Unless you have a background in addressing mental illness, it’s common for occupational therapists to find the mental health field to be an intimidating realm of treatment, especially for US-based OTs.
Those with a lack of familiarity with mental health as a whole tend to immediately concentrate only on the abnormally aggressive behaviors, while ignoring the wider range of dysfunction that plagues a large portion of the adult population worldwide.
It is important to acknowledge that there appears to be an aversion to working with mental health patients. One particular study (Tsan et. al) showed that the majority of 108 occupational therapy students surveyed preferred to work with patients who were “gainfully employed, middle-aged female clients with physical disabilities and no history of aggressive behavior.”
A separate but more encouraging study (Beltran et. al) showed that OT students’ attitudes change for the better with more efficient tutorials and exposure to mental illness via fieldwork experience. When OT’s attitudes shifted, they were able to focus on interventions and help their patients with mental illness.
So for this article, we will provide you with the occupational therapy mental health setting basics, including exploring six settings where OTs provide mental health treatment and can gain experience in this important population.
The Top Settings for Mental Health Treatment
While there are indeed many misconceptions and stigmas related to mental illness, we will explore this topic in terms of OT treatments by setting type. By having a basic understanding of interventions in each setting, you may be able to reduce your own reservations about working with patients with complex mental illnesses.
1. Acute Care Setting
Acute care in a hospital setting addresses critical or life-threatening medical conditions. Individuals with a history of mental illness often are admitted to the hospital as a direct result of reduced mental capacity. Examples include malnutrition, dehydration, prescription or illicit drug overdose, falls, exposure injuries, failure to adhere to medications (i.e. diabetes management).
Aside from stabilizing the patient, occupational therapists assist patients in daily functional activities. AOTA states that OTs working in the acute care setting specifically addressing psychiatric factors will probably address self-care (including medication management), home management, and community/social participation.
Other interventions include “stress management and coping skills, community re-entry strategies, sleep hygiene, pre-vocational skills, body image issues, and money management” (Occupational Therapy in Acute Care, AOTA). Functional tasks can become more advanced as the patient stabilizes through inpatient care.
2. State Hospital Setting
This is probably the most controversial setting because of occupation therapy’s promotion of de-institutionalization and development of mental health community centers. It also scares a lot of new clinicians away based on the severity of the patients.
For those who are up for the challenge, OTs in state hospital settings create care plans based on intensive evaluations with the goal in mind that the patient can re-enter the community without being a danger to themselves and to others.
Such approaches are quite similar to those in the acute care setting including ADLs, community re-integration, social participation, and pre-vocational skills. For settings that address the pediatric population, family therapy and involvement is intensely added to the multi-disciplinary mix (Utah Department of Human Services).
3. Skilled Nursing/Transitional Care
Skilled nursing facilities and transitional care units are designed to be a stepping stone between “medically stable” and “prior level of function.” Occupational therapy has a huge role in assisting and determining the patient’s ability to safely return home.
This is essential for patient’s passing through with secondary mental illnesses including schizophrenia, bipolar disorder, chemically-induced disorders, etc. The OT works on everything similar to that in an inpatient setting, but with more vigor and a longer duration as tolerated by the patient.
Patients with mental illnesses often need emphasis on carry-over in order to safely and independently conduct daily living tasks at home in order to prevent readmission to the hospital.
4. Assisted Living Facilities
It is assumed that residents who are in assisted living settings are high-functioning enough to do so, but may require some minimal assist for meals, medication management, and community activities. OTs are less focused on discharge to a different home and more concentrated on fine-tuning the resident’s current function in order to promote a higher quality of life.
Examples include establishing a community outing routine while integrating stress management techniques in order to reduce behavioral incidences in public. Others include establishing a therapeutic exercise program in order for the patient to continue with safe mobility.
5. Home Health
The home environment can impact the patient’s mental health for better or for worse depending on what kind of living situation they reside in. Persons living with dedicated caregivers in a clean home can often succeed in completing daily living tasks and mobility with very little safety concerns.
For others who live at home alone and have an out-of-control living space, they can be subject to all sorts of safety hazards. OT’s roles in home health for clients with mental illness include home and environmental modifications to reduce functional barriers and fall risks, medication management, education in emergency access, family and caregiver education in therapy strategies, and cognitive/problem-solving strategies to increase carryover of learned tasks.
6. Community Centers
Although the community setting encompasses the home, this area refers to other centers including group homes, club houses, after-school programs, vocational programs, senior centers, correctional facilities, homeless shelters, and outpatient group therapy. Therapists have a vast influence in theses settings and come well-equipped with methods for community reintegration.
Rather than focus on a staunch medical model, occupational therapy in mental health promotes the active recovery model by enabling people with mental illness to participate in their community through employment, volunteer work, social and educational programs, etc.
OTs can introduce therapeutic treatments to curb disruptive symptoms and behaviors including coping skills, sensory processing techniques, and cognitive remediation/adaptation (Occupational Therapy’s Role in Community Mental Health, AOTA). This can help aid in the person’s quality of life and help them truly live their lives to the fullest potential.
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We hope this post gave you some new perspective on the most common occupational therapy mental health settings! Did we miss any? Did any of these surprise you? Let us know your thoughts in the comments below!
References
Beltran, R.O., Scanlan, J. N., Hancock, N., and Luckett, T. (2006). The effect of first year mental health fieldwork on attitudes of occupational therapy students towards people with mental illness. Australian Occupational Therapy Journal. 54 (1). DOI: 10.1111/j.1440-1630.2006.00619.x
Hector W. H. Tsang; Fong Chan, and Chetwyn C. H. Chan (2004). Factors influencing occupational therapy student’s attitudes toward persons with disabilities: A conjoint analysis. American Journal of Occupational Therapy. July/Aug. Vol. 58, 426-434.
As of recent, the role of occupational therapy within PrairieCare has transitioned from the inpatient setting to a solely outpatient consultation basis. The purpose of this blog is to identify the role of occupational therapy in the mental health setting and to highlight the plethora of evidence-based approaches with children and adolescents.
What is Occupational Therapy (OT)?
To start, the profession of occupational therapy is defined as “the therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of enhancing or enabling participation in roles, habits, and routines in home, school, workplace, community, and other settings” (American Occupational Therapy Association [AOTA], 2014, p. S1). To put it more simply, occupational therapists help individuals get back to doing what they want to do. Occupational therapists can work with individuals with physical injuries, cognitive impairments, psychosocial dysfunction, mental illness, and developmental or learning disabilities. Occupational therapists evaluate the whole individual by looking at the transaction between client factors (values, beliefs, spirituality, mental function, sensory function, etc.), performance skills (motor skills, process skills, social interaction skills), environment/context, and performance patterns (habits, routines, roles, rituals) in order to promote, establish/restore, maintain, or modify the task to enable participation in desired life activities. In addition, occupational therapists can focus on prevention of the potential barriers to participation in desired activities (AOTA, 2014).
Occupational therapists working in the mental health settings focus on enabling individuals to re-engage in meaningful occupations through a variety of skill sets such as skills development, establishing positive habits and routines, setting therapy goals, using cognitive-behavioral techniques (CBT), and understanding underlying physiological influences (AOTA, 2016b). Specifically, occupational therapy within the setting of child and adolescent mental health focuses on those underlying physiological influences and teaching patients to identify and utilize self-regulation strategies in order for patients to get back to participating in meaningful occupations such as going to school, being with friends, and participating within the family system (AOTA, 2016a). In addition, occupational therapists can work with individuals with sensory processing disorders (SPD) and social-emotional learning dysfunction, which are commonly seen within the child and adolescent setting of mental health (AOTA, 2016b).
What approaches do OT’s use with clients/patients?
The following evidence-based approaches support the profession of occupational therapy within this child and adolescent mental health setting. These evidence-based approaches include:
- Providing education on coping skills and self-regulation skills to use in a variety of contexts
- Providing education on sensory exploration and implementation of sensory approaches for self-regulation
- Incorporating yoga and movement interventions to provide sensory input and achieve self-regulation
- Utilizing CBT approaches to facilitate participation in desired activities
- Identifying and implementing healthy, positive habits and structure into daily routines
- Providing education and implementation of skills related to social competence, such as making and keeping friends, coping with anger, solving problems, learning about social etiquette, and following school rules
- Evaluating factors interfering with success in school, home, community, etc.
- Modifying the environment to support improved attention, participation and decrease sensory overload in the classroom
- Providing parents with education on behavioral and psychosocial approaches to enhance the child’s daily functioning
- Reducing restraints and seclusions in the inpatient setting by conducting comprehensive assessments to determine facilitators and barriers to participation in life tasks, promoting the use of self-awareness and skills development, collaborating with the client to develop attainable goals, modifying the environment for optimal fit, promoting use of self-regulation and sensory strategies, and educating the interdisciplinary team on prevention techniques.
Overall, it is clear that occupational therapists have the distinct knowledge and skill sets to provide effective, holistic interventions within the mental health setting. There is strong evidence to support the incorporation of occupational therapy skills such as sensory approaches and psychosocial techniques within psychiatric settings to facilitate daily life functioning.
Alison Tonsager, Occupational Therapy Student
Madonna Mitzel, MS, OTR/L, Outpatient Occupational Therapist
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1– S48. doi: 10.5014/ajot.2014.682006
