Interventions for Mental Health. An Evidence-Based Approach for Physiotherapists and Occupational Therapists PDF
Preview Interventions for Mental Health. An Evidence-Based Approach for Physiotherapists and Occupational Therapists
BUITERWORTH-HEINEMANN An imprint of Elsevier Science Limited © 2003, Elsevier Science Limited. Allrights reserved. No part of this publication may be reproduced, stored ina retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copy ing in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London WIT 4LP. Permissions may be sought directly from Elsevier's Health Sciences Rights Department in Philadelphia, USA: phone: (+I) 215 238 7869, fax: (+l) 215 238 2239, e-mail: [email protected]. You may also complete your request on-line via the Elsevier Science homepage (http.Z/www.elsevier.com), by selecting 'Customer Support' and then 'Obtaining Permissions'. Firstpublished 2003 ISBN07506 4965 8 BritishUbraryCataloguingin PublicationData Acatalogue record for this book isavailable from the British Library libraryofCongressCatalogingin PublicationData Acatalog record for this book isavailable from the Libraryof Congress Notice Medical knowledge isconstantlychanging. Standardsafety precautions must be followed, but as new research and clinical experience broadenour knowledge, changes intreatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturerof each drug to be adminis tered to verify the recommended dose, the method and duration of administration, and con traindications. It isthe responsibility of the practitioner, relying on experienceand knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the Publisher nor the editorsand contributors assumes any liabilityfor any injury and/or damage to personsor propertyarising from this publication. The Publisher yoursourceforbooks, journalsandmultimedia . . inthehealthsciences www.elsevierhealth.com The publisher's policyistouse Cover design based on an original idea by Lee Haynes papermanufactured fromauatalnableforeata I Printed inChina Contributors DianaBeaven Grad Dip Phys Senior Physiotherapist, Barrow Hospital, Bristol, UK PatsyBrodie Dip COT Head of Occupational Therapy Service Adult Mental Health, Royal Dundee LiffHospital, Dundee, UK Helen Burl MScPGCert LTDip COT Senior Lecturer, Sheffield Hallam University, Sheffield, UK David Carless MScBA Researcher in Exercise and Health Science, University of Bristol, Bristol, UK Sarah Childs BOcc THE Head IVOccupational Therapist, Rehabilitation and Continuing Care, Fair Mile Hospital, Cholsey, Berkshire, UK AndrewClyne Grad Dip Phys Senior Physiotherapist, Adult Mental Health Service, Swindon, UK NicolaConnolly D Clin Psych MABA Clinical Psychologist, Highfield Adolescent Unit Warneford Hospital, Oxford, UK Shelagh Creegan BSc(Hons) Health Studies, Dip COT Head Occupational Therapist, Adult Mental Health, The Community Workshop, Dundee, UK JenniferCreek MScDip COT FETC Freelance Occupational Therapist Pam Dawson PhD PGCED MCSP Principal Lecturer in Allied Health Professions Research, Newcastle upon Tyne, UK Marie Donaghy PhD BA(Hons) FCSPILTM Head of School, Health and Biological Sciences, Queen Margaret University College, Edinburgh, UK Jonquil Drinkwater PhD AFBPsS Head of Child and Adolescent Psychology, Oxfordshire Mental Healthcare Trust, Oxford, UK vii viii Contributors EdwardASDuncan BSc (Hons) Dip CBTSROT Senior Occupational Therapist, The State Hospitals Board for Scotland, Carstairs, Lanark, UK Tina Everett MScMCSP Head Physiotherapist for Oxfordshire Mental Healthcare NHSTrust, Warneford Hospital, Oxford, UK Alice Farrington DClin Psych Clinical Psychologist, The Park Hospital for Children, Headington, Oxford, UK Guy Faulkner BEd MScPhD Lecturer in Exercise and Sports Psychology, University of Exeter, Exeter, UK SallyFeaver MABA DipOT Principal Lecturer, Oxford Brookes University, Headington, Oxford, UK Kenneth Fox BSc MScPhD Professor and Head of Department of Exercise and Health Sciences, University of Bristol, Bristol, UK Colin Godfrey RGN SPSA Activities Development Nurse for Oxfordshire Mental Healthcare NHS Trust, Oxford, UK Caroline Griffiths MCSP Grad Dip Phys Clinical Specialist Physiotherapist, Northamptonshire Healthcare Trust, Northampton, UK John Hall PhD FBPsS Clin Psychol Head Clinical Psychologist for Oxfordshire Mental Healthcare NHS Trust and Senior Clinical Lecturer in Clinical Psychology, University of Oxford, Oxford, UK GitaIngram Dip COT SROT Senior Occupational Therapist, Royal Hospital for Sick Children, Edinburgh, UK DerekJones BA(Hons) Dip COT SROT Lecturer in Occupational Therapy, Queen Margaret University College, Edinburgh, UK Mary Kavanagh MScBA(Hons) Dip COT SROTCert. Couns, Lecturer in Occupational Therapy, Oxford Brookes University, Headington, Oxford, UK Denis Martin DPhil MSc(Applied Statistics) BSc (Hons) MCSP Grad Stat Director Scottish Network for Chronic Pain Research, Queen Margaret University College, Edinburgh, UK Louise Montague-Jones Dip COT SROT/Cert THE Senior Occupational Therapist, Oxfordshire Mental Healthcare NHS Trust, Oxford, UK Conceptual frameworks for community careand working with carers ix Nanette Mutrie OPE, MEd PhD Professor of Physical Activity and Health Science, University of Glasgow, Glasgow, UK Margaret Nicol Dip COT MPHILPhD Acting Head of Department, Occupational Therapy and Art Therapy, Queen Margaret University College, Edinburgh, UK GwynethOwen MScMCSP Professional Advisor, Chartered Society of Physiotherapy, London, UK Catherine Pope MAMCSP Physiotherapy Manager, Nottinghamshire Healthcare NHSTrust, Nottingham, UK NickRose MBChB MAFRC Psych Consultant Psychiatrist and Honorary Senior Lecturer, University of Oxford, Oxford UK Mick Skelly MScMCSPDip Phys Dip AD SRP Superintendent Physiotherapist, Rosslynlee Hospital, Roslin, Midlothian, UK Unette Whitehead BA MSc(Oxon) Consultant Clinical Psychologist, Warneford Hospital, Oxford, UK Emma Williams BSc(Hons) MPhii (Clin Psychol) PhD Consultant Clinical and Forensic Psychologist, Oxford Mental Healthcare NHSTrust, Oxford, UK Foreword Physiotherapy as a therapeutic intervention in the management of people with mental illhealth has come a long way since itssmall beginnings in the 1970s. It is now part of the central core of the profession, helping to fur ther broaden the boundaries and scope of physiotherapy. Occupational therapy has a much longer history, almost since the inception of the pro fession in 1937 (in Scotland), occupational therapists have been providing a central therapeutic role in the rehabilitation and management of people with mental illhealth. Both disciplines are still advancing with the applica tion to practice of the emerging evidence and the desire for more collab orative working. These wide developments are well covered in this text book, based on the solid evidence-base of real benefits to clients and the pioneering techniques that show promise for the future in treating partic ular conditions. Mental health is a key priority for the modern NHS and social services. This is unsurprising considering that depressive disorders are the fourth most important cause of disability worldwide. In the UK, anxiety and depression are one of the major sources ofvisits to GPs, make a large com ponent of the primary care drugs bill and result in over 80000 working days lost annually, at a cost of at least £5.3 billion. The total cost of treat ment in both primary and secondary care is huge. It is therefore unsur prising that governments have a major interest in care solutions that can help to improve mental health in its varied forms. This is why mental health is an exciting and evolving area of work for physiotherapists and occupational therapists. It focuses on the reality that the mind and the body are one - they are not distinctive entities. People can become clinically depressed as a result of a physical disorder or those who have a mental disorder can develop a physical disorder as a conse quence. The physical image of themselves that people with eating disor ders have can be radically different from that of the rest of the world. Anxiety, depression or addictive behaviour can be heavily influenced by physical factors, self confidence or awareness. As this book illustrates, physiotherapists and occupational therapists working in mental health are uniquely placed to provide an extensive range of physical approaches to treatment aimed at relieving symptoms, boosting confidence and improving quality of life. Interventions include physical activity, exercise and sport, balance, postural and movement edu cation, useful occupation, creative therapy, achieving goals and life skills, management ofchronic or acute pain, relaxation techniques, manual ther apies, acupuncture and complementary therapies. xii Foreword Available evidence suggests that exercise, training and increased goal oriented physical activity produce definite improvement in reducing depression and anxiety, improved physical status, bettercognitive function and can facilitate hehavioural lifestyle changes. The enormous expansion of private gyms and sport facilities in the UKis testimony to the extent to which physical activity as a stress reducer has become accepted hy the wider public. More broadly, physiotherapists and occupational therapists are also involved in advice, guidance and education of users, carers and staff. The promotion of self confidence and self awareness, motivation and social ization are important components in this armoury. Increasing evidence suggests that interventions such as cognitive-behavioural therapy, coun selling and exercise can reduce anxiety and depression and enhance psy chosocial function either as an adjunct to therapy or as an alternative intervention. The psychological benefits of exercise in dealing with alco hol and other addictions is becoming better known. The occupational therapist and physiotherapist in mental health are team players in a wider interdisciplinary team of social workers, psychol ogists, nurses and others. To this teamworking, occupational therapists and physiotherapists hringa breadth ofassessment and treatment expertise that is often delivered alongside prescribed pharmacological or psychological interventions. This new texthook, written hy experts in the field of mental health therapy, can only help to expand the horizons of the possible in improving mental health in the UK. Phil Gray 2003 Introduction The decision to write a new book for physiotherapists and occupational therapists working in mental health, rather than update the previous book Physiotherapy in mentalhealth: a practicalapproach (Everett et al 1995) was taken to reflect current changes and trends in the delivery of services for people with mental health problems. These changes include the need to provide evidence-based interventions and the need for greater involve ment of both physiotherapists and occupational therapists to promote and share best practice. The need for an integrated approach is emphasized in the standards of the National Service Framework for Mental Health and in the NHS Plan. Throughout the book we have attempted to stress the importance of working in partnership with the individual to whom we are delivering the service, with primary care and specialist mental health teams, voluntary agencies and social services. Wesupport the concept that the person with mental illhealth should be placed at the centre of decision making, with the therapist as enabler. We appreciate the need to promote more interdisciplinaryeducation and teamwork while recognizing the chal lenges that this can present. The previous book evolved from the clinical interest group Chartered Physiotherapists in Mental Healthcare providing a standard text, with a global distribution, for physiotherapists working in this specialist field. This new book has been written as a key text by and for occupational thera pists and physiotherapists, with notable contributions from other health care professionals, particularly clinical psychologists and academics in the sport and exercise sciences. It is hoped that the book will be of value to clinicians in other professions, particularly nursing and medical colleagues. A growing number of skilled technical instructors with degrees in sport and exercise science work within physiotherapy and occupational therapy teams and it is envisaged that this book will be a useful text for them also. The editors are very conscious of the fact that the authors are writing from a British perspective and that named government initiatives are mainly from the UK. However, attempts have been made to draw from research worldwide, and it is the intention that the book will be of value internationally. Each chapter provides a description of the theoretical underpinning or a critique of theoretical issues and an inclusion of the research supporting the efficacy ofthe therapeutic intervention. It isourintention that this book will provide physiotherapists and occupational therapists andstudents with a scientific basis and an appropriate context in which decisions regarding the selection of intervention can be made. xiii xiv Introduction When considering applying the evidence presented within the text to practice, it is important to distinguish between the efficacy of an interven tion, i.e. the results achieved within the context of a therapeutic trial, and clinical effectiveness, i.e. the results achieved in everyday clinical practice. Research into therapeutic interventions involves a compromise between providing rigorous procedures to implement and evaluate the intervention and taking account of what normally happens during a therapeutic inter vention, includingthe evolving and changing nature of the therapeutic rela tionship. There is a tension between the need to achieve high internal validity with an identifiable homogenized population and the extent to which these findings can then be generalized to other clinical settings where people with mental health problems differ in socioeconomic cir cumstance, psychological and physical function. The context in which the therapeutic intervention takes place also needs to be considered, particu larly in relation to available resources that will impact on the frequency and length of treatmentofferedand onthe quality of links with family and other professionals and services. The ability of physiotherapists and occupational therapists to provide a clinically effective service will be informed by an understanding and interpretation of the research evidence considered alongside a critical analysis of their own practice and the context in which they operate. The content of this book has been organized into three sections. Section 1 provides background knowledge and sets the book in context for the reader. It includes: an introduction to mental disorder from different view points (Chapter 1), definitions and diagnostic categories of mental disorders including medical and psychological interventions (Chapter 2), the differ ent contexts that inform the delivery of services including policy, service evaluation and accountability (Chapters 3, 4 and 5). Section 2 takes a thematic and principles-based approach, with the emphasis firmly placed on activity and occupation. The intervention strate gies presented were selected for their generic applicability across a range of mental health problems. The reader is presented with evidence and arguments to support the important role of physical self perceptions, in relation to self-esteem and personal identity. This provides theoretical links to the principles of and the evidence for physical activity as a legitimate intervention strategy for people with mental health problems (Chapters 6-9). Chapter 10 is dedicated to cognitive-behavioural strategies, this reflects the importance of this approach for occupational therapists and physiotherapists and signals that this approach iscurrently being integrated into a number of therapeutic interventions. Further chapters in this part of the book provide the reader with specific examples of the application of principles to deal with stress, aggressive behaviour and managing pain (Chapters 11-13). This part closes with chapters on enabling occupation and users' views on occupation (Chapters 14 and 15), stressing the impor tance of this therapeutic intervention within the rehabilitation process. The third and final section of the book brings together for the reader a comprehensive knowledge ofspecific areas of physiotherapy and occupa tional therapy practice. Some of the chapters in this section are defined by population, for example children, adolescents and the elderly (Chapters 16 and 17), others are defined by nature of the specialist topic that is often Introduction xv associated with other symptoms and behaviours, for example eating disor ders, chronic fatigue, sexual abuse and self harm (Chapters 21-24). These topics should not be viewed in isolation but are recognized for their asso ciation with other problems in mental health. Chapters 18, 19 and 20 intro duce the reader to severe mental illness, forensic psychiatry and substance abuse. The final chapter, entitled 'Employment for health' is included to remind us that, for some people and their families, this isan importantgoal (Chapter 25).The reality, however, isthatfor many people itwill be achiev able but that for others it will not. For both physiotherapists and occupa tional therapists, an understanding ofthe process will inform realistic goal setting for other interventions Some of the chapters contain case studies of clinical service user expe rience - these examples are generally created from clinical experience rather than being identified with one particular person. The names chosen bear no relation to any particular individual. Quotes from service users have either been published elsewhere or chosen anonymously from serv ice audit. Identity has been hidden and, where necessary, permission has been obtained. Complementary therapies, although referenced in some ofthe chapters, do not feature in this text. This is in recognition that complementary med icine is now an established therapy in its own right with several key texts published in this area. This book is dedicated to Eirean Ricketts, a Fellow of the Chartered Society of Physiotherapy and editor of the previous text for physiothera pists, who sadly died ofcancer. Eirean was a pioneer physiotherapist from Cardiffwho, through vision and hard work with her occupational therapy colleagues, gained recognition for physiotherapy in the management of people with mental health problems. 2003 Tina Everett Marie Donaghy Sally Feaver Reference Everett T, Dennis M, Ricketts E (eds) 1995 Physio therapy in mental health: a practical approach Butterworth Heinemann, Oxford 1 Models of mental health disorder Marie Donaghy Introduction Models are defined, for the purpose of this chapter, as representations of a particular body of knowledge, put forward as an explanation and interpretation of events. They are intended to give the reader insight into the application of different theoretical approaches to the clinical setting. Numerous models inform the work of physiotherapists and occupational therapists, and many of these are contained in other chap ters of this book. Those selected for this chapter have been brought together to illustrate how knowledge from medicine and psychology provide different viewpoints of people with mental health problems and ultimately the interventions they are engaged in or prescribe. The biomedical and neurobiological models are presented alongside the family therapy, humanistic, psychodynamic and cognitive-behavioural models from psychology. Social models have also been developed to challenge and reject the establishedviews of mental illness (Kovel 1982, Laing 1967, Szasz 1961). These were discussed by the author in an ear lier publication (Donaghy 1995) and are not included here because they are perceived to be less relevant to the strategies currently used by physiotherapists and occupational therapists in the management of peo ple with mental health disorders. Mental health Mental health disorders can be studied from two major standpoints: (1) disorders how the brain works; and (2) from knowledge about how man inter acts within the environment (Goldberg & Huxley 1992). The first approach is from the biomedical perspective and considers the scien tificdiscipline of the neurobiology of mental illness, including genetics. The otherapproach comes from the social sciences and considers meth ods of inquiry derived from epidemiology, sociology and psychology. Areview of recent developments from the medical perspective suggests that although there have been advances in the field of neurobiology, progress is lagging behind other medical advances. The excitement over the genetic breakthrough in schizophrenia and manic depression in the 1980s has been replaced with the recognition that, to date, 3
The list of books you might like
