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<b>Background</b>: Physical health comorbidities are closely associated with mental health diagnoses, particularly among older adults. While physiotherapy services are increasingly integrated into older adult inpatient mental health settings, robust service-level evidence remains limited. <b>Objective</b>: This service evaluation aimed to assess the clinical characteristics, physical outcomes, and associative factors within a dedicated physiotherapy service in this complex setting. Secondary aims included determining the clinical utility and applicability of outcome measures for risk stratification and functional assessment, and identifying patterns related to serious injury and falls within this specific, complex older adult mental health inpatient population. <b>Methods</b>: Retrospective data was extracted from 302 patients (mean age 78.9 years) across five older adult inpatient mental health wards in one NHS trust, covering the period from January 2023 to November 2024. Data analysed included demographics, diagnoses, physical outcome measures (e.g., Hand Grip Strength, MRC-SS, and Tinetti Balance Score), falls per year, length of stay, and destination placement. <b>Results</b>: Delirium (44.4%) was the most prevalent primary diagnosis, followed by functional (40.1%) and dementia (15.6%). Physical health measures showed that patients with serious injury had lower mean Tinetti scores and a higher mean number of falls per year (<i>p</i> = 0.040 and <i>p</i> < 0.001, respectively). Intervention type was significantly associated with falls per year, with patients who received no intervention due to mental health reasons reporting more falls (<i>p</i> = 0.006). <b>Conclusions</b>: The weak association found between age and strength, balance and falls in this population emphasises the need to utilise objective assessment tools, such as the Tinetti Assessment for risk stratification, including for falls. This study emphasises the need for tailored service pathways and active patient involvement towards discharge planning, and the essential role of physiotherapy integration within the multidisciplinary team. Future research remains essential in demonstrating the effectiveness of physiotherapy intervention and building the evidence base for physiotherapy in older adults' mental health inpatient settings.