To Ross Farmer, the mental health field offers physiotherapists unparalleled opportunities to put their clinical and communication skills to the fullest possible use.
Though it was the urge to get to grips with his first managerial role that prompted Mr Farmer to apply for his current post, rather than because he harboured long-held ambitions to work in a mental health setting, he quickly discovered that the clinical work was as rewarding as running a team.
As head of physiotherapy and clinical exercise at what is arguably the country’s most prominent mental health trust South London and Maudsley NHS Foundation Trust (SLaM)
Mr Farmer is keen to promote physiotherapy in mental health on a national, and even an international, platform.
‘I manage a corporate team of three physios who work across all the trust’s clinical advisory groups (CAGs) such as neuropsychiatry and care of older adults though some of the CAGs have their own physios as well,’ he explains. ‘The rest of my team is made up of four clinical exercise trainers.’
As well as containing the Bethlem Royal Hospital, whose roots can be traced back to the 13th century, and the world-renowned Maudsley Hospital, where Mr Farmer is based, SLaM delivers inpatient and community-based mental health care to people in four south London boroughs Lambeth, Southwark, Croydon and Lewisham.
‘As a trust, we operate in 120 sites in the south London area and have recently taken on responsibility for some child and adolescent mental health services in Kent as well,’ he notes.
Unique service
But what makes SLaM unique is that it also runs a range of highly specialist units that treat individuals from across the UK, many of whom are referred by mental health professionals who lack the expertise to respond effectively.
Soon after joining the trust last year, Mr Farmer witnessed at first-hand how a multidisciplinary team at one of the Maudsley’s ‘national’ units can transform service users’ lives.
‘I was working at the Lishman Unit, where people with brain injuries and “conversion disorders” are treated,’ he recalls.
‘People with a conversion disorder might present as having been bed-bound or even quadriplegic for many years, but after tests no physical reason can be found to explain their condition,’ he notes.
Remarkable recovery
In one remarkable case, Mr Farmer was involved in caring for an inpatient in his mid-20s who had lived as a quadriplegic for around five years.
A battery of diagnostic tests failed to uncover any underlying neurological cause for the man’s condition and he was diagnosed as having a conversion disorder.
‘This man had played basketball to quite a high standard as a teenager, and we helped to rekindle his interest in the sport.
Within three months of being placed on an intensive rehabilitation programme he was shooting balls into a hoop from the half-way line of a basketball court.
‘It was really exciting and we had to keep telling the physio students who were there that it was not the norm to find someone who was so disabled having a series of miraculous recoveries like this almost on a daily basis.’
As part of his remit to raise the profile of physiotherapy in mental health, Mr Farmer is scheduled to speak later this month at the three-day International Conference of Physiotherapy in Psychiatry and Mental Health (IC-PPMH) in Edinburgh.
Mr Farmer will present the findings from a preliminary study in which he examined why service users were referred to his team over a three-month period.
The most commonly cited reasons were musculoskeletal (MSK) injuries, chronic conditions and mobility problems.
A small number of service users were referred for falls, neurological symptoms and orthopaedic issues.
Mr Farmer will tell delegates: ‘This work can be used to identify key areas for continuing professional developments and help to show the ways in which physiotherapy in a mental health setting can help the physical needs of service users.’
Pioneering event
As project leader for the IC-PPMH conference, Anne Parker, superintendent physiotherapist at the Royal Edinburgh Hospital, has had a hectic new year. She hopes the event will attract around 150 delegates from Europe and beyond.
‘This is the fourth IC-PPMH conference and we are very pleased that there has been so much interest,’ says Ms Parker. Previously the conference has been held in Belgium, Sweden and Norway countries in which physiotherapy has traditionally had a higher profile in the mental health field than here.
Scottish dancing
Though Ms Parker is unsure why physiotherapy in the UK has tended to focus more on patients’ physical health rather than their mental health, she points out that in her native Norway, and in Scandinavia more generally, there is a tradition of seeing both aspects as being equally important.
She believes this is in part due to the influence of the controversial psychiatrist and psychoanalyst Wilhelm Reich, a pupil of Sigmund Freud, who settled in Norway for five years in the 1930s after fleeing Nazi Germany.
He became interested in patients’ physical responses during therapy sessions.
The Edinburgh event is titled ‘Promoting Quality of Movement: The contribution of physiotherapy to mental health and wellbeing.’
Anyone tempted to attend the conference because they associate the word ‘movement’ in the title with dancing will not be disappointed.
As well as hearing a presentation on using the dance steps of the tango as a way of stimulating movement among service users, delegates will be invited to have a go at traditional Scottish dancing at the ceilidh that follows the conference dinner.
‘Dance has been used by physiotherapists working with people with some success,’ says Ms Parker.
‘If the music reminds them of some dance steps and gets them moving again, then it can be very helpful.’ fl
Why Monitoring Service Users' progress presents special Challanges
Proving the worth of physiotherapy interventions in the mental health field is not a straightforward matter, according to Catherine Pope, associate director of allied health professionals and clinical director of specialist services at Nottinghamshire Healthcare NHS Trust.
‘Physiotherapists working in mental health have always struggled to capture how they have an impact on a person’s mental health.
While it’s relatively straightforward to measure the physical aspects in an objective way, to show how you might have helped a person to become less anxious, for example, is much more subjective.
‘Though some standardised tools are available, such as the Beck Depression Scale, you can’t really say as a physiotherapist that it’s your intervention that has made the difference because so many other people will have worked with the service user as well.’
Last month the Department of Health released its Outcomes Framework for 2012-13, which voices a commitment to developing an indicator for dementia while acknowledging that ‘this may take time’.
Ms Pope points out that many outcome measures used with older people to test their balance, for example, have been used in trials with people who don’t have dementia.
‘When working with a person with dementia you usually have to change your instructions or adapt your behaviour so that he or she understands what you’re asking, and this immediately invalidates the measure you are using.’
Ms Pope, who represents the East Midlands on the CSP Council and is also President of Chartered Physiotherapists in Mental Healthcare, said mental health professionals are keen to incorporate patient reported outcome measures (PROMs) into their practice.
She stressed that there would always be a subjective element when deciding whether a service user has reached his or her goals.
In their everyday practice, the allied health professionals at Ms Pope’s trust use the East Kent Outcome System (EKOS), which she describes as ‘a form of goal attainment scaling’, and Therapy Outcome Measures to monitor progress.
‘With EKOS, the professional and service user might agree a goal of walking to the shops and doing the shopping within a set timeframe.
You then measure whether this has been partially or totally attained, or perhaps even been exceeded. We also collect patient feedback.’
Ms Pope is concerned that service users living in the community who have MSK problems could lose out if they miss an outpatient session and are automatically discharged from the system, or because they are expected to telephone clinics to make appointments like everyone else.
‘Someone who is quite depressed might forget about an appointment or find that he or she can’t manage to get out of the house that day.
They might need a lot of reminding and motivating. Mainstream services don’t fully meet the needs of people with mental health problems,’ she adds.
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