By Kristina Kokorelias & Amanda Ali
“If you want to heal the body, you must first heal the mind” – Plato (427-347 BC)
Mental health is largely overlooked in the physical rehabilitation domain despite its important connection to physical health outcomes. According to Turton et al. (1), moving past a physical ailment requires improving well-being and regaining a role as a citizen in society. The effect of negative emotions experienced during rehabilitation can persist and exacerbate decline in social activities following discharge (2). Moreover, the stress that is often associated with recovering from injury or illness can worsen a range of health problems for patients undergoing rehabilitation. For example, patients who receive hip arthroplasty may experience anxiety and depression, and this stress can trigger muscle tension or muscle spasms that may increase pain and make physical recovery more difficult (3). Social and psychological factors that impact the rehabilitation process, such as anxiety and depression (3), and reduced motivation and increased fear (4), must be considered. Physical rehabilitation professionals must support their patients’ mental health to better facilitate their health, well-being, self-esteem, and functioning post-rehabilitation (5, 6). As researchers who focus on chronic physical health conditions, we believe there is a critical role for rehabilitation professionals in recognizing and treating the mental health needs of patients undergoing physical rehabilitation.
Effective teamwork is essential in professional environments and rehabilitation clinics are no exception. Due to the fragmented nature of the health care system, including the disconnect between hospitals and rehabilitation clinics, care is usually provided by individuals with a limited set of knowledge and skills based on discipline-specific training. Physicians, physiotherapists, occupational therapists, and other rehabilitation professionals practice within silos where they seldom have the opportunity to communicate or coordinate care (7), given contextual factors such as a lack of resources and time. Rehabilitation professionals often work with patients, their families, and wider interdisciplinary teams from the time of patient admission through to discharge, and in some cases, also during follow-up. We believe that rehabilitation professionals are uniquely equipped to offer continuity of care through their ongoing relationship with patients during the rehabilitation process, in comparison to other medical disciplines where time spent with patients is often limited. For example, general practitioners may only meet with individual patients a few times per year, making it difficult to establish rapport and observe the subtleties that often reflect mental disorders. Having continuity of care has been said to enhance the quality of mental health services (8), given the greater ability to detect signs and symptoms of emotional distress, and rehabilitation professionals are more likely to be involved with their clients as they move from acute care to rehabilitation to the community than other health care professionals.
While training individuals to work on interdisciplinary teams is crucial, it is also essential that physical rehabilitation professionals are interdisciplinary in their knowledge. This includes skill in providing mental health support to clients and caregivers throughout treatment and care plans. It remains unclear whether it is within the role of rehabilitation professionals who work in physical health settings, such as physiotherapists, speech-language pathologists, and occupational therapists, to offer mental health treatment plans to patients in rehabilitation, given that they are not specifically trained to diagnose medical conditions. We believe that all physical rehabilitation health care practitioners should be encouraged to pursue this specialized training since mental health is so critical to physical health (and vice versa), and since rehabilitation professionals may have longer term involvement with patients during which detection and treatment of mental health is possible.
Psychosocial aspects of care may already be incorporated into the standardized training for rehabilitation professionals, but we suggest there be a sharp focus in the initial and ongoing training of rehabilitation professionals to diagnose and refer patients with mental health conditions. Although not geared specifically towards rehabilitation, the Trillium Health Partners now offer a novel continuing education program entitled the Medical Psychiatry Collaborative Care Certificate (MP3C) which aims to train health care providers in bridging the gap between mental and physical health (9). While expansion in the training and responsibility of rehabilitation professionals is an ambitious goal that may be met with resistance, significant improvements in care can be made by ensuring professionals are equipped with the tools to support mental health conditions. Improved understanding of the relationship between psychological factors and functional outcomes after rehabilitation will be instrumental in this endeavor. This type of reform will effectively move the rehabilitation health sector closer to the ultimate goal of providing personalized care to help patients achieve their personal definition of well-being.
- Turton P, Demetriou A, Boland W, Gillard S, Kavuma M, Mezey G, Mountford V, Turner K, White S, Zadeh E, Wright C. One size fits all: or horses for courses? Recovery-based care in specialist mental health services. Social psychiatry and psychiatric epidemiology 2011;46:127–36.
- Salkeld G, Ameratunga SN, Cameron ID, Cumming RG, Easter S, Seymour J, Kurrle SE, Quine S, Brown PM. Quality of life related to fear of falling and hip fracture in older women: a time trade off study (commentary): Older people’s perspectives on life after hip fractures. BMJ 2000;320:341–6.
- Brownlow HC, Benjamin S, Andrew JG, Kay P. Disability and mental health of patients waiting for total hip replacement. Annals of the Royal College of Surgeons of England 2001;83:128.
- Voshaar RC, Banerjee S, Horan M, Baldwin R, Pendleton N, Proctor R, Tarrier N, Woodward Y, Burns A. Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people. Psychological Medicine 2006;36:1635.
- Hayes A, Gray M, Edwards B. Social inclusion: Origins, concepts and key themes. Department of the Prime Minister and Cabinet; 2008 Oct.
- Stucki G, Stier-Jarmer M, Grill E, Melvin J. Rationale and principles of early rehabilitation care after an acute injury or illness. Disability and Rehabilitation 2005;27:353–9.
- Le Boutillier C, Croucher A. Social inclusion and mental health. The British Journal of Occupational Therapy. 2010 Mar 1;73(3):136-9.
- Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ: British Medical Journal. 2003 Nov 20;327(7425):1219.
- Hospital News. Continuing education program for healthcare providers integrates training in mental and physical healthcare [Internet]. Canada; N.D. Available from: http://hospitalnews.com/continuing-education-program-healthcare-providers-integrates-training-mental-physical-healthcare/