Evaluation of a Specialist mental health physiotherapist working into Acute Liaison service

Purpose

It is widely acknowledged that older people with a mental health problem often have difficulties accessing appropriate services (NHS England 2019, Jackson et al 2017) Seitz et al (2016) found that between 2003-2011, people living with dementia 40.1% did not receive any rehabilitation post fractured neck of femur as they were deemed to have ‘no rehabilitation potential’. Hall et al (2017) found the rational for ‘no rehabilitation potential’ is multifaceted, included restrictions applied to time frame for rehabilitation, lack of knowledge regarding the ‘potential’ for people living with dementia, lack of research in the area. For these reasons they acknowledge the need for specialist MH physiotherapists Specialist physiotherapist play a pivotal role in the MDT management of people living with complex mental health problem, and often help to bridge the well documented gap between physical and mental health illness (Soundy 2020). Our aim is to restore maximum movement, functional ability and wellbeing of people with mental ill health – bridging the gap between physical and mental health This service is for patients with an organic and/or functional illness who are age 18+

25% of patients
required assessment, some advice and/or brief involvement 39% required full intervention and management
39% of patients
required full intervention and management

Approach

Specialist physiotherapist working clinically collected quantitative data on referrals and outcome measures data, qualitative data from carers, liaison staff and acute physio.

Outcomes

Results: Quantitative results Total number of referrals in 2019 = 158. 25% required assessment, some advice and/or brief involvement 39% required full intervention and management Of those people: 37% went home – 34% of these were directly due to MH physio 12% went to an IC bed for further physio – 58% directly due to MH physio involvement. Signposting for ongoing MH physiotherapy input to ensure that any patient with further potential sees the right person at the right time. 68% did not need further MH physio follow up - saving resources for those that do. 22% of those discharged to 24 hour care were signposted onto CMHT physio to complete therapy. Qualitative Results Direct feedback from carers, liaison staff and acute physio colleagues have been collected and collated all with positive feedback. Outcome Measures results Therapeutic Outcome Measures (TOMS) is the outcome measure chosen. The measure focuses on 4 dimensions: Impairment, Activity, Participation and Wellbeing and assesses both physical change but the mental impact on wellbeing and ability to engage. Measures are taken pre and post intervention. In all domains a significant difference was made.

Conclusion(s): The data presented strongly promotes the need for a MH physiotherapy service. From the evidence discussed, through the various case studies, the outcome measures shown and the large amount of qualitative data it can be concluded that there is a significant need for the provision of a specialist MH physio service within acute liaison. Increased qualified staffing would enhance the service further.

Cost and savings

I have additional information regarding possible financial savings available on request.

Implications

· Better outcomes for patients both physically and mentally.

· Facilitating appropriate discharges and avoiding premature admission to 24 hour care.

· Education and joint working with acute physio staff to improve knowledge and confidence with dementia patients.

· Access to subsequent specialist mental health physiotherapists

Top three learning points

No further data 

Funding acknowledgements

Funding for the band 7 physiotherapist was initially gained through core 24, after the first evaluation permanent funding was agreed as part of the team budget.