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Exercise physiology and speech pathology support treatment engagement in forensic mental health in community health: evidence from a retrospective cohort study

Year: 2026

Type: article

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.

Source: Frontiers in Psychiatry

DOI: 10.3389/fpsyt.2026.1964444