Occupational therapy in mental health: A review of the literature

This review of the literature was conducted as part of the development of a position paper on the way ahead for research, education and practice in occupational therapy in mental health. It included publications over the past decade and concentrated on the British Journal of Occupational Therapy. Recognising experience from other countries would be beneficial, aspects of the literature from the National Journals in American, Canada and Australia which were most relevant to practice in the UK were included. The shortage of articles on mental health was conspicuous and their diverse topics and descriptive nature were notable. In the UK literature, the clinical subjects featured most often were dementia, work rehabilitation, community mental health and forensic psychiatry, with other subjects either appearing infrequently or not being included. The literature from the other countries also explored new roles for occupational therapy, reflecting the changes in the delivery of mental health services. In the American Journal of Occupational Therapy there was concern about the declining number of occupational therapists working in mental health. The review identified major themes in the literature and posed questions for education, research and practice in occupational therapy and formed the foundation for the position paper

Educating occupational therapists for mental health practice

The last of four elements of the Mental Health Project, established by the College of Occupational Therapists to produce a position paper on the way ahead for research, education and practice in occupational therapy in mental health (Craik et al 1998a), focused on educating occupational therapy students to work in mental health. First, the views of practitioners about their pre-registration education were derived from one component of the practitioners' survey (Craik et al 1998b). One hundred and eleven (81%) practitioners considered that their pre-registration education had been sufficient or partially sufficient to meet their needs on first working in mental health. Secondly, the views of occupational therapy educators were elicited by a short qualitative survey that replicated three questions about future issues in mental health, which had formed a key constituent of both the practitioners' survey (Craik et al 1998b) and the managers' survey (Craik et al 1999). Important issues for educators were focusing on clients who would benefit most from occupational therapy in community and primary care settings, preparing undergraduates for the unique approach of occupational therapy and the need for more research to support evidence-based practice. Both groups highlighted the value of positive fieldwork placements

Students’ choice of occupational therapy as a second degree

There has been little research in the United Kingdom into the recruitment of occupational therapy students. This study focused on one aspect and surveyed students already holding a degree, in order to ascertain the factors that attracted them to occupational therapy and why they chose a further 3-year degree course in preference to postgraduate alternative routes to qualification. Sixty-four students, holding degrees predominantly in the human sciences and the arts, were motivated to study occupational therapy at Brunel University through a desire to obtain a vocational qualification and to pursue a career that helped others and offered variety and personal satisfaction. The majority of the students learned of the profession through working in health and social care environments, and chose to study at Brunel University owing to its location in London and its reputation for attracting mature students. Although 90% of the students had been aware of the 2-year accelerated postgraduate diplomas in occupational therapy, more than a third preferred to undertake a 3-year degree course because it allowed more time for study and part-time employment. The need to target recruitment at school leavers, graduates in related degrees and those already working in health or social care was identifie

Factors supporting and hindering the participation of people with mental health problems in leisure

Although leisure is recognised as a key aspect of occupational therapy, few studies have explored it in relation to people with enduring mental health problems. Using a qualitative design, semi-structured interviews were conducted with 10 participants with mental health problems living in the community, randomly selected from clients referred to a local assertive outreach service in South-East England. Initially, the data were analysed for content and the phrases, language and words used; subsequently, emerging themes were identified, which were confirmed by a second occupational therapist. The three themes arising from the data reported here were the number and range of occupations engaged in, the factors enabling participation in leisure and the factors hindering participation in leisure. The range of leisure occupations was similar to that noted in the literature. The main enabling factor was having an adequate network of people to provide support, while the main hindering factors were physical limitations, lack of finances and lack of transport. In the absence of paid employment, leisure was important to the clients. Occupational therapists need to recognise that enhancing the factors enabling participation in leisure and assisting clients to overcome the factors hindering participation in leisure will lead to the increased wellbeing of people with enduring mental health problems

The use of evidence based practice by occupational therapists who treat adult stroke patients

The study identified the extent to which members of the National Association of Neurological Occupational Therapists (NANOT) who treated adult stroke patients used evidence-based practice (EBP). A random sample of NANOT members (n = 200) was surveyed by a postal questionnaire on the use of EBP and the results were analysed for the 125 therapists who worked with adult stroke patients. The principal factor that `greatly’ influenced the choice of intervention of three-quarters of the respondents was working with other therapists, followed by attendance at postgraduate courses; gaining postgraduate qualifications had the least influence. Although over 90% of the respondents considered that they used EBP at some time, the most frequently reported levels of evidence used were custom and practice and expert opinion, which were at the lower end of the hierarchy. Therefore, although the respondents who treated adult stroke patients did use EBP, they did not use the higher levels recommended. The respondents who used the higher levels of evidence were those who were most recently qualified. The factors influencing the use of EBP were the relevance of research to practice, time, lack of therapists’ knowledge and lack of support

Careers advisors’ opinion of the College of Occupational Therapists Careers Video

Using a mixed methodology, this study investigated the effectiveness of the College of Occupational Therapists’ careers video in increasing the knowledge of six careers advisers about the profession and obtained their views of the video as a promotional tool. To quantify the advisers’ knowledge, a pre-test post-test questionnaire was used before and after viewing the video. A short qualitative interview then ascertained their impressions of the video. Despite a high baseline knowledge, viewing the video was effective in increasing it. The advisers had mixed opinions about the video, suggesting that it could be improved and clarified

Occupation, mental illness and medium security: A study of occupational engagement in two forensic regional secure units

Research investigating occupational experience among people with mental illness has highlighted their difficulties in selecting, organising, valuing, enjoying and competently performing occupations. Although occupational therapy literature consistently identifies environmental factors as key in facilitating successful and valued engagement, few authors have studied the implications of detention in secure mental health settings for this population. This study investigated the occupational experiences of five people with schizophrenia in two forensic regional secure units. Quantitative and qualitative methodologies were used, with semi-structured interviews adding depth and subjectivity to Occupational Questionnaire (Smith et al 1986) responses. The quantitative data were analysed using non-parametric analysis, with content analysis applied to the qualitative data. Time-use was characterised predominantly by engagement in passive leisure and rest occupations. This reflects the findings of both inpatient and community-based studies elsewhere and suggests that mental illness is a common factor influencing time-use. The participants chose occupations based on expectations of enjoyment and success, and associations with independence and normality. Significant correlations were found between perceived competence, value and enjoyment (p<0.01), and the participants were more likely to enjoy self-chosen occupations (p<0.05). Forensic occupational therapists must use evidence to optimise resources and deliver interventions that facilitate choice and autonomy and reflect individual needs. Further research with larger samples and longitudinal methodologies will facilitate generalisation and establish temporal perspective

Promotion of occupational therapy as a career: A survey of occupational therapy managers

A careers pack distributed to 184 occupational therapy managers in and around London contained a questionnaire which gathered information about their role in promoting occupational therapy as a career. Twenty-six managers responded (14.1%) and considered that the College of Occupational Therapists had the principal responsibility for promoting the profession. Three-quarters considered that the careers pack was fairly effective and two-thirds were willing to use it to promote the profession. Although pleased to have received the pack, the managers had more negative than positive comments about it. Managers may not appreciate their influential position in recruitment to the profession and other stakeholders should collaborate to support them in their pivotal rol

Some factors influencing occupational engagement for people with schizophrenia living in the community

With the emergence of occupational science, there has been renewed interest in the health benefits of occupational engagement and a call for more research into the occupational nature of humans. Engaging in occupations is known to have a positive effect on an individual’s health and sense of wellbeing. A common feature of people with schizophrenia, however, is a decrease in volition and a reduction in the occupations performed. This study explored some of the influences on occupational engagement for people with schizophrenia living in the community. A qualitative approach was chosen, using semi-structured interviews. Four male and four female participants, aged 23 to 49 years, described the influences on their occupational engagement. Content analysis, primarily using coding and memoing, was employed to categorise the data. Four main themes emerged: health, routine, external factors and internal factors. Some specific factors identified within these themes were medication, daily schedules, staff, family, work, self-concept and challenges. The implications of the results are discussed, with particular reference to assisting occupational therapists to enable clients with schizophrenia to engage more successfully in occupations

Without leisure … ‘it wouldn’t be much of a life’: The meaning of leisure for people with mental health problems living in the community

Previous research has explored the occupational engagement of people with mental health problems. This study set out to establish the meaning and value of leisure for people with enduring mental health problems living in the community. Using a mainly qualitative design, semi-structured interviews were conducted with 10 participants randomly selected from clients referred to a local assertive outreach service in South-East England. Initially, the data were analysed for content, phrases, language and words used; subsequently, emerging themes were identified which were confirmed by a second occupational therapist. Three themes are reported here: why certain occupations were considered to be leisure, the feelings expressed during leisure and the value of leisure. Although the participants had some difficulty in articulating their views, leisure was differentiated from other occupations, with the time available to complete a task in the absence of pressure being the distinguishing feature. Overall, the participants had positive views about leisure, which was valued in terms of meeting their individual and unique needs. The implications for occupational therapy are explored. In determining the meaning and value of leisure for people with mental health problems, more emphasis should be given to their actions and less to their skill in verbalising emotion