Impact of exercise physiology and speech therapy in a forensic community mental health program

Frances SHAWYER1, Raja DHUNGANA1, Ben ATKINSON1, Kate FANNING1,3, Joanne ENTICOTT1, Graham MEADOWS1,2,4

1Monash University, Melbourne, Australia
2Monash Health, Melbourne, Australia
3Forensicare, Melbourne, Australia
4University of Melbourne, Melbourne, Australia

Introduction: The Forensic Mental Health in Community Health (FMHiCH) Program at Monash Health is one of five in Victoria, Australia which provide mental health services to people on Community Corrections or Parole Orders. The program aims to improve the mental health of offenders with a moderate mental illness and assist them fulfil their Order. The program at Monash Health uniquely includes Exercise Physiology (EP) and Speech Therapy (ST) as a critical part of their multidisciplinary service model, including for client engagement. Although there is evidence that exercise can improve mental health, and ST can reduce offending through improved language skills, there is little research examining mental health treatment outcomes of EP and ST with adult offender populations. The aim of this project was to examine whether EP and ST were associated with treatment success in the Monash Health FMHiCH program.

Methods: Using service data from program inception late 2018 (n = 1111), mixed-effect univariate and multivariate logistic regression models were employed to examine the association of ST and EP with treatment outcomes (completed treatment versus failed to engage; treatment goal achieved versus not achieved). Sensitivity analyses used Multiple Imputation by Chained Equations to impute missing values in outcome variables and other covariates.

Results: EP and ST clients had significantly higher odds of attaining the service treatment goal than other clients (odds ratios: 7.3 and 3.8 respectively in fully adjusted models). Greater direct time and number of EP and ST service contacts increased the likelihood of achieving the treatment goal. EP and ST services also significantly increased the likelihood of completing treatment versus being discharged with failure to engage. Sensitivity analyses showed comparable findings.

Conclusion: Findings support the use of EP and ST services in forensic community mental health settings, noting the key limitation that this is an observational study only.