Physiotherapy in Mental Health: A Mixed Methods Systematic Review of Practitioner and Student Knowledge, Attitudes, and Perceptions

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ABSTRACT Background and Purpose Mental health physiotherapy is increasingly recognised as a specialised area of practice. Adequate knowledge and positive attitudes are essential for ensuring safe evidence‐based care and for directly influencing the quality of services delivered. Despite this, research on mental health literacy and attitudes within physiotherapy remains fragmented. This study aims to synthesise evidence on the knowledge, attitudes and perceptions of physiotherapists and physiotherapy students regarding roles in mental health practice. Methods A mixed‐methods systematic review was conducted and registered in PROSPERO (CRD42024611691). An initial search of Embase (via Ovid), PubMed, PsycINFO, Scopus, CINAHL and Google Scholar was performed from inception to November 2024, followed by an updated search of the same databases in January 2026. Empirical studies examining knowledge, attitudes or perceptions related to mental health were included. Study quality was appraised using the mixed method appraisal tool (MMAT). Findings were synthesised narratively for quantitative data and thematically for qualitative data, with integration through a convergent segregated approach. Results A total of 42 studies were included, comprising 2780 physiotherapists and 2715 students. Participants generally demonstrated positive attitudes towards people with mental illness, whereas reported mental health knowledge varied from limited to good across studies and populations. Experiential learning through direct client interaction appeared to be associated with a more integrated understanding of mental health in physiotherapy and greater confidence, comfort, empathy and reflective capacity. However, the included studies were methodologically heterogeneous, and psychometric properties of the assessment instruments were often insufficiently documented. Discussion Participants recognised the importance of mental health support and held positive attitudes, but may not have been prepared to address mental health concerns in physiotherapy practice. Limited education, clinical exposure and role clarity may have contributed to this lack of readiness. These findings support the consideration of more targeted mental health education and structured training initiatives. Trial Registration The protocol for this review was registered in the PROSPERO database (CRD42024611691)