Multidisciplinary approach to mental health issues, how a physiotherapist fits into the team

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Introduction

One of the statutory functions of the Mental Health Commission is to foster and promote high standards of care and best practice in the delivery of mental health services. Planning for the Future (Department of Health, 1984) recommended the establishment of multidisciplinary teams as “different approaches to treatment. The participation of people from a number of professional disciplines is required to cater adequately for the needs of the mentally ill”. It recommended that the psychiatrists and psychiatric nurses, psychologists, social workers and occupational therapists should form “psychiatric teams” to provide comprehensive treatment and care for the mentally ill.

A key strength of multidisciplinary teams is that the combined expertise of a range of mental health professionals is used to deliver seamless, comprehensive care to the individual. The research evidence supports a multidisciplinary team working as the most effective means of delivering a comprehensive mental health service to people with mental health problems, especially those with long-term mental health problems (Tyrer, 1998).

The rationale for multidisciplinary team working

The delivery of mental health treatment and care by multidisciplinary teams has developed in parallel with the demise of large psychiatric institutions (Leff et al., 2000). Since the 1950’s mental health care has moved from the mental hospital to community-based care. This movement was the result of improvements in pharmacological treatments along with key social, political and economic trends. These included increasing emphasis on human rights, understanding of the detrimental effects of institutionalisation, the involvement of family and service user organisations, value for money, and the influence of the therapeutic community movement. The latter emphasised the social determinants of mental illness stressing the role of relationships in treatment (Burns, 2001). The growth of community-based care has been largely pragmatic, reflecting a clinical view that ‘the needs of the severely mentally ill can rarely be met by a single individual’ (Burns & Lloyd 2004; Onyett, 1992).

The need to establish community-based alternatives to hospital treatment and to ensure the coordinated health and social care for the severely mentally ill established the team as a central feature of virtually all forms of modern mental health care. According to one of the four guiding principles of the Health Strategy Quality and Fairness: A Health System for You (2001) – person-centeredness, describes very well the central aim of providing mental health care through a multidisciplinary team. A person-centred health system is described as one which “identifies and responds to the needs of the individual, is planned and delivered in a coordinated way, and helps individuals to participate in decision making to improve their health”. Mental health services have been to the fore in providing this type of person-centred care for some time. The starting point is the individual using a mental health service. Individuals with mental health problems often have a wide range of needs that may be social and psychological. They wish to have access not just to doctors and nurses, but to psychologists, social workers, occupational therapists and other therapists. They want access to the range of interventions offered by this variety of mental health professionals.

What is multidisciplinary teamwork?

The multidisciplinary team is members of different professions working together. There are different definitions and descriptions which capture important features of multidisciplinary work. A team is described as a group of people with complementary skills who are committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable. According to Jefferies & Chan (2004), multidisciplinary team working is described as the main mechanism to ensure truly holistic care for patients and a seamless service for patients throughout their disease trajectory and across the boundaries of primary, secondary and tertiary care. According to Junor, Hole & Gillis ( 1994 ), multidisciplinary team working is known to “maximise clinical effectiveness”. The teamwork just doesn't happen magically. The teams need to:

• have shared goals and values,
• understand and respect the competencies of other team members,
• learn from other disciplines and respect their different views and perspectives.

Individual team members may need to reassess exclusive claims to specialist knowledge and authority in order to form effective multidisciplinary teams which can provide the best possible care to the individual service user.

Why are multidisciplinary teams important?

Multidisciplinary teams convey many benefits to both service users and the mental health professionals working on the team, such as continuity of care, the ability to take a comprehensive, holistic view of the service user’s needs, the availability of a range of skills, and mutual support and education.

With increasing specialization in healthcare, and expanding knowledge about health and mental health conditions, having a forum for assembling groups that reflect different areas of specialization is increasingly necessary. Some of the benefits of multidisciplinary team models include improved consumer health outcomes and functioning, enhanced quality of life, reduced costs, and utilization of medical services  

Members of the multidisciplinary team

The mental health team is made up of a group of people each of whom possesses particular skills and expertise. The team consists of a consultant psychiatrist, his registrar and housemen, nurses, clinical psychologists, social workers, occupational therapists, speech therapists, physiotherapists, dietician and hospital chaplain. Some members of the team may meet daily or weekly to discuss patient treatment and progress. Other members will provide their services as and when necessary

Each member of the multi-disciplinary team needs to have an understanding of other members' roles in meeting the needs of patients. There is usually some blurring of roles in the therapeutic milieu and team members will not relate equally to every patient. Some team members may act as key workers with particular patients or groups of patients. The person who acts as the key worker for a particular patient may be selected from any member of the team, and therefore from a number of different disciplines. This person may be the nurse, the social worker, the psychologist or another professional with appropriate training.

How a physiotherapist fits in the team

Most health professionals, commissioners, policy-makers and the general public recognise physiotherapists as experts in back and neck pain, but would not be aware of the contribution they make to the care of the people with mental health problems. Physiotherapy in mental health is a speciality within physiotherapy. It aims to optimize well‐ being and empower the individual by promoting functional movement, movement awareness, physical activity and exercises, bringing together physical and mental aspects. It is based on the available scientific and best clinical evidence. Physiotherapists in mental health contribute to the multidisciplinary team and inter‐professional care

Physiotherapists are highly trained and experienced in managing physiological conditions such as musculoskeletal conditions, cardiorespiratory and neurological conditions. Through a multidisciplinary approach, physiotherapists can address the physical well-being of people with mental health conditions from across the lifespan. Improvements to physical well-being can improve mental well-being and prevent the development of mental health conditions, such as depression which is often associated with other physiological conditions. With an established role in assessing and diagnosing musculoskeletal and physical conditions, physiotherapists can be engaged in planning, decision making, advocating for, and case management of the physical health of people with mental health conditions.

There is evidence that improvements in body function including balance, posture and flexibility are linked to a sense of improved security and better self-esteem. Improvements to posture, for example, can benefit self-image and raise mood, in addition to decreasing back or neck pain. As well as preventing its onset, strong evidence also exists to suggest that an appropriate exercise regime effectively improves the well-being of people with depression.

Physiotherapists can also encourage people with mental health conditions to take an active role in their own care by supporting and providing resources to facilitate self-management. It is acknowledged that enhancing physical health will promote mental well-being.

Physiotherapists working in the mental health sector were amongst the first to apply holistic and biopsychosocial approaches to physiotherapy assessment and interventions – these approaches are now recognised within the physiotherapy profession and utilised in other areas including complex pain management.

Conclusion

Within mental health care systems, physiotherapists should be seen as valuable members of a multidisciplinary approach. Several strategies should be used to initiate and stimulate physiotherapy within the mental health care systems:

1. Continued medical education should be used to inform supervising mental health care professionals on the importance of physiotherapy,

2. Policymakers should be made aware that investment in physiotherapy could optimize mental and physical health improvements while the inclusion of physiotherapists in lifestyle interventions will improve adherence and reduce dropout and consequently will be cost-effective.

3. Physiotherapy institutions should focus on the importance of physiotherapy for mental health in order to improve the competencies of their graduates in this field.