Exercise physiology and speech pathology support treatment engagement in forensic mental health in community health: evidence from a retrospective cohort study
4 affiliations
- 1Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University
- 2Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University
- 3School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University
- 4Mental Health Program, Monash Health
Abstract
Background: Adults completing community-based orders (CBOs) imposed by courts in Victoria, Australia, often present with complex mental health needs and face barriers to treatment engagement. The Forensic Mental Health in Community Health (FMHiCH) program was established to address these challenges through multidisciplinary care within a community health model across multiple sites. At one site, exercise physiology (EP) and speech pathology (SP) were introduced to enhance engagement and support treatment success, however evidence for these interventions in forensic mental health settings is limited. Because the FMHiCH dataset did not contain a direct measure of engagement, this study examined whether EP and/or SP involvement was associated with two behavioural indicators of engagement: treatment completion and treatment goal achievement, and whether greater service dose improved these indicators.
Methods: A retrospective cohort study analysed de-identified FMHiCH data (December 2018–June 2023) from 1,111 care episodes. Mixed-effect logistic regression was used to examine associations between EP and SP involvement and the two treatment outcomes, adjusting for demographic and socio-economic factors. Dose effects were explored using univariate logistic regression for EP and SP contact time and number of contacts.
Results: EP and/or SP involvement was positively associated with both engagement indicators across minimally adjusted (treatment completion: EP OR 5.65 [95% CI 2.41–13.23], SP OR 2.50 [1.18–5.33]; goal achievement: EP OR 6.67 [2.42–18.42], SP OR 4.05 [1.66–9.85]) and fully adjusted models (treatment completion: EP OR 5.68 [2.10–15.37], SP OR 2.44 [0.93–6.36]; goal achievement: EP OR 7.26 [2.32–22.66], SP OR 3.75 [1.38–10.17]). Higher EP and SP contact hours were significantly associated with treatment completion and treatment goal achievement. Demographic factors such as secure housing and employment showed associations with engagement indicators.
Conclusions: Integrating EP and SP into community-based forensic mental health care was associated with improved behavioural indicators of engagement - treatment completion and goal achievement. The findings suggest that these allied health interventions may enhance engagement and rehabilitation for adults completing CBOs. Controlled studies, such as stepped-wedge cluster randomised trials, are warranted to confirm these associations, clarify dose effects and further explore the influence of social determinants of health.
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BibTeX
@article{shawyer2026exercise,
title = {{Exercise physiology and speech pathology support treatment engagement in forensic mental health in community health: evidence from a retrospective cohort study}},
author = {Frances Shawyer and Kate Wilson and Raja Ram Dhungana and Ben Atkinson and Lyndsey Hipgrave and Shrinkhala Dawadi and Joanne Enticott and Graham Meadows},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1964444},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1964444/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Exercise physiology and speech pathology support treatment engagement in forensic mental health in community health: evidence from a retrospective cohort study
AU - Frances Shawyer
AU - Kate Wilson
AU - Raja Ram Dhungana
AU - Ben Atkinson
AU - Lyndsey Hipgrave
AU - Shrinkhala Dawadi
AU - Joanne Enticott
AU - Graham Meadows
PY - 2026
DA - 2026/10/19
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1964444
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1964444/full
AB - Background: Adults completing community-based orders (CBOs) imposed by courts in Victoria, Australia, often present with complex mental health needs and face barriers to treatment engagement. The Forensic Mental Health in Community Health (FMHiCH) program was established to address these challenges through multidisciplinary care within a community health model across multiple sites. At one site, exercise physiology (EP) and speech pathology (SP) were introduced to enhance engagement and support treatment success, however evidence for these interventions in forensic mental health settings is limited. Because the FMHiCH dataset did not contain a direct measure of engagement, this study examined whether EP and/or SP involvement was associated with two behavioural indicators of engagement: treatment completion and treatment goal achievement, and whether greater service dose improved these indicators. Methods: A retrospective cohort study analysed de-identified FMHiCH data (December 2018–June 2023) from 1,111 care episodes. Mixed-effect logistic regression was used to examine associations between EP and SP involvement and the two treatment outcomes, adjusting for demographic and socio-economic factors. Dose effects were explored using univariate logistic regression for EP and SP contact time and number of contacts. Results: EP and/or SP involvement was positively associated with both engagement indicators across minimally adjusted (treatment completion: EP OR 5.65 [95% CI 2.41–13.23], SP OR 2.50 [1.18–5.33]; goal achievement: EP OR 6.67 [2.42–18.42], SP OR 4.05 [1.66–9.85]) and fully adjusted models (treatment completion: EP OR 5.68 [2.10–15.37], SP OR 2.44 [0.93–6.36]; goal achievement: EP OR 7.26 [2.32–22.66], SP OR 3.75 [1.38–10.17]). Higher EP and SP contact hours were significantly associated with treatment completion and treatment goal achievement. Demographic factors such as secure housing and employment showed associations with engagement indicators. Conclusions: Integrating EP and SP into community-based forensic mental health care was associated with improved behavioural indicators of engagement - treatment completion and goal achievement. The findings suggest that these allied health interventions may enhance engagement and rehabilitation for adults completing CBOs. Controlled studies, such as stepped-wedge cluster randomised trials, are warranted to confirm these associations, clarify dose effects and further explore the influence of social determinants of health.
SN - 1664-0640
ER -