At the beginning there was an international network of physical therapists working in the field of psychiatry and mental health with the origin at Leuven University (Belgium) from in 2006. The International Organization of Physical Therapy in Mental Health (IOPTMH) was accepted as a World Confederation for Physical Therapy (WCPT) subgroup at the 17^th General Meeting, in 2011 and reconfirmed in 2015 and 2019, including 21 member countries, Australia, Austria, Belgium, Colombia, Denmark, Estonia, Finland, Greece, Iceland, Japan, Latvia, Mexico, The Netherlands, Norway, Poland, Spain, South Africa, Sweden, Switzerland, Turkey, UK, but within IOPTMH [1-3], there is a network of individual physical therapists, representing 59 nations from 6 continents.

The IOPTMH provides a consensus statement on the role of qualified physical therapists within mental health. This policy statement has been developed by the Executive Committee and physical therapists with expertise in mental health (2019).

According Probst et al., “Physical therapy in mental health is defined as a specialty within physical therapy. It is implemented in different health and mental health settings, psychiatry and psychosomatic medicine. Physical therapy in mental health is person-centered and aimed at children, adolescents, adults and elderly with mild, moderate and severe, acute and chronic mental health problems, in primary and community care, inpatients and outpatients. Physical therapists in mental health provide health promotion, preventive health care, treatment and rehabilitation for individuals and groups. Physical therapists in mental health create a therapeutic relationship to provide assessment and services specifically related to the complexity of mental health within a supportive environment applying a bio-psycho-social model. The core of physical therapy in mental health is to optimize wellbeing and empowering the individual by promoting functional movement, movement awareness and physical activity, exercise, bringing together physical and mental aspects Physical therapists in mental health play a key part in the integrated multidisciplinary team/inter-professional care. Physical therapy in mental health is based on the available scientific and best clinical evidence” [4,5].

Observation & evaluation tools

It is based on:

• Observation of the person's behavior or physical characteristics, in movement or posture (recording information)
• Self-observation and self-esteem of the individual (completion of questionnaires)

It is applicable at the beginning, in between & at the end of the physiotherapy session.

Design and implementation of individual and group therapeutic exercise programs

Exercise as a means of treatment, either supervised or guided:

• Protects against the onset of depression
• Prevents the development of mental illness
• Patients with depression and schizophrenia are less likely to stop exercising when monitored by a physiotherapist
• It improves the quality of life and self-esteem of people experiencing mental health issues
• It has a large and significant antidepressant effect in people with pre-existing depression
• It helps to better manage anxiety disorders
• Reduces food symptoms in food intake & improves body image
• Prevents weight gain & deteriorates mental health in patients of psychiatric prison structures
• It protects against dementia but also slows the progression of the disease.

Closeness/Touch/Massage

Since ancient times it has been a valuable therapeutic and preventive measure, keeping pace with the mental and psychosomatic evolution of the human species. By contacting and manipulating, it transmits the feeling of a wave of euphoria, relaxation and calm.

It is not an individual technique but is a functional part of the broader therapeutic intervention. The physiotherapist is responsible for the delicate balance between positive and negative reactions related to contact and immediacy.

Biofeedback

According to the international references for biofeedback and the guidelines of the International Society of Applied Psychophysiology and Biofeedback [6] is indicated with a high-level score (4/5) in:

• Anxiety disorders
• Headaches and especially tension type
• Phobias
• Somatoform disorders

Relaxation and breathing techniques

Prevents the growth of harmful effects on the physical and mental health, reduces the respiratory rate by improving the way of breathing, and normalizes the process of ventilation and restores the normal cardio-respiratory parameters.

It is demanding and need:

• Explaining and understanding how to execute and act.
• Repetitions and precise guidance from a physiotherapist.
• Effort, perseverance and patience for the right way of execution

Psychomotor therapy

It is based on the unity of mind and body. It uses physical awareness and various motor activities, to positively affect the motor and emotional development of individuals.

Repetitive transcranial magnetic stimulation (rTMS)

A non-invasive, painless technique in which a pulsed magnetic field exerts an effect on electroencephalogram activity with general indications with strong based evidence in chronic neuropathic pain & major depression but possible efficacy in depression & schizophrenia [7-9].

Virtual reality application techniques

Research findings revealed that it can cause significant behavioral changes in real-life situations and so its application is mainly supported in the treatment of phobias & stressful events [10].

Pediatric psychiatry specific elements

Though physical therapy in mental health for children and adolescents is currently well embedded in different setting (such as child psychiatry, rehabilitations centers, private practices, etc.), it is a relatively young domain. The field of physical therapy in mental health in children and adolescents encompasses different approaches and therapeutic techniques, ranging from assessment and observation to body awareness techniques, relaxation, experienced oriented family therapy, physical activity, etc. [11,12].

Geriatric psychiatry specific elements

The cornerstones are to improve the quality of life of the elderly with mental health problems (e.g. dementia and functional psychiatric disorders)

The goals are:

• Slowing down the reduction of daily activities
• Improving cardiovascular function
• Strength, coordination and balance improvement
• Reduction of the risks of falling due to the psycho-pharmaceutical treatment but also the weakening of the possibilities of vision and gait

Adapted therapeutic exercise and body-oriented approaches such as yoga-, tai chi-, mindfulness-derived exercises or massage have a positive influence on cognition, communication, social behavior, sleep, depression and anxiety [13].

Incorporating physical therapy into mental health will lead to improve both physical and mental health as well as experiencing feelings of well-being from our patients.

Let’s bring the contribution of physical therapists in mental health into the spotlight, starting from completing the application as an interested physiotherapist (http://www.ioptmh.org/Colleagues.html) and participating en masse at the 8^th international conference of physiotherapy in psychiatry and mental health (February 8-10, 2021 due Covid19), Helsinki, Finland and at the 9^th in Athens, Greece, in 2022.

• Director and Professor of Postgraduate Programs, Guglielmo Marconi University of Rome, Italy
• Physiotherapist specialized in Neurological & Neuropsychological diseases Rehabilitation
• Founder & Coordinator of the scientific section “Physiotherapy in mental health” of Pan-Hellenic Physiotherapist Association (Greece) and its representative in the International Organization of Physical Therapy in Mental Health (IOPTMH)
• Member of the special interest group of sleeping disorders of World Confederation for Physical Therapy (WCPT) Network for Health Promotion in Life and Work
• Individual member of the World Federation for Mental Health (WFMH)
• Secretary of managing board of European Network of Active Living for Mental Health (ENALMH)