When Paula fell ill and looked depressed and became incompetent due to the decline of her mental functions, no one knew.
No one knew because she was silent [it took too much effort to speak] and she did not know what was wrong and so couldn’t communicate anything except distress.
The lungs and the brain are linked, the brain needs enough air to function properly and the lungs need instructions from the brain in order to exchange air and manage acid base in the body. Did you know that in Traumatic Brain Injury, respiratory dysfunction is the most common medical complication that occurs? This is why neural-rehbilatation knowledge is key to knowing how disabled a person has become when injured and how much function [brain, lungs, ventilatory skeletal muscles] they can recover and how much supportive care they are likely to need before letting them leave the rehab facility.
This model is perfect for psychiatry patients. Psychiatry patients have sensory-motor issues and difficulties involving the brain and maybe even problems involving their ability to exchange air without effort. they may be unable to live independently and may require physical support and care due to the level of disability during the period they are ill.
Psychiatric wards have physical therapists that see the patients but their focus is NOT on assessment of physical as well as cognitive disability. What a waste of a great resource. Physiotherapists are trained to assess disability and they are not doing this in psychiatry. Again, this is because psychiatrists do not understand the link between mind problems, motor problems and possible skeletal motor ventilatory problems affecting acid base of the brain.
I think that psychiatric physiotherapists should be using the Functional Independence Measure [FIM] test to assess the physical and cognitive needs of their mentally ill patients.
The Functional Independence Measure (FIM) is an 18-item measurement tool that explores an individual’s physical, psychological and social function. This is par of Uniform Data System for Medical Rehabilitation (UDSMR) The tool is used to assess a patient’s level of disability as well as a change in patient status in response to rehabilitation or medical intervention. The FIM uses the level of assistance an individual needs to grade functional status from total independence to total assistance. It takes 30-45 minutes to assess the patient and will also detect altered mental status and cognitive/memory deficits. This test will guide rehabilitation and treatment of inpatients and will help decide what level of physical care is needed if a group home is required upon discharge.
When Paula was “depressed” she had significant memory and cognitive impairment , speech impairment [yes, physiotherapists have assessments for this], breathing difficulty [agin respiratory physiotherapists have assessments for this too] and was unable to do conduct her Activities of Daily Living because she was so impaired.
No one was aware of how disabled she was during her attack of “depression” because no one assessed her with these rehabilitation physiotherapy assessments measuring mental and physical impairment.
Why do patients spend weeks and months on psychiatric wards without getting these kind of services?
Because psychiatry is unmoored from reality and badly needs to be reformed for the 21st century, if they wish to help their patients, even a little.
Please give this blog to any doctor who cares about the “mentally ” ill and the services they are getting that are unmoored from what they need.