Physiotherapy in Forensic Mental Health

1. Physiotherapy in Forensic Mental Health

2. Our service • Forensic mental health services • community team • forensic rehabilitation unit • court liaison service • IPCU • Ailsa Hospital • Ayrshire and Arran

3. “A strong AHP workforce in mental health brings benefits for all”. “It brings benefits to AHPs and their colleagues in the multidisciplinary,multiagency team through the recognition and deployment of highly-skilled, clinically effective AHP practitioners as part of integrated mental health services”. Shona Robison, MSPMinister for Public Health and Sport By including a dedicated Physio in the Forensic Service NHS Ayrshire and Arran is supporting the development of new models, systems and ways of working to facilitate early interventions and timely access for service users and carers. (RP Rec 1)

4. Role of Physiotherapist • Use physical approaches to promote, maintain and restore physical, psychological and social well being (RP Rec 4) • Promote health related behaviours including smoking cessation, weight management and physical activity. • Maintain focus and raise awareness in all staff groups of the importance of health related behaviours. • To ensure the provision of evidence-based, socially inclusive and accessible physical activity rehabilitation programmes for service users and carers. (RP Rec 4)

5. Physical Activity • Evidence based • Socially inclusive • Accessible • Helps optimise mental well being • Helps optimise physical health • Reduces the risk of early death

6. Focus Groups • Service users have confirmed that being physically fit and active is important to them • Recent research in service users experiencing schizophrenia and living in the community identified barriers to engaging in physical activity • Limited experience of physical activity • Impact of illness and medication effects • Anxiety and the influence of support networks

7. Interventions • Tailored to the individual taking into account • Low motivation • Poor concentration • Sedentary Lifestyle • Weight Gain • Movement Disorder • Other side effects of medication

8. Staff Engagement • Work with partners to promote and enhance the provision of evidence-based, socially inclusive and accessible therapeutic activity in a range of settings.(Realising Potential Rec 6) • Hobbies and interests of staff identified and matched with those of patients • Staff encouraged to participate with patients • Appropriate equipment accessed

9. Structured activity • Healthy eating and dinner groups • Two walking groups per week • Daily gym sessions / Swimming access/Yoga • Badminton group weekly • Ward cycles for usage by patients • Golf supported at driving range and golf course • Exercise groups at local leisure centres • Mindfulness sessions • All patients have a timetable which is agreed with the named nurse and updated weekly

10. Blood pressure

11. Blood pressure

12. Weight Loss

13. Staff Comments • I have a fuller and more holistic perception of clients needs. • Keeps team ‘eye on the ball’ when it comes to physical health. • Specialist input readily available • Consistency of care from inpatient to community helps maintain health gains and support activity. • Encourages staff to take stock of own physical well being • Staff are considering activities that can have an impact on the whole team’s health • It’s had a positive impact on staff sickness absence

14. Conclusions • High prevalence of physical health problems in those with mental health problems and this is rising. • Higher Mortality Rates • Good evidence that physiotherapy led interventions are effective in improving health and wellbeing • Good health gains achieved • Measuring effect of physiotherapy in a forensic population to ascertain effectiveness of these activities in improving physical health is ongoing.