Mental health and physiotherapy

This coming Saturday is World Mental Health Day. As physiotherapists, it’s true that our work is mostly physical.  But much of what we do has an impact on (and is impacted by) the patient’s mental health.  For example, if a patient is unwilling to participate in treatment due to depression, we will not be able to achieve the desired outcomes physically.  This becomes a vicious cycle, as loss of ability and/or increased pain levels also tend to increase the symptoms of depression.

What exactly do we mean when we say, “mental health”?  Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to contribute to his or her community. Mental health is fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living, and enjoy life. Studies have shown that 1 in 4 people will experience a mental health issue of some sort during their lifetime, and people with mental health issues are more at risk of having poor physical health. It has also been reported that 70% of premature deaths in people with mental health issues are due to poor physical health. Mental disorders comprise a broad range of problems. They are generally characterized by a combination of abnormal thoughts, emotions, behavior, and relationships with others. Some examples: schizophrenia, depression, intellectual disabilities, and disorders due to drug abuse. 

Misunderstandings and stigma surrounding poor mental health are widespread, and this is a huge problem here in Nigeria where resources to help deal with mental health issues are scarce. Despite the existence of effective treatments for mental disorders, there is a belief that they are untreatable or that people with mental disorders are difficult, not intelligent, or incapable of making decisions.  Many people also believe that it is socially unacceptable to get help for mental health conditions, which prevents them from seeking the help that they need. This stigma can lead to abuse, rejection and isolation and exclude people from health care or support.

Determinants of Mental Health

Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. Many factors contribute to mental health problems, including:

• Biological factors, such as genes or brain chemistry
• Life experiences, such as trauma, abuse or sexual violence, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, human rights violations.  
• Family history of mental health problems

Early Signs/Symptoms of Mental Health Impairments

Experiencing one or more of the following feelings or behaviors can be an early warning sign of a problem:

• Eating or sleeping too much or too little
• Pulling away from people and usual activities
• Having low or no energy
• Feeling numb or like nothing matters
• Having unexplained aches and pains
• Feeling helpless or hopeless
• Smoking, drinking, or using drugs more than usual
• Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared
• Yelling or fighting with family and friends
• Experiencing severe mood swings that cause problems in relationships
• Having persistent thoughts and memories you can’t get out of your head
• Hearing voices or believing things that are not true
• Thinking of harming yourself or others
• Inability to perform daily tasks like taking care of your kids or getting to work or school.     

How Does Physiotherapy Relate to Mental Health?

Poor mental health is identified as one of the biggest causes of disability, poor quality of life, and reduced productivity. There is also a strong association between mental health conditions and people reporting multiple pain sites (conditions such as fibromyalgia for example).  It has been documented that physical activity can improve quality of life for people with serious mental illness. Improved physical health can alleviate psychiatric and social disability.  However, the most frequent encounters physiotherapists have with mental health problems is when dealing with the elderly.  Whether it’s due to the gradual changes of old age, or an injury, or a hospitalization, as people age they tend to decrease in their level of physical function. With a loss of physical function comes a loss of independence as well.  Imagine one day when suddenly someone will have to assist you while you use the toilet and the bath.  Imagine not being able to walk around the house or get out of bed without assistance. These things seriously impact a person’s mental and emotional wellbeing.   At the same time, they are experiencing more frequent deaths of their close friends and family members.  They are less mobile and therefore experience a decrease in social interaction and participation in activities.  All of these things combined make it difficult to maintain a good quality of life. 

Physiotherapy has an important role to play in helping those with mental health problems. Research shows that regular exercise affects mood and increases self-esteem. Physiotherapy can assess people & devise a safe, enjoyable exercise and movement program tailored to their needs, which will help to build their mental and physical wellbeing. 

Physiotherapy Goals with Regards to Mental Health:

• Optimize wellbeing and empower the individual by promoting functional movement, movement awareness, physical activity, and exercises, bringing together physical and mental aspects.
• Prescribing individualized exercise programs, which can improve mood, promote wellbeing, and address co-morbidities associated with mental health diagnoses.
• Interventions to address physical issues of people with mental health diagnoses which hinder social participation and recovery, e.g. minimizing or counteracting the side-effects of some psychotropic medications.
• Motivating where appropriate and promoting self-management in the context of mental and physical health issues.
• Management of falls and mobility issues for older people and developmental issues for children and young people.  Improving their independence and ability to participate in functional activities, social activities, etc.
• Intervention to address impaired body awareness and reduce dissociation (disconnection from ‘thoughts, feelings, memories or sense of identity) associated with poor mental health.
• Development and delivery of individually tailored lifestyle and weight management programs.

People with mental health problems can get better and many recover completely. Several physiotherapy interventions are potentially effective in improving physical and mental health and health-related quality of life.   If you are concerned about your own wellbeing or if you are concerned about someone you love getting the help they need, give us a call at PCA.  We would be happy to assess for whatever we can do to help, as well as make the appropriate recommendations and referrals to make sure you get on track to living with the best possible quality of life.