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 that experience from other countries would be beneficial, aspects of the literature from the national journals in the USA, Canada and Australia which were most relevant to practice in the United Kingdom were included.

The shortage of articles on mental health was conspicuous and their diverse topics and descriptive nature were notable. In the United Kingdom 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 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, posed questions for research, education and practice in occupational therapy and formed the foundation for the position paper.

Occupation or Therapy? The Attitudes of Mental Health Professionals

A questionnaire study of mental health staff on a psychiatric unit investigated their views about occupational therapy. The study evaluated the attitudes to the role of the occupational therapist, the referral and assessment process, the importance of therapeutic activities, and communication and feedback between occupational therapists and other disciplines. Sixty-four out of 89 staff responded (72%).

Most respondents thought that occupational therapy should start within a week of admission, even though many referrals took much longer than this to arrive. There was some confusion over who was responsible for getting the patient to attend occupational therapy. Although occupational therapy was felt to increase people's confidence, some staff suggested that patients should not attend until they had gained confidence. There was uncertainty about who should decide on a patient's suitability for occupational therapy. In addition, there was a blurring of rotes between occupational therapists and other disciplines. Many staff were well able to recognise the main functions of occupational therapy. However, they were not confident about this and did not fully apply this knowledge in their clinical practice. Occupational therapists were generally seen in a positive light.

This study emphasises the importance of better communication between occupational therapists and the other professions and, in particular, the need to raise the profile of occupational therapy within local teaching programmes.

Audit of a Group Programme for Inpatients in an Acute Mental Health Setting

This article documents an audit of the ward occupational therapy service in the Hartington Wing, an Acute Mental Health Unit in Chesterfield and North Derbyshire Royal Hospital NHS Trust. A revised service based on ‘open-door’ groups aims to make occupational therapy more accessible at the point of admission and more responsive to changing needs, and it drew praise at the unit's last visit from the Mental Health Act Commission.

The findings of the audit demonstrate increased uptake of occupational therapy, with patient contacts almost doubling and the time taken from referral to first patient contact being significantly reduced. The ward nursing staff were positive about the changes but their perception of the occupational therapist's role in ward group programmes remains unclear.

How do Occupational Therapists define their Role in a Community Mental Health Setting?

The aim of this study was to examine how occupational therapists define their role in a community mental health setting, within a framework of current concern about a lack of knowledge and recognition of the profession among both other health professionals and the general public, including clients of the service. Nineteen practising occupational therapists were interviewed by telephone and invited to give their definitions of occupational therapy.

The main finding was that there was a lack of a uniform definition of occupational therapy in community mental health settings. The need for the development of agreed definitions of occupational therapy is discussed.

The meaning and form of occupational therapy as experienced by women with psychoses. A phenomenological study

The meaning and form of occupational therapy as experienced by women with psychoses: a phenomenological study The aim of this study was to illuminate the experiences of occupational therapy interventions in individuals with psychoses. Repeated tape-recorded narrative interviews were conducted with six women participating in occupational therapy immediately after an intervention. The subsequent analyses followed a phenomenological approach. Key constituents integrated in two structures, are the main findings. The meaning of occupational therapy as expressed in the key constituents relief, self-knowledge, belief in the future, capability, resistance and satisfaction formed one structure. The form of occupational therapy as expressed in the key constituents time, environment, guidance, voluntariness and collaboration represented the other structure. These findings confirm and give empirical support to beliefs and assumptions expressed in occupational therapy literature. The results form a conceptual base for developing an evaluative assessment instrument for individuals with psychoses participating in occupational therapy.