**8. Conclusion**

physical complaint, the psychosomatic physiotherapist focuses specifically on the psychophysi‐ ological and behavioural characteristics of the client's motor performance‐related problem. The aim is to recognize and gain insight into the complex relationship between motor and psycho‐ logical performance within a psychosocial context and positively influence disrupted internal and external regulation mechanisms. The psychosomatic‐oriented physiotherapist is inspired by cognitive behavioural interventions (see **Figure 2**) [113, 114], including graded activity and active pacing therapy. The therapist uses a number of specific awareness‐raising methods such as relaxation techniques, breathing and communication methods, (bio‐) feedback, problem solv‐ ing strategies and stress management. The status of the patient is observed using the 'SCEGS model' (soma, cognitions, emotions, behaviour and social environment). Treatment objectives are formulated in terms of the SMART criteria. The relationships among the need for help as expressed by the patient, body language, body posture, movement and gestures are explored. In addition, verbal language is analysed. The balance between supporting load and supporting strength, tension and relaxation, and body and illness perception and reality is explored during

Mental health problems are the leading predictor of years lived with disability worldwide. Furthermore, without more intensified prevention and management, the burden is estimated to increase to a greater extent [115]. The consequences of mental health problems are devastating for the person and society as a whole and are compounded by physical health comorbidities with which most people with mental health problems are confronted [115, 116]. Physical health comorbidities are a major cause of the reduced life expectancy of 15–20 years in this popula‐ tion [118–120]. The relationship between mental health and physical activity is supported by a growing number of articles [92]. There is rigorous evidence now that physiotherapy improves mental and physical health in this vulnerable population [121]. Unfortunately, these efforts are becoming integrated into clinical practice at a slow pace. Physical activity is not always consid‐ ered to be a worthwhile strategy. The benefits of physical activity are twofold, as people with mental health problems are also at an increased risk of a range of physical health problems, including cardiovascular diseases, endocrine disorders and obesity [115–124]. Physical activity influences cognition [122] and cardiorespiratory fitness [123] and reduces dropout [121] due to a wide range of mental health problems. The relationship between physical activity and men‐ tal health has been widely investigated. The health benefits of regular exercise are improved cardiovascular fitness, improved sleep, better endurance, a positive influence on metabolic syndrome and diabetes, stress relief, improved mood, increased energy and reduced tired‐ ness. Exercise reduces anxiety, depression, negative mood and social isolation and improves

Old age psychiatry consists of two groups: dementia syndrome ( Alzheimer, frontotemporal degeneration, vascular dementia) and functional psychiatric disorders (depression, addiction, mood disorders, personality disorders and schizophrenia). Elderly people experience declin‐ ing physical activity levels and functional capabilities, loss of dependence, decreasing social

the sessions.

192 Clinical Physical Therapy

**7.7. Exercise and physical activity in mental health**

self‐esteem, cognitive functions and quality of life [115–124].

**7.8. Physiotherapy with the elderly in old age psychiatry**

Today, there is a professional need in society for a physiotherapeutic approach to treat people who are suffering from chronic musculoskeletal and mental health problems. The general aims of physiotherapy in mental health are summarized in **Box 3**.

**"Promoting, advising, teaching, warning, motivating maintaining, working, treating, assessing"**

**To promote** human well‐being and autonomy in people with physical health needs that are associated with a mental illness or learning disability and/or to use physical approaches safely to influence mental health.

**To offer advice** on the prevention of stress and physical problems as well as quality‐improvement techniques.

**To teach** on topics relating to exercise, relaxation and communication.

**To warn people** about the side effects and to advise people on the use of quality‐improvement techniques.

**To motivate** people to engage in healthy living habits.

**To maintain** (or to regain) physical mental and social skills to preserve the ability to function and the quality of life.

**To work** with the senses and motor skills of children with bodily and behavioural difficulties.

**To treat** physical and psychosomatic problems.

**To assess**treatment effectiveness and patient satisfaction.

**Box 3:** General aims of physiotherapy in mental health.

In contrast to other fields in medicine, mental health consists of a labyrinth of conventional, complementary and alternative therapies and approaches [128]. A person with fluctuating mental health is more receptive to alternative approaches. Conventional health caregivers have to guide the patient in the search for optimal help. For that reason, physiotherapy interventions in mental health should at least satisfy four criteria. The nature of the interventions should be described clearly. The claimed benefits of the services must be stated explicitly. These benefits must be scientifically validated. Individual effects that might outweigh the benefits must be ruled out empirically. Collaboration and connections with other mental health care special‐ ists within and outside physiotherapy are necessary to broaden the field of physiotherapy in mental health (see Box 3), avoid isolation, build a quality framework and cope with future challenges. In mental health care, boundaries between specialities have become increasingly more blurred. Intensive specialization of physiotherapy has been called into question. The demands to collaborate at the interdisciplinary (i.e. mutual contact between care providers) and transdisciplinary (various caregivers are at each other's domain) levels have increased. The inclusion of ideas from the social sciences and humanities in mental health care has become increasingly more important [129]. In the future, therapists will need to obtain informed con‐ sent for each treatment. Each therapist will need to explain that the proposed method has value for the patient and provide information about what, why, where, when and how he or she will proceed and what the potential outcomes are. Dialogue with the patient is important for the outcome and patient satisfaction. By definition, interventions in mental health are complex, given the nature of mental health and illness. Physiotherapists who work in mental health are well‐trained therapists with knowledge of mental health (allegiance to theory) and motiva‐ tion skills and have empathy (therapist‐client alliance). The quality of the therapeutic relation‐ ship or alliance is important for the outcome of the physiotherapy treatment. Interventions require careful planning and sufficient resources to implement the programme as planned. Interventions are individually adapted according to the individual's psychophysical function‐ ing, needs and wishes. The source of the most advanced knowledge of physiotherapy in men‐ tal health is a combination of scientifically derived knowledge and knowledge gained through years of experience (professional practice) (see **Box 3**). The different physiotherapy approaches are cost‐effective and secure. Furthermore, they do not have side effects. They involve the patient and provide practical skills and insight for use in daily life. After a physiotherapy observational and/or evaluation assessment, the approaches focus on functional and (men‐ tal) health promotion. The patient's voice becomes increasingly more important. This chapter provides additional insight into why physiotherapy education needs to give more attention to the field of mental health in the curriculum. Currently, from the patient perspective, it is not acceptable for physiotherapists, as health care providers, to not have any or have limited courses on mental health during their education. Many excellent colleagues in primary care are not well prepared to work with persons with mental health, not because of their illness but because of their lack of information on how to address the illness.

#### **Author details**

#### Michel Probst

Address all correspondence to: michel.probst@kuleuven.be

KU Leuven, Department of Rehabilitation Sciences, Belgium

#### **References**

[1] World Health Organization (WHO). Promoting mental health: Concepts, emerging evi‐ dence, practice: report of the World Health Organization, Department of Mental Health and substance abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne; 2005. Geneva: World Health Organization.

[2] Probst M, Skjaerven L. Editors. Physiotherapy in mental health and psychiatry: a scien‐ tific and clinical based approach. London: Elsevier; 2017, in press.

challenges. In mental health care, boundaries between specialities have become increasingly more blurred. Intensive specialization of physiotherapy has been called into question. The demands to collaborate at the interdisciplinary (i.e. mutual contact between care providers) and transdisciplinary (various caregivers are at each other's domain) levels have increased. The inclusion of ideas from the social sciences and humanities in mental health care has become increasingly more important [129]. In the future, therapists will need to obtain informed con‐ sent for each treatment. Each therapist will need to explain that the proposed method has value for the patient and provide information about what, why, where, when and how he or she will proceed and what the potential outcomes are. Dialogue with the patient is important for the outcome and patient satisfaction. By definition, interventions in mental health are complex, given the nature of mental health and illness. Physiotherapists who work in mental health are well‐trained therapists with knowledge of mental health (allegiance to theory) and motiva‐ tion skills and have empathy (therapist‐client alliance). The quality of the therapeutic relation‐ ship or alliance is important for the outcome of the physiotherapy treatment. Interventions require careful planning and sufficient resources to implement the programme as planned. Interventions are individually adapted according to the individual's psychophysical function‐ ing, needs and wishes. The source of the most advanced knowledge of physiotherapy in men‐ tal health is a combination of scientifically derived knowledge and knowledge gained through years of experience (professional practice) (see **Box 3**). The different physiotherapy approaches are cost‐effective and secure. Furthermore, they do not have side effects. They involve the patient and provide practical skills and insight for use in daily life. After a physiotherapy observational and/or evaluation assessment, the approaches focus on functional and (men‐ tal) health promotion. The patient's voice becomes increasingly more important. This chapter provides additional insight into why physiotherapy education needs to give more attention to the field of mental health in the curriculum. Currently, from the patient perspective, it is not acceptable for physiotherapists, as health care providers, to not have any or have limited courses on mental health during their education. Many excellent colleagues in primary care are not well prepared to work with persons with mental health, not because of their illness but

because of their lack of information on how to address the illness.

Address all correspondence to: michel.probst@kuleuven.be KU Leuven, Department of Rehabilitation Sciences, Belgium

[1] World Health Organization (WHO). Promoting mental health: Concepts, emerging evi‐ dence, practice: report of the World Health Organization, Department of Mental Health

**Author details**

Michel Probst

194 Clinical Physical Therapy

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**Provisional chapter**
