Why mental health must be part of every physiotherapist’s practice

A recent podcast on the importance of addressing mental health in physiotherapy highlights how physiotherapists, who often spend more time with patients than any other healthcare provider, are uniquely positioned to recognise mental health struggles and advocate for holistic care that addresses both physical and psychological needs.

Motivational speaker Scott Chesney waited 35 years after becoming paralysed at age 15 before receiving his first mental health therapy session. This striking reality was discussed in a recent podcast with Scott and should concern every physiotherapist – his experience reveals a critical gap in rehabilitation care that physiotherapists are uniquely positioned to address.

When Chesney entered rehabilitation in 1986, his schedule included physiotherapy, occupational therapy and activities of daily living. Absent was mental health support. Despite experiencing profound trauma at fifteen, he was screened and deemed not to need psychological intervention because he appeared upbeat and had family support. “Emotionally, mentally, this is traumatic for everybody,” Chesney emphasised during the podcast. The assumption that someone with a smile on their face doesn’t need mental health support has persisted for decades, and it’s a dangerous one.

The connection between physical and mental health is undeniable. Chesney explains: “When we experience enough pain in our lives, we will make a change.” But why wait for the breaking point? Physiotherapists, who often spend more time with patients than any other healthcare provider, witness this deterioration firsthand. They see the patient who stops making progress, the one whose pain seems disproportionate to their injury, the athlete whose performance mysteriously declines.

What makes physiotherapists particularly suited to address mental health is the unique bond that forms during treatment. As Chesney noted, when someone starts moving your body, it triggers emotions. “There’s a great opportunity,” he said, describing how physiotherapists can become that vocal advocate for mental health support. 

The statistics Chesney shared are sobering. In his rehabilitation facility, mental health therapy is mandated only when deemed necessary through screening, while physiotherapy, occupational therapy and speech therapy are insurance mandates. “Where’s mental health therapy?” he asked pointedly. Current insurance protocols in the USA allow patients with paraplegia six weeks in rehabilitation, patients with quadriplegia slightly more. In that compressed timeframe, without automatic mental health support, patients are expected to process life-altering trauma while learning to navigate a completely different physical existence.

First and foremost, give patients permission to feel whatever they’re feeling.

For physiotherapists wondering how to incorporate mental health awareness into their practice, Chesney offered practical guidance. If someone is angry during a session, provide an outlet. If tears come, let them flow. “That’s another sign of strength is when you allow yourself, you give yourself permission,” he said. Validation matters enormously. When veterans tell Chesney they’ve let their country down by becoming injured, he responds by acknowledging their pain while redirecting their perspective: “You’re still here. And because you’re still here, there is a place and a purpose for you.”

The mindset traps physiotherapists should watch for include the belief that asking for help is weakness, the stoic suppression of all emotion, and the dangerous slide into excessive emotional spiraling. Chesney advocates for what he calls the “wise mind,” a balance between practical stoicism and emotional awareness. It’s not about crying all day or shutting down completely, but giving oneself permission to feel while maintaining forward momentum.

Perhaps most importantly, physiotherapists must normalise the conversation around mental health. Chesney’s primary recommendation is simple but profound: “If you are not seeing a therapist at this time, make the call and see one.” He believes everyone should begin mental health therapy by age twelve, understanding that even well-meaning parents cannot shield their children from all trauma. For patients in rehabilitation facing life-altering changes, this support isn’t optional; it’s essential.

Recognising the growing need for mental health competency in physiotherapy practice, Physiopedia Plus (Plus) has a comprehensive suite of courses designed to equip practitioners with the knowledge and skills to address these critical issues. The Mental Health Programme provides a thorough foundation in understanding mental health within the context of physiotherapy, while specialised courses address specific populations and scenarios. Mental Health Considerations in Cerebral Palsy explores the unique psychological challenges faced by this patient group. Mental Function Considerations in Rehabilitation examines how cognitive and emotional factors impact recovery outcomes. Psychological Support in Rehabilitation offers practical strategies for providing emotional support alongside physical treatment.

“The mental game that is forced to be played, is far more challenging than the physical”

These educational resources acknowledge what Chesney’s forty-year journey with paralysis has proven: the mental game is paramount. When patients struggle mentally, it manifests physically. When they’re consumed by fear, disbelief, or despair, progress stalls regardless of the treatment plan’s technical excellence.

Chesney’s story illustrates both the problem and the potential solution. After finally engaging with mental health therapy at age fifty, he experienced profound transformation. He grieved the loss that fifteen-year-old experienced. He processed decades of accumulated trauma. He learned that he didn’t have to figure life out alone. “I don’t have to figure this thing called life out on my own,” he said, tears in his eyes. That realisation, coming after thirty-five years, represents an enormous lost opportunity for earlier healing and growth.

The call to action for physiotherapists is clear. Every patient interaction is an opportunity to recognise not just physical limitations but emotional struggles. It’s a chance to say, as Chesney suggests, “I’m just letting you know you’re not alone.” It’s an opportunity to normalize mental health support as a standard component of rehabilitation, not an afterthought for those who appear to be struggling visibly.

The profession stands at a crossroads. Physiotherapists can continue treating the body while hoping someone else addresses the mind, or they can embrace their unique position in patients’ lives and become advocates for holistic care. The latter approach doesn’t require physiotherapists to become therapists themselves, but it does require awareness, compassion, and willingness to refer patients to appropriate mental health resources.

The integration of mental health awareness into physiotherapy practice isn’t just good medicine; it’s essential care. With proper education, physiotherapists can transform from practitioners who treat bodies to professionals who recognise and respond to the whole person. The courses available through Plus represent an important step towards that, providing the knowledge base that makes this expanded role possible.