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There is not one skill that will make us successful with MH patients. The way to think about it would be lots of little things that will make it possible. When presenting to physical health staff on the skills of working with MH health patients I was often asked what to do when a patient becomes aggressive or disruptive on the ward. My answer would be, in that situation you use de-escalation strategies but really the mistakes were made a long time earlier. The goal is to never get there in the first place and to do that involves lots of small and on their own insignificant changes but all together will make it much less likely that the big problems occur. This could be considered the aggregation of marginal gains or broken windows theory. In the famous school Michaela Community college they are asked what they do when children get aggressive and start throwing chairs around. The head teacher Katharine Birbalsingh will reply that they do not have that problem. They get all the little things right and this situation never occurs. Do everything that you can to prevent the patient’s mental health problem from ever hijacking their appointment in the first place. What follows are ways that the little things can be adapted and optimised.
The Beginning
We will start from the beginning long before you actually see a patient. Consider what can be done before you even know that someone is thinking of referring to you to make your appointments go smoother. These things can be optimised and improved. One such topic is how your service will be described or sold to the patient. I assume you will gain your referrals from clinicians around you, from the mental health nurses from the occupational therapists from the psychologists from the psychiatrists and from the support workers. What they know about you and how they describe you and who they refer is very important. It is always surprising for new physios come to work in mental health to discover that the professionals around them don't really understand what it is that they do. Other professionals often don't really understand the role of a physiotherapist in mental health. This is in stark contrast to the experience of physiotherapists going through university on student placements in hospitals. Where are the doctors’ nurses and occupational therapists have a good grasp of what it is the physiotherapist does and where they fit in the chain of treatment for a patient and where they fit in the patients’ journey.
The mental health physio has a fairly unique position in MH services as they are the one profession which straddles both the physical and mental health world. Given the very likely background of a physiotherapist coming to work in mental health, they will have a high level of physical knowledge and a very small knowledge of mental health. The people around you are in the opposite boat and the physio new to mental health may be surprised at the lack of physical health knowledge of the professionals surrounding them. Even those that have completed physical health training, such as the psychiatrists, very many of them will not have worked in the physical health world for decades, because the degree of training needed do achieve their specialty.
It is very easy for the physiotherapist coming to work in a mental health trust to assume that everybody around them knows what they do and knows how they will do it. That everyone knows who to refer and for what. That everyone knows where physiotherapy sits in the patient journey and knows how to describe what do they do and how they work with sufficient subtlety, accuracy and brevity to begin a patient's journey into physiotherapy in an way which will optimise the process for the patient.
Something like this may seem trivial, and not a major factor as to whether your intervention is ultimately successful. It is the aggregation of lots of minor factors or ‘broken windows theory’ which will make the difference between your intervention being successful, and not. The more of these factors, you can optimise the more likely you are to be successful.
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