• This is always the first question a physiotherapist working in mental health will be asked and often by other physiotherapists.

• It is quite simply physiotherapy, as defined by the Chartered Society of Physiotherapy (CSP), (www.csp.org.uk): a profession that:

• In mental health the psychological disorder may be the primary health risk and physiotherapeutic skills may be used to reduce this, but it may also be the case that on assessment it is physical dysfunction and the treatment of this that is of paramount importance in the holistic management of the person.

• In all cases it is important to assess and treat the physical difficulties and dysfunction alongside any psychological dysfunction that may be present.

• Working with the multidisciplinary team (MDT) is essential, as it is in many specialties of physiotherapy. In the field of mental health the difference may be that the physiotherapist is regarded as the physical expert in the team.

• The physiotherapist’s knowledge has to be broad, so that it is possible to assess a wide range of conditions and evaluate which are appropriate for mental health physiotherapy intervention and which need another specialist physiotherapist, e.g. musculoskeletal.

• Research undertaken at Cardiff University with students prior to beginning mental health placements has shown that pre placement education helps the student (Sarin 2008). This should be no surprise; however the main reported advantage was not to do with physiotherapy assessment, but rather assuaging the student’s fear of violence and psychological trauma.

• Challenging behaviour management should be addressed within any team working in a mental health setting. It is the responsibility of the individual to ask for training if it is not offered. On in-patient wards, staff are likely to wear alarms in order to summon help for patients or colleagues. In the community, safeguards will include: having clear lone working policies and procedures, which in most cases insist that students or junior staff always work with an experienced member of the team (www.hse.gov.uk).

• As in any health setting the safety of the patient/client and staff is of paramount importance and risk assessment of the treatment environment and of the individual client should be undertaken in all circumstances, in relation to all aspects of safety. Knowledge of the patient is essential and awareness of family and physical environment factors will increase your confidence in working with this client group.

• A physiotherapist working in mental health will encounter patients with musculoskeletal, neurological, respiratory and other physical dysfunction who also have psychological difficulties or who are experiencing psychological aspects of disease or disorder (Everett et al 2003).

• The type of patients that will be encountered will depend greatly on the structure of the service in which the physiotherapist is working.

• It may vary from primary care for mild to moderate depression and anxiety to long-term and enduring illness in supported housing or may be an acute adult in-patient service or a specialist dementia service.

• The term used for people accessing mental health care is often ‘service user’, sometimes ‘client’ and rarely ‘customer’.

• Working with older adults however the term ‘patient’ is most often used.

• Service user, patient and client will all be used in this chapter and the case studies included as part of the web resource accompanying this book.

• Patients are divided by age groups and conditions as follows:

• Experience will vary throughout the UK, with some mental health services there is discrete physiotherapy input in primary, secondary or tertiary services.

• For other patients, seen by their GP or primary care psychological service they may receive their physiotherapy from a general outpatient department.

• Adults referred to a Community Mental Health Team (CMHT), are most likely to be seen by a general physiotherapist initially.

• If patients are referred to a mental health physiotherapist it is usually because of the rigid structure of the process in a general outpatient department, such as the standards relating to appointment times, the discharge of patients if they ‘do not attend’, fast turnaround assessment and treatment times, often precluding a successful outcome for patients with psychological disorders (Griffiths 2009).

• A useful definition of mental health is that used by the World Health Organization (WHO):

• The Mental Health Foundation has defined a mentally healthy individual as one who can:

• Defining mental disorder is difficult, because it is not one condition, but a group of conditions.

• There is intense debate about which conditions are or should be included in the definition of mental disorders.

• Specifically in the UK, in relation to personality disorder and substance misuse and for some eating disorders there is disagreement as to their classification.

• For legal purposes, the UK’s Mental Health Act (2007) defines mental disorder succinctly as, ‘any disorder or disability of the mind’. It is clear that there is a marked circularity to this statement as the WHO states that mental disorder is more than the absence of mental health.

• The focus in this chapter will be on those disorders which are recognised and treated within the NHS and which are likely to be presented to a community mental health trust (CMHT) or mental health inpatient setting.

• It should be remembered that there are many disorders which the physiotherapist may encounter in any physical medical specialty and in general outpatient departments and so this information should be applicable to any physiotherapy setting.

• Both the WHO, International Classification of Diseases, 10th edition (ICD10) and American Psychiatric Association Diagnostic and Statistical Manual-IV (DSM IV) are used to diagnose mental disorder.

• Their purpose is to make a diagnosis and this is not always appropriate as many of the disorders are not necessarily a disease in the medical sense.

• Mental disorder may be described in a biological system focusing on changes in brain chemistry, e.g. hormones, genetic formation.

• Psychological systems focus on personal development and thinking, e.g. cognition. Social systems focus on environment, social structures and family relationship.

• A mental disorder may be described using any individual or combination of these systems.

• The main categories of ICD10 are:

– The following descriptions and symptom lists are drawn from WHO ICD10.

– Also included are some definitions from the support organisation ‘MIND’, which give a more person-centred description of mental disorders.

– It should be noted that there is still discussion about what schizophrenia is and the MIND website provides information relating to current thinking about schizophrenia (Henriques 2011).