Psychosocial Disability: How Occupational Therapy and Exercise Physiology Support Recovery

What is psychosocial disability?

Psychosocial disability describes the impact a mental health condition has on a person's ability to take part in everyday life. It is most often associated with conditions such as schizophrenia, bipolar disorder, severe depression, severe anxiety disorders and borderline personality disorder. The diagnosis matters less than the effect: difficulty keeping routines, looking after the home, working, studying, managing money or connecting with others.

The physical health gap

People living with severe mental illness in Australia die up to 15 years earlier on average than the general population, mostly from preventable physical conditions such as heart disease and diabetes. Some antipsychotic and mood-stabilising medications cause weight gain and changes to blood sugar and cholesterol and low motivation, poor sleep and social isolation make it harder to stay active.

This is why initiatives like Equally Well and the Keeping the Body in Mind program put physical activity at the centre of mental health care. Exercise improves mood, sleep and fitness and helps counter medication side effects.

A recovery-oriented approach

Recovery-oriented practice means the person sets the direction. Goals are about living a meaningful life, whether or not symptoms are present. Both OTs and EPs work this way: starting small, building on strengths, celebrating progress and adjusting around difficult periods rather than giving up on the plan.

Mental health can be episodic, with good and bad periods. Flexible, home-based therapy helps keep momentum. On a harder week, a session might be a short walk and a chat about sleep. On a better week, it might be a gym session or practising catching the train to a new class.

Why OT and EP are stronger together

Routine is one of the most powerful tools in mental health recovery and exercise is one of the easiest anchors to build a routine around. The OT builds a weekly structure with regular wake times, meals and activities and the EP's sessions become fixed points in that week. The EP builds the energy and fitness that make the OT's goals achievable, such as the stamina for a part-time job.

Working with your mental health team

OT and EP complement, rather than replace, your psychiatrist, GP, psychologist or mental health clinician. With your consent, we keep your treating team informed, especially where exercise may interact with medications or where physical health results need monitoring.

NDIS funding

Psychosocial disability is a recognised NDIS disability type where a mental health condition is likely to be permanent and substantially reduces functioning, even if symptoms vary over time. Both are usually funded from your Capacity Building budget, most often under Improved Daily Living Skills (Category 15). Exercise physiology can also be funded under Improved Health and Wellbeing (Category 12). Equipment and home modification recommendations from your OT are funded from your Capital budget. If you are not an NDIS participant, exercise physiology may be available through a GP Chronic Disease Management plan or private health.

Evidence referenced in this article

• New resources address the longevity gap for people living with mental illness. Equally Well Australia.
• Firth J, et al. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. The Lancet Psychiatry, 2019.
• Equally Well. National Mental Health Commission.

Written by the Exercare allied health team. This article is general information only and is not a substitute for individual medical advice. Exercare provides mobile exercise physiology and NDIS occupational therapy across south-east and eastern Melbourne.

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