The role of occupational therapist in mental health
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
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
There are a lot of people who don’t know what occupational therapy is, but even fewer know about the role of OT in mental health. But in fact, the profession of occupational therapy first came to be known within psychiatric hospitals.
This is why the term occupational therapy contains the word occupation. Therapists who worked in behavioral health in the 1950s and 1960s would engage patients in meaningful occupations (or activities) in an attempt to keep them productive, attentive, and generally healthy. Handiwork was thought to have a large impact on the recovery process. The general idea behind this science is helpful, since individuals are often more motivated for rehabilitation if they can stay busy and feel useful.
Of course, the way they went about this is now viewed as overly simplistic and outdated, since the extent of their treatment would be working to complete arts and crafts such as basket weaving, lacing, and coloring.
The context of an OT’s role in mental health is the reason why we now delineate between activities and occupations. The purpose of OT is not simply to give our patients something to do, but rather to tailor treatment to the patient’s preferences, goals, and needs across a range of areas.
For this reason, mental health is thought of as one of the most customizable practice areas. Therapists in these settings are not typically held to the strict productivity standards that therapists in skilled nursing facilities and hospitals are. This means that an occupational therapist can use a high amount of creativity, planning time, and evaluation to understand what their patients need and work to make it happen.
The Role of OT in Mental Health
The role of a mental health occupational therapist varies slightly across inpatient and outpatient settings. But the goals are often shared in that treatment focuses on increasing a patient’s awareness of their condition (also called insight) and expanding the range of skills and tools they regularly use to manage their disorder.
One of the main ways that occupational therapists assist patients in behavioral health settings is through psychoeducational groups. These groups focus largely on education but as it directly pertains to someone’s condition. So rather than a standard educational group that involves telling someone what options they have in a certain area, psychoeducational groups show patients how they can engage in these areas despite symptoms, treatment plans, and more.
Psychoeducational groups in both outpatient and inpatient settings typically address the following topics:
Self-care includes dressing, eating, toileting, bathing, and grooming. Therapists in nursing facilities may practice these skills in a hands-on way with patients. Therapists in mental health settings focus more on the barriers to self-care such as poor motivation, low energy, variable mood, unstable housing, and a lack of financial resources.
Relaxation and stress reduction techniques
Stress reduction techniques can range from hobby engagement, yoga, exercise, and many more strategies to engage in relaxation and therefore reduce levels of stress.
This can differ from stress reduction in that coping skills can often be used in more subtle ways such as on public transportation, in the store, or at work. People can use techniques like deep breathing, brief periods of meditation, or guided imagery to cope with stress in the moment and improve their ability to function within the community.
Ranging from anger management to interpersonal dynamics to conflict resolution, this area is a great way to address uncomfortable feelings that are present with nearly every mental health concern. It is a good idea to focus on emotions that are especially uncomfortable such as abandonment, loneliness, fear of rejection, and unworthiness.
This may also include anger management, conflict resolution, interpersonal dynamics, social skills training, and more.
Education regarding symptom management often includes coping skills, stress reduction techniques, and emotion regulation. But a group solely focused on this topic should include personalized plans to deal with each patient’s symptoms. This makes it more powerful and far more effective for each person.
Instrumental activities of daily living (IADLs)
IADLs cover a wide range of topics intended to focus on those higher level self-care tasks such as health maintenance (including the management of medications, appointments, and other treatment-related requirements), budgeting, and household management such as laundry, driving, and cooking. These groups can be approached much the same as those focused on self-care in that education should crucially cover the factors that impact IADL completion.
Depending on the facility’s rules, funding, and physical treatment space, it may be appropriate or necessary to practice some of these skills in an individual or group atmosphere to assess a patient’s safety, function, and general capabilities in each area.
Community mobility or re-entry
Depending on the setting (inpatient or outpatient), education may cover accessing the community safely and effectively or reentering the community after a hospitalization. Some patients may benefit from instruction on using public transportation or ride shares, maps, medical transportation companies for appointments, online navigation systems, identifying signage, locating important buildings in their community such as the hospital, store, and police station.
Reentry groups can focus on social etiquette when in public settings, personal safety when around others, and some basic community navigation.
Social skills and communication
Along with emotion regulation, social skills are crucial to managing a mental health condition. Depending on the severity of someone’s condition and their level of functioning, some patients will benefit from education on acceptable social behavior such as how to utilize verbal and non-verbal cues, being sensitive around certain topics, giving respectful replies, disclosing an appropriate amount of information, and more.
Far too often, patients don’t receive enough information about their own diagnoses or treatment plan. Education on what to expect with each condition is very helpful, including prognosis, treatment options (as provided by the patient’s doctor), medications, and adjunctive treatments.
It is important to note that, while you can talk about general symptoms that are common with many mental health concerns, it breaks HIPAA to discuss a person’s specific diagnosis or circumstances in a group setting. So if this type of education is indicated or requested by the patient, it is best to provide it during one-on-one time.
Each person has roles to fulfill and mental health concerns can often get in the way of that. It’s possible to complete a psychoeducational group that covers a range of roles in a general sense so that each person can get back to meaningful roles they prioritize. This may include being a daughter or son, grandparent, parent, worker, church member, volunteer, or caregiver. Either way, they should receive education on how to manage their condition while still engaging in these roles in the ways they wish to.
Hobbies and leisure activity are another important area that can assist with recovery. Individuals may not be aware of viable leisure pursuits or they may have trouble participating due to motivation and other factors discussed earlier. For this reason, education should focus on helping patients successfully engage in whatever leisure activities are of interest to them.
The above areas serve as the crux of occupational therapy treatment in both community-based settings such as outpatient clinics, clubhouses, and drop-in centers, as well as inpatient settings such as hospitals and residential facilities. Occupational therapists have a large impact on the rehabilitation process of individuals living with any type of mental health concern.
This is yet another meaningful way that OTs can impact change and assist the movement toward improving our society’s mental health.
What is your favorite way that OTs can address mental health? What would you add about the role of OT in mental health in general? Let us know in the comments!
And for more about mental health occupational therapy, be sure to check out our other article, Occupational Therapy in Mental Health: An Overview of 6 Typical Settings.