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Information for junior physiotherapy staff


Physiotherapy at Springfield

As in any other service, psychiatric patients can injure themselves or have a musculoskeletal, neurological or cardio-respiratory impairment. Some conditions/injuries may be a result of behaviours due to their mental health condition (ie. self harm) others may be due to exercise or activity on their ward or others may have been present prior to the current admission. Physiotherapy may be an appropriate treatment, as it would be with patients in any other hospital or outpatient setting.

Whilst you are at Springfield, your caseload will be very mixed, to give as much experience as possible. You will have out patients, treat people on the acute wards, cover an older person’s day hospital and see patients in the community.

The physical therapies department at Springfield consists of physiotherapists, exercise therapists and massage therapists. There is a close working environment, and a good chance to discuss patients with the other therapists and pick up some handy tips!

The physiotherapy team you will be working with are based at several sites, Springfield hospital, Tolworth hospital, Barnes hospital and Twickenham (St Johns and Amyand house).

Although you are away from the main St George’s site, its only a short walk down the road and you still maintain your links with the department by attending the junior musculoskeletal IST and by attending the Thursday lunchtime IST and staff meetings.

Contact numbers

Physical therapies department (Springfield) 0208 682 5873

St George’s physiotherapy department ext 1360

NB remember to phone St George’s (speak to Delene ext 1360) at the end of each month for your positive reporting (for annual leave, sick leave etc).

PS Another perk of being at Springfield is that you have four months freedom from the lovely blue and white physio uniform!

 

Safety

The media portrays people with mental health conditions to be aggressive and violent. Everyone has the potential to be violent and aggressive, although there is a slightly higher incidence of violence in the mental health population. At Springfield every attempt is made to keep risks to a minimum.

Personal safety

  • Ensure the rest of the team know where you are (use the white board and home visit books)
  • Be aware of A alarm positions and escape routes!
  • Always sit closest to the door
  • Try to be aware of the patient’s current mental state talk with the team and consult the medical notes¥
  • If you are unsure of a patient ask another member of staff to sit in on the session, to provide you with support.

 

Dealing with aggression

  • Introduce yourself and explain the purpose of the interview
  • Listen to the person and be unhurried
  • Do not make comments about personality or be judgemental
  • Position furniture to allow an easy escape
  • Don’t let the patient get between you and the exit
  • Do not argue against delusions or hallucinations, they are real to that person

The Trust's services

Forensic psychiatry
Forensic psychiatry is concerned with assessment, diagnosis and treatment of patients whose behaviour, due to mental illness, has brought them, or is likely to bring them into conflict with the law (Fletcher, 1995).

Forensic wards at Springfield hospital

  • Halswell                      
  • Turner
  • Ruby
  • Hume

The team continually assesses and observes the patient’s behaviour, responses, attitudes and mental state, noting where they are inappropriate and give cause for concern.

 

Physiotherapy on forensic wards...
Just the same old physio stuff! Traditional treatment that is appropriate for the condition.

Treatment usually takes place on the wards, because there is usually a restriction on the patient’s freedom. There is a clinical room and a gym available for assessment and treatment on Turner and Hallswell wards.

An escort (one of the nurses!) is available to supervise the session at your request.

Be aware that equipment (weights, theraband etc) can be used as a potential means for self-harm, or as a weapon (by any patient not just the one receiving treatment) so liaise with the nursing staff and they can supervise its use.

 

Addiction services
Alcohol assessment and Treatment Unit (AATU). At Springfield this is based on Heather ward. This unit provides a detox service for those with alcohol addictions.

There are often referrals for physiotherapy treatment and advice from this ward, as some of the patients tend to be in quite poor physical condition.

 

Drug detox and drug rehab services
This is an inpatient and outpatient service. At Springfield, the inpatient services are based on Rowan ward.

 

Behavioural and Cognitive Psychotherapy Unit (BCPU)
This unit is based on Heather ward (with the alcohol assessment and treatment unit).

On this ward are patients with obsessive compulsive disorder (OCD) and body dismorphic disorder.

If you are unsure of what OCD is, it’s the condition that Jack Nicholson has in the film ‘As good as it gets’!

 

Mental Health Conditions

1 in 4 people will experience a mental health illness at some time in their life (Goldberg & Huxley, 1991).

Neurosis

Depression
This is one of the most common forms of mental illnesses. This term is used to describe a range of moods, ranging from low spirits to more severe problems where depression interferes with everyday life. An estimated 1 in 6 people will have some form of depression in their lifetime.

Anxiety
This is characterised by excessive worrying and agitation, accompanied by physical symptoms such as increased respiratory rate and increased heart rate. More than 1 in 10 people will have a disabling anxiety disorder at some time in their life.

 

Psychosis

This term is used when a person’s ability to distinguish between reality and imagination is impaired.

Schizophrenia
This can be characterised by two groups of symptoms:

-Abnormal experiences (feeling out of control, hallucinations and delusions)

-Symptoms that represent a loss of functioning (sleep problems, lack of motivation and energy)

An estimated 1 % of the population will have schizophrenia at some point in their lives.

Bipolar affective disorder
Bipolar affective disorder is also known as manic depression. This condition is characterised by the individual experiencing mood swings far beyond what most people ever experience in the course of their lifetime. The mood swings may be low (depression) or high, periods where we may feel very elated (known as phases of mania).

This is much less common than a depressive illness. Approximately 1 in every 100 adults will suffer from bipolar affective disorder at some point in their lives (Royal College of Psychiatrists).


Personality disorder
A personality disorder is an ‘enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture', this pattern is manifested in two or more of the following areas

-cognition

-affectivity

-interpersonal functioning

-impulse control’

(DSM-IV)

 

Acute  Wards

There are many acute wards at Springfield, all providing management of an exacerbation of the individual’s psychiatric symptoms or managing the first signs and symptoms of the illness leading to the diagnosis.

The wards include:

  • Seacole
  • Bluebell
  • Jupiter

Patients are assigned to these acute wards according to their home address rather than their diagnosis.

Spending time on these wards provides a great opportunity to understand more about mental health conditions. In general most of your patients are in a stable state of their mental health condition, on these wards are patients who are in the more acute stages or exacerbations of their illness. On these wards you will observe the signs and symptoms of mental illnesses, which will help you to understand the impact of the illness on the individual and their family and will also help you to recognise these signs in other patients that may be relapsing.

 

Eating disorders Unit

Eating disorders are manifested when a person (at conscious or subconscious level) first uses, then looses control of their eating in an attempt to cope with their problems (Davison, 1995).

Anorexia Nervosa

  • Characterised by loss of weight in the absence of any disease that would explain the weight loss.
  • Diagnostic criteria includes
    •           Intense fear of weight increases
    •           Weight loss of at least 15% of body weight
    •           Distorted body image
    •           Amenorrhoea in women

Bulimia

The disease is characterized by binge eating.

The diagnostic criteria includes

  •           Recurrent bingeing (2 per week for at least 3 months)
  •           Lack of control during binges
  •           Self induced vomiting, use of laxatives or diuretics
  •           Over concern with body weight and shape

The eating disorders wards include     

  • Avalon
  • Wisteria (day unit)
  • Merlin

Conditions I treated on these wards included, the management of osteoporotic fractures. The patient’s anorexia can cause a hormone imbalance, this combined with the insufficient intake of vitamins and minerals lead to the development of osteoporosis. So again it was the same physio techniques, with a different patient group.

Members of the MDT in the Mental Health setting

Consultant Psychiatrist
They diagnose the patient's mental health condition, they are in charge of the over all patient care.

They manage the weekly ward rounds and operate an open philosophy of treatment and care, encouraging the team to make decisions.

 

Psychologist
Not medical doctors although some do have doctorates just to confuse!

They are not involved in the patient’s medical management, only the treatment of their mental health condition. Involved in the therapy and rehab side focus on the patients care. They use techniques such as CBT and family therapy etc...

 

Doctors

  • Registrar

Often acts for the consultant in their absence. Runs the management ward rounds. Sees the patients in clinic following their discharge (if indicated).

  •  SHO

Often first contact when the patient arrives on the ward. They assess the patient’s medical condition and deal with any medical issues that may arise.

 

Nurses can be RMN or RGN
Offer support and sources information. Carries out regular observations of the patients on the ward, monitoring both their mental and physical state.

 

Community Psychiatric Nurse (CPN)
A mental health nurse that has specialised in working in the community. (They can either be registered general nurses that have specialised in mental health, or just specialist mental health nurses.) They are often the patient’s keyworker (see below).

 

Keyworker (can be any clinical member of the CMHT eg. CPN, OT, psychologist)
Meets with the patient regularly, offers support and helps to supply required information. They help the patient to focus on their aims and objectives. A big role is acting as a liason person for all other professionals to link with. You will find the keyworkers a very valuable part of the team!

 

Occupational Therapist
Provides a range of skill based therapeutic groups. Works individually with the patient to help address specific needs. Works with the patients to help them plan their work/study/day-time activities and plan their leisure activities. They have very different roles to those seen in the ‘general’ hospital setting.

 

Physiotherapist
Us! We are found in the physical therapies department. We assess and treat physical problems. These problems may lie in any of the following areas: musculoskeletal, neurological, cardiorespiratory and elderly rehabilitation. We treat people in the inpatient, outpatient and community settings.

 

Massage Therapist
They live in the same area as us, the physical therapies department! They run an inpatient and outpatient service. Patients who are referred for massage can receive a 30 minute massage, once a week for three weeks. Patients always appear from the massage rooms looking very chilled, the therapists have magical hands!

 

Exercise Therapist
Also live in the physical therapies department! The department has its own gym, which is where you’ll find them! They see patients from the inpatient and outpatient setting. They provide individual assessment sessions to offer advice and to provide a personalised exercise programme. They also run group sessions, in the gym on the wards and at different sites (such as Tooting leisure centre). They also run a service in the gym for staff who want to exercise at lunch or after work. They are able to offer you valuable advice on exercise programmes and progressions for your patients.

 

Dietician
Provides specific dietary advice when required. May help patients that are having difficulties planning a diet or to ensure patients on EDS are eating correct amount to gain weight.

 

Pharmacist
Often attends the ward rounds, works closely with the doctors to reach decisions on medications (prescriptions, dosage and method of medication).

 

Social Worker
Assesses the patient and helps to address problems due to their:

  •           Financial situation
  •           Housing situation
  •           Legal problems

They also help to plan discharge arrangements.

 

I’ve never met the following therapists, but I’m guessing their role is as their name suggests!

Dance Therapist, Music Therapist, Art Therapist, Drama Therapist

They use their skills in dance, music, art and drama and take a psychological approach to its application to assist with the therapy of individuals with mental health conditions.

Older people with mental health conditions

 

Dementia
Dementia is a condition characterised by a progressive loss of mental abilities, accompanied by changes in behaviour and a gradual loss of the abilities required to carry out daily activities. The likelihood of developing dementia increases as people get older.

Statistics from 1998 show that approximately 670,000 people in the UK have a form of dementia. This number will have increased over the past few years.

 

Alzheimer’s disease
“This is a physical disease that causes progressive decline in the abilities to remember, learn, understand and reason. It is the most common type of dementia.”

(Alzheimer’s disease society information sheet.)

 

Vascular Dementia
Vascular dementia is the term given to types of dementia associated with problems in the circulation of the blood (cerebrovascular disease). If blood vessels in the brain burst or are blocked, surrounding brain tissue dies and a stroke may result.

It is thought that one fifth of people who have a stroke will develop problems with their mental abilities including dementia.

You will gain more experience in this area on the rotation as you will spend time on an older persons ward  (Poplar ward) and you will cover the Jubilee day hospital.

 

Helpful hints!

  • Use yes/no questions to provide a simple choice.
  • Use direct statements, limit the use of jargon and technical terms.
  • Explain what you are doing while you are doing it.
  • Don’t assume the person can search their own memory, triggers may help.
  • Routine can help minimize the effects of a poor memory.
  • Bring yourself to the same level as the person, this may help to minimise distraction and focus the person’s attention.
  • Considerations when treating a patient with a mental health condition

 

Adaptation of treatment

  • Be aware that the patient may be anxious or apprehensive, even scared
  • Introduce yourself as soon as possible
  • Make allowances for time, assessment may have to be staged over several appointments, it may take longer to develop a therapeutic relationship
  • The patient may not feel comfortable undressing, you may have to assess through clothes
  • Be aware that some patients will not be used to touch, give them good warning and ensure that you gain full consent. Ensure that the patient wants treatment and is aware of the referral
  • You should be aware of the behavioural differences of the patients prior to assessment or treatment. E.g. with a very depressed patient you don’t want to be making jokes throughout
  • Some areas of the subjective assessment may be sensitive, e.g. injury sustained as a result of self-harm or a suicide attempt
  • Do not argue with hallucinations or delusions, but don’t reinforce them either
  • You may need to adapt the location of the treatment, e.g. due to conditions such as agrophobia

 

Personal Skills

  • Listen and feed back to the patient to show you are paying them full attention
  • Be aware of your body language
  • Try to maintain a relaxed approach to the assessment and treatment
  • Be non-judgemental
  • Keep your eyes open to be aware of any changes in mental state

 

 

(Written by Helen West on completing her rotation at Springfield).