**3. Mental health problems and disorders**

It is important to distinguish between mental health problems and mental health disor‐ ders. A mental health problem is a negative mental experience that is part of everyday life and interferes with emotional and/or social abilities. These problems are less severe than those associated with a mental health disorder. As previously mentioned, persons with mental disorders have a growing imbalance in their abilities. A mental disorder is defined as a syndrome characterized by a clinically significant disturbance in an individu‐ al's cognition, emotion regulation or behaviour [see **Box 1**]. It reflects a common or severe dysfunction in the psychological, biological or developmental process underlying mental functioning [4, 5].

One out of four persons might face a mental health disorder at a certain point in their life. Depression, anxiety, post‐traumatic stress disorder and other problems can be triggered by personal and lifestyle pressures such as bereavement, relationship breakdown or job loss. Drug or alcohol dependency, illness or long‐term physical disability can cause depression. This mental health disorder is the fourth most significant cause of disability worldwide.

#### **Common mental health disorders**

The goal of this chapter is to present an overview of why physiotherapy in mental health is nec‐ essary and what it can offer to fulfil requests for help and to increase the quality of life of persons with mental health problems. It describes physiotherapy methods and their applications in the

Mental health refers to cognitive and/or emotional well‐being. More concretely, it refers to how a person thinks, feels and behaves. Mental health can affect daily life, relationships, the ability to enjoy life and even physical health. Mental health involves finding a balance between life activities and efforts to achieve resilience. According to the World Health Organization (WHO) [1], mental health is 'a state of well‐being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community'. More concrete mental health includes different components of life; for example, in terms of relationships, having a good relationship with family and having supportive friends, with the ability to talk about feelings. For leisure time it is about having hobbies, doing exercises on regular basis and having regu‐ lar holidays. Furthermore, it is important to follow a healthy lifestyle that includes, having healthy eating habits, not smoking or drinking and not taking no‐prescribed drugs and at least being able to achieve some goals in life [2]. Mental health is not merely the absence of a mental disorder. It exists on a continuum to include flourishing mental health, very good mental health, mean mental health, decreased mental health, mental health problems and

It is important to distinguish between mental health problems and mental health disor‐ ders. A mental health problem is a negative mental experience that is part of everyday life and interferes with emotional and/or social abilities. These problems are less severe than those associated with a mental health disorder. As previously mentioned, persons with mental disorders have a growing imbalance in their abilities. A mental disorder is defined as a syndrome characterized by a clinically significant disturbance in an individu‐ al's cognition, emotion regulation or behaviour [see **Box 1**]. It reflects a common or severe dysfunction in the psychological, biological or developmental process underlying mental

One out of four persons might face a mental health disorder at a certain point in their life. Depression, anxiety, post‐traumatic stress disorder and other problems can be triggered by personal and lifestyle pressures such as bereavement, relationship breakdown or job loss. Drug or alcohol dependency, illness or long‐term physical disability can cause depression. This mental health disorder is the fourth most significant cause of disability worldwide.

fields of mental health and psychiatry.

**2. Mental health**

180 Clinical Physical Therapy

mental health disorders [3].

functioning [4, 5].

**3. Mental health problems and disorders**

Common disorders refer to obsessive‐compulsive and related disorders, trauma and stressor‐related disorders, dis‐ sociative disorders, somatic symptom and related disorders, eating disorders, disruptive, impulse‐control and conduct disorders, substance‐related and addictive disorders and neurocognitive disorders

**Severe mental health disorders:** Severe mental disorders include schizophrenia, bipolar disorders, mood disorders.

For the diagnostic criteria see:

World Health Organization: International classification [5]

American Psychiatric Association: diagnostic [4]

**Box 1:** Common and severe mental health disorders

Mental health problems/disorders often begin with the thoughts and beliefs related to a (physical or mental) problem. These thoughts and beliefs are the source of emotions and feelings that act as a driver of actions/behaviours. Behaviours are a choice and have consequences at some point.

#### **4. Mental health and physiotherapy**

The importance of the implementation of physiotherapy in both common and severe men‐ tal health disorders and psychiatry is underestimated, even if there is a tradition of more than 50 years in some countries (Belgium, Scandinavia, etc.), even if the attention to 'the moving body' increases in society and even if the moving body is an important issue that is integral to psychopathology. To overcome this problem, physiotherapists who were working in mental health and psychiatry applied in 2011 for recognition as a subgroup within the World Confederation of Physical Therapy [6]. The main goal of this subgroup is to bring the different physiotherapy interventions in mental health and psychiatry together to clarify the role of physiotherapy in this field. For that reason, the International Organization of Physical Therapy in Mental Health (IOPTMH) [7, 8] adapted the recom‐ mendations of the WHO [1] concerning mental health care using physiotherapy language (see **Box 2**).

[adaptation]

**Box 2:** Recommendation for mental health care of the World Health Organisation [1] adapted by the IOPTMH.

**<sup>1.</sup>** To improve [*physiotherapy*] mental health care

**<sup>2.</sup>** To organize specific [*physiotherapy*] care for different ages including children, adolescents and elderly and risk‐ related groups as persons with eating disorders, psychotic disorders, etc.

**<sup>3.</sup>** To ensure access to primary [*physiotherapy*] care for people with mental health problems

**<sup>4.</sup>** To provide treatment in 'community‐based [*physiotherapy*] services for persons with severe mental health problems.

#### **4.1. Mental health in physiotherapy**

Not all physiotherapists realize that mental health is all the business of physiotherapy. However, it is well illustrated in the following quotation: 'no health without mental health'.

As health care providers, physiotherapists are also involved in the prevention and promotion of health, including mental health. It is their responsibility to inform individuals adequately about mental health, eliminate misconceptions about mental illness and refer them when nec‐ essary to specialized professionals in mental health and psychiatry.

Consciously or unconsciously, colleagues will be confronted in their practice with indi‐ viduals with frail mental health, chronic musculoskeletal disorders, chronic pain and psy‐ chosomatic disorders. In their stories, components of mental health are interwoven, and the patients deserve an appropriate physiotherapy intervention. In addition to these conditions, more severe physical diseases such as cardiovascular diseases, Parkinson's disease, rheuma‐ toid arthritis, hypertension, Diabetes mellitus, metabolic syndrome, asthma, asthma/chronic obstructive pulmonary disorder (COPD), cerebrovascular diseases (stroke), obesity, epilepsy, cancer and other diseases are frequently accompanied with a 'rollercoaster' of emotions, feel‐ ings of anxiety and pain. After all, individuals with mental disorders have numerous physical health complaints (cardiovascular diseases, metabolic syndrome, obesity, osteoporosis, etc.) due to medication, sedentary behaviour or inactivity and consult primary health services.

In summary, it all adds up for the health care providers to optimize access to physiotherapy for people with mental illness, give them the most appropriate treatment [9] and give addi‐ tional thought to the mental health dimension of their patients' physical conditions [10].

#### **4.2. Physiotherapy in mental health care**

In some countries, physiotherapists have a long tradition of using physiotherapy in mental health and developed specific approaches for common and severe disorders aimed at improv‐ ing the quality of daily life. It is time to bring all the knowledge together to consolidate it and centralize the interventions with a view to offer appropriate care to a specific vulnerable but growing group in society. For these persons, specific interview, assessment and therapeutic skills are necessary. The interview is based on the principles of the bio‐psychosocial and moti‐ vational interview [11]. The story, including the context, life events and chronic stressors in relation to the health of each patient, is mapped. The assessment focuses on lifestyle in rela‐ tion to the health, mood and anxiety features, illness behaviour and psychological well‐being.
