Hi, I’m Claire and I am a specialist mental health Physiotherapist in Inverclyde HSCP inpatient mental health services, with a focus on dementia care. I have worked in mental health for almost 12 years, and it is true that every day is different. There is no such thing as a standard day for me. Every person I meet brings new challenges and I am always learning from the people around me – something I plan to never stop doing!
For me, getting to work involves a drive down the coast. This gives me time to prepare for the day ahead. Often I practice mindfulness en-route – a skill that people use to reduce stress and anxiety. Why don’t you give it a try?
On arrival at work, I check my diary, answerphone and emails – this can often take some time! E-mails may include referrals, requests for information or presenting, advice, policy comments, or day to day activities, and many of these require a quick response.
Once the admin has been dealt with, I go and see patients. Working in mental health services, I treat people with complex presentations of mental ill-health, who may also have physical health concerns. This can include (but is not limited to) people with anxiety, depression, personality disorder, schizophrenia, huntingtons disease, parkinsons disease and dementia (all types).
Many of the people with dementia we see in our wards are admitted due to complex concerns related to aggression, agitation, mobility, falls and communication, and they cannot currently be cared for at home / in a care home as a result. Our teams’ role is to find ways of managing these risks and to provide any required rehabilitation. Our goal is to support people to return to a home environment when and if they are able to do so.
My first patient has advanced dementia, and is recovering from a hip fracture.Physiotherapy is core to their rehabilitation to get out of bed, walk, identify and manage pain (using observational pain measures e.g PAIN-AD and Abbey), and provide information to other staff on safe moving and handling.
Recovery will vary, but people with dementia CAN participate in rehabilitation. They may however present differently to those without cognitive impairment and require more personalised approaches with varied timescales.
My next patient has anxiety and has developed a fear of falling. Fear of falling can be debilitating, impacting on how people live, affecting social lives, and ultimately resulting in people becoming less mobile. Using physiotherapy rehab techniques and exercises, in conjunction with anxiety management techniques, and graded activity, people can overcome these fears and lead more active lives.
Next up is a patient with severe depression, who has been receiving ECT (electro-convulsive therapy). This is a last resort treatment, but to those who receive it, it is essential. People with depression tend to be more inactive, and at worst, can become immobile. Physiotherapy can promote specific exercises and activities to help people become more active again and improve strength and balance after a period of immobility. It is also great to get carers involved in doing these exercises with patients to ensure they are part of the team – its always more fun to be active with someone else!
My final planned patient involved completing a car transfer assessment for a person with dementia with my occupational therapy colleague. We support risk enablement, and encourage open discussions with carers to set appropriate goals that often include encouraging mobility and social interaction. Having completed the assessment, this person is now looking forward to a day off the ward with their family as part of their pre-discharge plan.
One of the things that working in mental health requires is flexibility. In planning my working day, I have to be ready to alter my plans if I receive an urgent referral or request for review.
Today I received an urgent call to see a patient with advanced dementia with a chest infection as a result of aspiration (inhaling food into the airways). Chest physiotherapy uses varied methods to help people clear secretions from their chests. This can improve peoples’ ability to breathe more easily, recover from infections and manage long term respiratory conditions. It can be challenging if people have a cognitive impairment and with this patient, I had to think outside the box. As a result I completed a singing chest assessment! – while I was singing they settled and I was able to listen to their chest so we could plan effective positioning and treatment, including specialist seating. My speech and language therapy colleagues also assessed this patients swallowing ability to reduce the risk of further aspiration.
Of course not all days look like this – after all, I have other roles as well as that of a clinician! Amongst other things I am a Dementia specialist improvement lead (DSIL), and as such I may attend meetings, provide training to other staff, develop resources, respond to policies……the list goes on. But that’s just how I like it – challenging and varied!
And then I head home! I look after my own health and wellbeing in the evening by participating in hobbies including dance classes, running and yoga.
How do you look after your own health and wellbeing?
After work, I often find myself looking at twitter. Social media is an excellent way to keep up to date with advances in Physiotherapy, mental health and dementia practice.
People post up to date research, examples of good practice, top tips, upcoming events and even tweetchats – @physiotalk provide a discussion topic on Monday evenings.
We have a team of tweeters @ahpdementia tweeting daily top tips about living with dementia – follow us for more information and follow the hashtag #withPHYSIOyouCAN for physiotherapy specific information.
So there you have it. A day in the life of a mental health physiotherapist.
I hope you have had a lovely day!