapy
proactive in engaging with local and national policy makers and in mental health at local and national level
with the CSP in seeking to influence future policy direction and in
raising the profile of physiotherapy in mental health
Models of service delivery/examples should be collated and shared Opportunities for collaborative working will be explored and CPMH
will liaise with CSP regarding the collation of service examples and
where and how they might be shared.
Evidence supporting the delivery of outcomes should be Networking locally and nationally
collected and shared
Learning and development
Promote appropriate mental health development opportunities CPMH to undertake a mapping and gap analysis exercise & to support
by mapping current provision and undertaking a gap analysis developing education programmes/use Skills for Health competence
frameworks – mental health
Promote engagement with the CSP about learning and CPMH ensure members engage with consultations and input to
development needs relevant discussions
Influence physiotherapy mental health education and service Influence the curriculum framework by demonstrating the role of
user and carer involvement in its provision physiotherapy in health and wellness; whole person personalised
services, engaging with CSP as part of the Charting the Future project.
Developing the evidence base
CPMH will work with its members and CSP to identify Participate as a Clinical Interest group in discussions
how the evidence base can be developed about research priorities.
Identification of active research already taking place
CPMH will continue to support the dissemination of evidence Publication of research findings in CPMH journal/Physiotherapy.
and its implementation in practice Grants to authors
Encourage CPMH members to utilise Supporting Knowledge In
Physiotherapy Practice [SKIPP] process to develop evidence
CPMH will develop ideas on how the above can be achieved CPMH to produce a briefing paper by 2013
– links to CSP’s R & D strategy
Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
x References
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agenda, London, CSP. www.csp.org.uk London, DH
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Recovering mind and body: a framework for the role of physiotherapy in mental health and wellbeing
The Chartered Society of Physiotherapy is the professional,
educational and trade union body for the UK’s chartered
physiotherapists, physiotherapy students and assistants. We
support our members at work, and through services such as
Copyright the Chartered Society of Physiotherapy © 2008. Chartered Physiotherapists in Mental Healthcare Chartered Society of Physiotherapy 2008-2013
our publications, courses and enquiries unit. We play a key
role in fostering professional learning and innovation, and in
championing physiotherapy’s role in modern healthcare.