Welcome back to the Healing Pain Podcast with Ryan McGrath

Physical therapists can and do play a role in promoting mental health wellness in patients, including managing psychological distress and even suicide prevention. In today’s episode, Australian physiotherapist Ryan McGrath uncovers the ways that physical therapists can identify and address signs of psychological distress in their patients. He talks about yellow flags as well as red flags and how you can implement effective assessment and management strategies for things like pain, catastrophizing depression, and how to screen for suicide. Ryan’s PhD specifically looks at ways physiotherapists support clients with psychological distress. Whether you are a physical therapist, a physiotherapist, or another health professional, and if you’re curious about the intersection of physical and mental health, this episode is for you. Tune in!

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The Physical Therapist’s Role In Managing Psychological Distress And Suicide Prevention With Ryan McGrath

We’re discussing the crucial role physiotherapists play in supporting mental health. In this episode, we’ll uncover the ways that physical therapists can identify and address signs of psychological distress in their patients. We’ll talk about yellow flags as well as red flags and how you can implement effective assessment and management strategies for things like pain catastrophizing, depression and how to screen for suicide.

Joining us is Ryan McGrath. Ryan is an Australian Physiotherapist and Early Career Researcher. He is exploring the intersection between physical and mental health. His PhD specifically looks at ways physiotherapists support clients with psychological distress. Whether you are a physical therapist, physiotherapist, or another health professional, and if you’re curious about the intersection of physical and mental health, this episode is for you. We’ll dive deep into the ways to assess and manage physiotherapy clients who are experiencing psychological distress. Without further ado, let’s begin and let’s meet Ryan McGrath.

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Ryan, thanks for joining me on the show.

Good to be here, Joe.

I’m excited to speak with you. I know you’re leading some amazing work in the realm of physiotherapy, psychologically informed physical therapy and mental health suicide. We’re going to talk about all those topics. You have some great research papers that I mentioned during the introduction to our episode, so people will be sure to link to those, click on those and read them. A good place to start is how do you get involved in mental health physiotherapy world, which is a small yet rapidly growing part of our practice?

My introduction to mental health physiotherapy probably came from when I was a physiotherapy student. I remember being on a placement in a neurological ward doing a bit of rehabilitation. I encountered a gentleman. He was in his 50s and he experienced quite a dense stroke. As you can imagine, the grief and loss that guy’s through. The previous day he was at work and the weeks after that, his life has changed.

I remember meeting his wife. She was there every day when we were doing rehab. She was talking about how they had planned a holiday. They were talking about all their retirement and she was going through quite a significant grieving process. For me, I’d always had a bit of an interest in mental health and psychology anyway. I considered that as an alternate career, but it showed to me that we can’t separate the physical and the mental health.

It was a bit challenging because whilst, we didn’t have social workers. We know from literature and in this situation that there’s not a lot of support that’s often given to people with post-struct in terms of their mental health. That showed me the relevance of physiotherapy, psychology and mental health to me at that stage.

I studied a little bit of it in psychology during my physiotherapy degree. I did a graduate diploma, which was a bachelor’s at the time because I hadn’t finished my physiotherapy degree at that stage. When I went through that process, I came into the area of persistent pain. There’s a huge movement within psychologically informed physiotherapy, at least in the literature. We’ll see to the extent that’s influencing practice but it seemed to be a natural conclusion that we’re talking about these psychological factors, pain related distress, and at times we’re talking about depression and anxiety. We’re not provided a lot of guidance around how to handle those situations.

I had experience volunteering at Lifeline, which is a crisis call center in Australia for suicide. For me, that program was about training people up within six months to be able to respond to phone calls and be able to handle those situations then in two years, you pretty much completed your training. That’s taking people with no health professional qualifications to that level. When I was reading this literature, particularly there’s a paper around cognitive functional therapy by Peter Sullivan. I have huge respect for the work that he’s doing.

It was talking about the type of things that you might hear from patients. Again, the whole thing about, does the pain get you down? Do you feel like there’s any way forward? The sample response was, “I feel hopeless. I see no way out.” For me, with my background in that lifeline training, I’m going, “That’s an invitation to ask about suicide.”

Papers are pretty not tightly focused and being able to cover that type of thing. That wasn’t the purpose of the article. That showed to me, as a student, how important many mental health was to all areas of physiotherapy, but particularly pain-related stress like business and pain. That got me interested in like, what do we do in mental health? There’s not a huge group of Australian physios involved in mental health physiotherapy, so I joined the national group.

I wrote a paper for my honors around the experiences of physiotherapists with clients with suicidal thoughts and behaviors and found a good community within that mental health physiotherapy space. There’s mental health physiotherapists in Australia that work in mental health services. The group that I’ve resonated with in a physio is working in all settings. I work in community health. I had experience working in a refugee health clinic for a little bit. For me, that’s where I see mental health physiotherapy. That’s where I see psychologically informed physiotherapy.

Managing Pain Related Distress

It’s a great way to start. One of the points that you brought up is so key that as licensed health providers, where for these opportunities to open doors to these conversations. We’re going to get into the detail about that but the most important part is identifying and screening for this as a first step. Which some of our colleagues are doing quite well and others are still learning what this is about and how to go about doing it.

Some of you guys read through some of your papers and there are a lot of terms in there. We should break down some of these terms just so physiotherapists and others understand these terms. You talk about in your one of your articles, health related distress, pain related distress, then psychopathology. Maybe you can explain to us. There’s some nuance in there and some overlaps. What are the differences between those three? Where are we working as physiotherapists with regard to those three topics? – That’s a very interesting question.

When I was looking at doing my paper around the experiences of physiotherapists with clients or experiencing suicidal thoughts and behaviors. I’d originally thought about looking at mental health more broadly, but I had a group of experienced supervisors. We’re going, “Don’t tackle topics so large.” We have to narrow it down. That’s why I looked at suicide. You won’t see suicide might be a symptom of depression. It’s associated with a whole range of mental health conditions, but it’s not a diagnosis.

When I moved into the PhD, I had a fortunate period of about six months when I was studying psychology through that process. I was able to engage in the full breadth of what are we talking about when we’re talking about mental health conditions? What are we talking about in mental health? What are we talking about like in flourishing and languishing? What is this concept of psychological stress because we don’t see it that much?

For example, the term pain-related distress. Physio talk about it particularly in a psychologically informed literature all the time. We’re talking about pain catastrophization. Again, that’s pain-related worry because I’m not a love of the term catastrophization. We’re talking about fear avoidance and this health-related distress. This may or may not be associated with an underlying a mental health condition that could be diagnosed.

Psychological stress is typically characterized by depressions of symptoms of depression and anxiety, but it’s much broader than that. It can include things like rumination, feelings of loss, grief, and sorrow. It doesn’t have to conform to any diagnostic criteria. In my experienced in Lifeline, we’re not trained in that setting to go and make diagnosis. We don’t care about diagnosis. We care about the distress that somebody’s calling us with and how to support them through that moment.

As a physio, that’s what I see quite commonly. We’ve seen clients that might be experiencing distress that’s primarily related to their pain or the extension of that, meaning that they might not be able to engage in employment anymore. They might not be able to pick up their children anymore because they’ve got an experiencing low back pain. We also encounter clients and one of those that I published looking at physio specifically frequency of contact with clients experiencing psychological distress. It was talking about things like financial related distress as well.

We had the COVID pandemic and a lot of isolation came out of that. For me, that’s what is interesting as we see distress. It happens one framework that has some value and there is some criticisms of the medicalization of psychological and mental distress. That’s where our mental disorders come into. We have a whole series of criteria. Again, the purpose of those diagnoses are to inform treatment like Lucy Johnstone’s, The power Threat Meaning Framework and Corey Keyes. There’s a few others that provide different conceptualizations of mental health.

That’s that background there. Much of the literature in physiotherapy is being led by researchers and physicist in pain also being that pain-related distress. More broadly, we talk about there’s a few papers in neurological physiotherapy where they’re seeing the same similar things, grief and loss associated with changing circumstances in one’s life. That’s what I broadly categorize as health-related distress. Again, whenever we try to lump categories on something. Things don’t fit and that’s a challenge with writing about all of this type of topic.

I appreciate you bringing up this idea of distress versus diagnosis because for some professionals when they first come to this space, they have an awareness that there is stress happening. They have a difficult time maybe separating distress from psychopathology. There’s potentially some harm we can do if we don’t explain this correctly to people. Don’t inform them in a way that is correct because they might see this as not being distressed, as you’re describing, but being somewhat of a psychopathology.

What we see is the stress is something that can reign from very mild and normal responses that we would all expect with injury or a significant loss or even minor losses to anything that is quite severe and intense. Maybe associated with suicidal thoughts and behaviors. Those symptoms of the stress or those behaviors associated with it may fit criteria for major depressive disorder or generalized anxiety disorder. From a physio perspective, distress is distress. Whether or not it meets diagnostic criteria, I see that it’s something that if I can help with or help refer to another clinician, it doesn’t matter from my perspective whether it meets that criteria or not.

Unidimensional Vs. Multidimensional Distress

As you’ve done your research, and you’ve read a lot of research in the process. If you have a sense of where we are as physios with regard to identifying unidimensional distress because you mentioned pain catastrophizing or worry about pain as one versus us starting to embrace a more multidimensional approach to distress, which is what you were talking about.

You’re already mentioning topics, for example, grief is not one that comes up that often in the pain literature with regard to psychological and informed care. We all realize that there is a sense or there can be a sense of loss that happens with pain or with the loss of physical function that happened in someone’s recovery. Again, the nuance between unidimensional distress versus multidimensional distress.

If we’re talking about that multidimensional distress, particularly good article published on it was by Peter Stilwell. It was called pain-related suffering. Suffering in that case. I’m probably going to oversimplify that very complex philosophically driven article, but we’re talking about those severe forms of psychological distress that affects the intactness of a person themselves.

It disrupts that being down right at their core. When we’re talking about multidimensional stress, there’s a lot of tools that have been developed and a lot of great work behind them that have looked at obviously single constructs. It’s amazing research. The [00:12:26] has been able to collapse all of these unidimensional tools into a multidimensional tool as well.

The statistics of how that’s happened is beyond my understanding. It is an amazing piece of work. A lot of those ones are still geared towards essentially psychological factors, meaning that they’re in relation to often physical health problem. We’re talking about pain, which I don’t think should be classified as a physical health problem or a mental health problem. It is a health problem. Even dichotomy between physical health and mental health is a problem in itself.

Again, it’s often either factors or in regarding to prognosis of something that traditionally physio see. Whereas when we’re talking about these multi-dimensional aspects, we might be uncovering distress that is health related and non-health related. There’s a whole cascade that can happen. There’s physios that I’ve spoken to as part of my qualitative research. They’ve had situations where they’ve had a client who’s experienced neck pain and that has led them to essentially no longer be able to retain their work.

Family situation has then fallen apart. They’re then isolated from their children, and in this case, they were talking about those thoughts of suicide emerged. One of the physios that I spoke with, he was last the last contact before a client who then died by suicide. It was that progression. It shows you one particularly life changing event can lead into many others.

That’s just one pathway that might happen. That’s where I see with those multi-dimensional screening approaches are a great start but in some ways, we need to broaden the scope of what we’re thinking about when we’re working with patients. For me, I’m a health person for first, health professional second, and physiotherapist third, and in that order. If there are issues coming up with mental health, I may not be a mental health professional. It’s not what I primarily deal with. That’s not my strengths but I still will sit with someone, understand their story, and see how I can help, including linking them into other services.

I’m in the US and we are rapidly waking up to psychologically informed care, I believe. We’re well into it at this point. Where you are in your country, if you have the sense that this is not optional care like this should be required for new and licensed physical therapists who are working in the field at this point. Some people see this as, “This is a specialty and this is not nice for something that I should be doing.” We all have thoughts and emotions and feelings that impact our recovery whether it’s health, pain and/or mental health.

I can’t recall who the author of this paper was off the top of my head, but there was an article published in physiotherapy theory in practice around what are the qualities of a good physiotherapist. All of these qualities of a good physiotherapist is from a patient perspective is what overlaps with psychologically informed therapy and humanistic approaches to the physiotherapy.

What we’re talking about in Australia is we’re selling that same shift toward psychologically informed physiotherapy. I don’t think we know still what it exactly looks like. There was an excellent paper that was published by a PhD student, Miriam Dillon at the University of Queensland. She looked at the concept of distress within low back paying consultations, so with physiotherapists and clients there.

We’re talking about things like time constraints being an issue. We might theoretically know and again, training at undergraduate level in Australia includes some aspects of psychologically informed therapy. Probably not enough to have clinicians confident yet when they leave practice. Even those who are, if we are talking about running on 20-minute or 30-minute consultations, it’s very challenging to be able to fit everything within that appointment.

Lots of clinics are starting to extend their appointments, but then we run into financial concerns. For me, if we’re talking about private physiotherapy in Australia. We also run into the issue that the longer that we make appointments because Medicare rebates in Australia are that high. We end up charging more, which leaves a group of people who are financially constrained often highly distressed less without services. They’re the ones that would benefit from psychologically informed physiotherapy, but they often can’t access it.

Promoting Psychologically Informed Care

I’m going to give you a follow up question to that because I thought about this too and the time is a challenge. What’s interesting to some extent and I’ll ask you this as a question but I’ll give you a little bit of time to think about it. In the United States, there are mental health providers. I’m sure this happens in Australia too, where they’re working in 30-minute treatment sessions, so they’re using brief interventions.

There’s some good research around it, so that may fit into our practice. I’m going to ask you that question if you don’t mind. The time constraints is a critical issue. There are definitely people who need more time. They deserve more time in their care and recovery. I also have colleagues who work in practice settings. They’re more behavioral health settings where they have shortened times.

There are psychologists or other mental health providers working in brief like 20 to 30 minute sessions. There’s some research to demonstrate that we can get some good outcomes with that. I wonder if we have to advocate for more time with people with complex and comorbid conditions, but that we can deliver things potentially in a brief way and be helpful for people as well.

I 100 % agree with that. The challenge in some settings, depending on how rigidly defined the referral is. If there’s information available, then depending on how many side issues potentially emerge during consultations. A approach that I learned at lifeline, they don’t use this one exactly now but I brought it across to physiotherapy. I’ll explain the relevance to my practice in a moment. I use the model called CFDECD, which was connect, focus to call, develop rapport, engage, coping and decide next steps.

I adapted it to look at rather than focus a call or consultation. Sometimes when we start a consultation, I’ll have a look at my referral because I work in community health. That’s a MSK predominantly persistent pain. There’s not a lot of services here in a rural area of Shefford and Victoria. Again, it’s a fairly high level of persistent pain. When I’m doing that consultation, my first job is trying to connect with them. That’s that basis that first consultation.

I’ll see where it goes because I’ll have a pretty vague referral often from a GP going, “This is going on and all this is going on.” GP and many medical practitioners in Australia or family doctor and that takes time. That’s the challenge if everything’s in order. You have a particular intervention in mind and it suits that individual quite well, then 30 minutes can work. I’ve got a colleague who works in the physio pain space in Australia in practice.

One strategy that she uses is to essentially have that first initial consult predominantly dedicated to assessment. You’re not getting into interventions and you just break that across. You might even have a second consultation where you’re still in that assessment phase. You might be starting to integrate a little bit of education or a little bit of treatment here or there. That’s another strategy to overcome that. It is a challenging space. I don’t think we’ve still got that sorted in Australia at least about how to handle these short consultation times.

That point of taking your time to assess and an assessment may take you the entire first session. Maybe the second session and resisting that reflex that we have as physios to jump in and show them the exercise or target fear, let’s say with regard to pain. That can be so validating for patients because it shows that you care, you’re there listening to them, giving them some space to talk and explain what they’ve been through. Allowing them to ask questions which can be very empowering for them before printing out two exercises that you have to do for your back pain.

That’s if we’re looking at persistent pain. Again, we’re probably not the first health professional that they’ve seen and they’ve probably done for years. How are we offering something different? How are we trying to make an impact that somebody else hasn’t necessarily in the past? There’s that temptation that we feel pressure that we have to fix everything in that moment. That translates very poorly if we look at mental health.

Another thing that I tend to find with the physios that I’ve interviewed, those who struggle a lot with engaging people, experiencing psychological stress feel unconsolidated because they don’t feel like they have the skills then they give them the expectation that they have to fix this at the end of this consultation. Whatever’s going on. It’s a bit of that hero complex that health professionals have that we try to help our patients as much as we can but some things take time and some things are beyond our control, unfortunately.

The PT’s Role In Suicide Prevention

It’s true. I struggle with the hero complex myself and it takes time. Once you get rid of it, it’s refreshing for both you and the patient in a lot of ways. We’ve talked a lot about distress so far in this first half of this interview. I want to shift and I want to start talking about suicide, which is another area of expertise of yours. You’ve already mentioned some of your work in that area, specifically with physiotherapists, though. Let’s put that under the microscope for a minute. Where do you see our role in the world of suicide prevention?

To me, you’ve had a couple of previous episodes. You had one episode years ago with Tony Burrell. He had a good paper around depression. The thing is suicide prevention fits within that broader mental health physiotherapy or psychological informed physiotherapy space or trauma-informed physiotherapy. There’s a lot of these terms going around at the moment, but it fits as an element of that.

I’m not necessarily advocating that physios go out there and essentially add that suicide question to every single consultation just as a dotted line. What we’re talking about is being attended to signs of distress. In some cases, we may hear invitations that suggest there might be underlying suicidal thoughts and maybes. If we hear those type of warning signs that there might be those thoughts, then it’s our role as a health professional to get an understanding of, “Is this person at particular risk now? What is their ability to cope with these thoughts? How well are they connected with other health professionals?”

That’s generally that role that I see that every physio, no matter what training they’ve got in the background, should be doing. It obviously gets a little bit more complicated because there’s a great number of physios particularly those who are trained in psychologically informed physiotherapy and mental health.

That can start to look at addressing determinants of suicidal thoughts and behaviors. That can be exercise interventions, general counselling, and psychosocial support. I’m not expecting every physios to be at that area of things, but all physios as health professionals should at least be able to have the conversation and go through that initial assessment process with someone.

When you say the conversation, I’m curious what that means to you because there are some professionals out there and this is not just in physiotherapy. This is in other health professions as well. They’re scared to have the conversation. They’re scared to open this can of worms, if you will, because they realize that some people are quite vulnerable and maybe in a vulnerable place. What is starting that conversation look like for you? What could that conversation look like for a beginner physiotherapist starting out and who’s learning?

I love that approach. It’s a bit cliche now, but that’s tell me a story. We’re talking about trying to connect and understand somebody’s story. As part of that process, if we start to hear those signs of middle defeat, perceived burdensomeness, isolation or that real profound sorrow. That’s that clue to go rather than pull back and go, “That sounds uncomfortable. Let’s go and have a look at your knee or do that assessment.” It’s just to sit with it and ask them to tell you more about their situation.

Empathize with them sitting there going, “That must be a difficult situation.” You don’t have to solve it. You’re trying to understand what’s going on. That’s important for your persistent pain assessment anyway. It’s all related. It’s not necessarily a particular suicide risk assessment or anything yet. As you keep going through that process, that’s when we’re hearing those types of things.

We want to ask that specific question, whether somebody is having thoughts of suicide. Depending on that answer, then we need to look at whether somebody’s got intent, plans in place and the imminency of those thoughts. For me, it’s a very natural progression that you have with someone. It’s not an additional assessment that you do. It’s just a line of questioning that you end up going down as somebody’s struggling.

Do you like including this in your verbal assessment versus placing key questions and intake paperwork? Do you maybe have an idea which is more valid? Do patients like one versus the other? I know some people, they’re so busy. They’re like, “I emailed the patient all the paperwork first and they fill it out so I can stick in this question and take paperwork.” Sometimes, there is a difference when you’re sitting down with someone one-on-one and having a conversation as you said about the story and what they’ve been struggling with.

I have an interesting opinion around this and this is an excellent area for further research and how we conduct that approach particularly through using instruments and psychometric that’s a psychological tools. I’m not going to remember the stats exactly, but there was people looking at screening for suicide within pediatric surgeon clinics in podiatrist over in the US. I can’t recall whether they had it as part of their question.

I think it was a part of a questionnaire that their nurse intake personnel would give to the client when they’re coming in. It was just like a tick box, “Are you having thoughts of suicide?” Knowing the client base that they’re working with, they had very few people that ticked and endorsed that statement. That’s my concern about those questionnaires that have that tool. It’s like, “Picking up anybody through those tool is a good thing. If it’s more than what we’re picking up already, then that’s great.”

We know from literature, depending on how we define suicidal thoughts behaviors. If we’re talking about death wishes, therefore, we around 30% of our clients would endorse having those thoughts at the moment. We’re talking about suicidal thoughts and behaviors in terms of suicidal ideation, probably around 10% that are having active thoughts. They’re not necessarily going to act on that.

When we’re talking about only 1% or 2% endorsing that through a form in that pituitary setting. That seems incongruent from what my understanding is. There’s a lot of stigma around reporting whether somebody has suicidal ideation. Also, if the particular client group that you’re working with doesn’t have an understanding.

They might have a cliche idea of what a bizarre physical therapist is. That’s just a physical health professional. They might go, “Why do you need to know that information? I don’t want to tick this.” For me, I tend to lean toward the interview brace process because that’s a bit more that former informed care that sensitive way of going about this line of questioning.

I love that. Those are all good recommendations and things for people to think about. What you’re hinting at is it may be a good way to help the therapeutic alliance which we’re developing in the first or second, and third. This is an ongoing relationship that we have with some people. It’s helpful to have conversations with people instead of, as you mentioned ticking a box with so many people move through fast.

There are people with low health literacy who can’t necessarily understand all the words that we’re using as health professionals. We should make attempts to simplify things for them. They’re all good recommendations. We appreciate them. Let’s talk about the thing that we usually don’t like to talk about, which are barriers. What are the barriers to starting to address suicidal behaviors in physical therapy practice specifically?

At this stage, there’s a large aspect of culture of what we see, what a physiotherapist is, and by extension of what our education supports. It took me quite a long time, and this is tangential to suicide. If I go through an initial assessment and I don’t prescribe an exercise. I still feel like that’s fine as a physio. I felt for a long time that I would have to do something movement related. I have to cram it in. Even if I was running overtime, I’d feel like they have to leave a something movement-based.

As soon as you release yourself from that, then you also go, “What do I have to cover in this initial assessment?” I don’t have to necessarily cover anything. We’ll see where this conversation goes. That’s something that’s empowering because when we go down that, “I fear.” Somebody disclosing source of thoughts and behaviors, that might take up people initial assessment. Particularly, if you’re in a 30 minute initial assessment, there’s probably not that much else that you can do if you’re going to do it sensitively and safely and that’s fine. Sometimes you need to even run over.

One thing that I found, again, this is where for me, the CFDECD model to connect, focus a consultation, develop rapport, engage, coping and decide next steps is helpful, because when we’re going through that process, I try to connect with every single patient that I’m seeing. I’m already going down that process when we’re talking about focusing the consultation. In some situations, I’m going back the major distress is that panel address.

I’ve got some tools that we might be able to work with someone and support them going down that area. Other times, we’ve got this disclosure of quite profound mental defeat burdensomeness. For me, I need to sit there and listen to that. I rarely ever get pushed back that clients feel they should have got something else from that consultation because they felt heard, listened to and showed that we cared. We come back and we plan for our next session. For me, it’s about if we can understand that we’re people first, health professionals second, and physiotherapists third, then that frees our practice up to being able to be attended towards experiences of suicidal distress in our patients.

Ryan’s Two Wishes

Ryan, I’m going to give you two wishes as we end this episode. The first wish is what would you like to see change with regard to how physiotherapists address suicide?

What I’d love to be able to see, again, within our education. We’re talking about psychologically informed physiotherapy needs to be mental health informed physiotherapy. It should be the same thing and we need to be starting with the process that we take. I don’t want to overuse it because it’s challenging to be holistic and whatever that means. We need to be able to look beyond the referral reason and go and say, “What are these other issues that grow our attention?”

Once we start having that, then we can start having that training fall in line. That’s one thing that I’d like to see changed. There’s a couple of states that have started, too. Washington mandates training in the US for suicide risk assessment amongst physios in Australia. We do things like mental health first aid, which is for the general population. We do need this high-level train so that we are confident.

When you mentioned before, they’re concern about opening up that can of worms that we know how to respond and we don’t feel like we have to just problem-solve. To anybody that’s looking for a little bit more specific advice, you had a episode a few years with Joan Rosenberg. Pretty much everything through that episode, I’d support in terms of physiotherapy practice.

Joan is a wealth of information and an amazing psychologist who’s done some research in that area. Wish number two, what do we change in physical therapist education or continue education, so to speak, to shift this toward a more psychologically informed/mental health physiotherapy approach.

I’d love every single physio to be highly confident in psychologically informed physiotherapy because it’s not limited to pain related. Physical pain setting is always not related to limited to neurological physiotherapies. It’s relative to all areas of physiotherapy practice. I would like to see some basic competencies in terms of supporting people experiencing stress for all physios, but we need to be paying attention to those particular areas and practice this way the prevalence of suicidal ideation among client loans is quite high.

There’s a paper that I’m hoping to publish soon that had a very small number of Australian physios who endorsed working primarily in the area of persistent pain. Out of the 16 of them, 15 reported having had a client disclose a plan to suicide to them at least once in their career. You go, if you work in that setting, we’re talking about you probably need more advanced competencies. Particularly if you’re working in isolation and not part of a multidisciplinary team. I’d love to see a more staggered approach to mental health and suicide prevention within physiotherapy.

Do you think we need a course in school? Oftentimes, these things are sometimes weaves throughout a curriculum. They’re not necessarily part of a specific course. We’ve seen in the US, at least some DBT programs have a three credit course on pain science education, let’s say. Do you think we need a separate course on physiotherapy and mental health in the DPT curriculum or the physiotherapy curriculum?

That’s essential because we can go off and do the external courses but it’s being able to translate into that physiotherapy context. All those barriers around culture and time. These are conversations that you have to work through as a profession, but also yourself to be able to implement these approaches within physiotherapies. As much as we can bring that back to that discipline specific lens, the better.

Ryan, it’s been great having you and talking to you about distress in physiotherapy and how we can identify and address suicidal behaviors. There’s super important topics for the persistent pain physios but for all physios because we’re all seeing this throughout physiotherapy practice. I appreciate you being here and the research that you’re doing. Let everyone know how you can learn more about you and follow your work.

At the moment, I’m a researcher at the University of Melbourne. If you put in Ryan L. McGraw at University of Melbourne, you’ll generally find most of my papers because that’s most of my contributions at the moment are through that platform. I’ve got a couple of other shows that have been involved in a couple of other sessions. Put me into Google and some things will probably come up.

Again, thank you, Ryan for being here. I asked you to share this episode with your friends and family on whatever social media channel. You can find me on all the channels at the handle @DrJoeTatta.

Important Links

• Ryan McGrath
• The power Threat Meaning Framework
• Peter Stilwell
• https://www.FindAnExpert.unimelb.edu.au/profile/1020737-ryan-mcgrath
• https://www.TandfOnline.com/doi/full/10.1080/09593985.2023.2284823
• @RyanLMcGrath – Twitter

About Ryan McGrath

Ryan is an Australian physio and early career researcher interested in the intersection of physical and mental health. His PhD investigates the experiences and practices of physiotherapists with clients experiencing psychological distress. He has completed training in psychology and suicide prevention, and is an advocate of the humanistic approach in physiotherapy.