Exploration of Australian and New Zealand indigenous people's spirituality and mental health

Background:  Spirituality has been defined as an overarching construct that involves personal beliefs or values that provide a sense of meaning and unity with self, people, nature and universe. Spirituality may be experienced within or outside formal religion. At least in English-speaking countries, therapists reported discussing spiritual issues with service users more frequently than before. In the literature, there continues to be debate regarding definitions of spirituality and how spirituality fits with occupational therapy practice models.
Methods and Results:  To advance the discussion, we explore the concept of spirituality among indigenous people of Australia and New Zealand, and use mental health as a practice setting to suggest how occupational therapists can address the spiritual needs of individuals recovering from mental health problems.
Conclusion:  The implications for assessment and interventions to improve coping skills, social support, self-esteem and instil hope of recovery from mental illness are considered.     

The Occupational Performance History Interview in community mental health case management: Consumer and occupational therapist perspectives

Background/aim:  This study aimed to explore the use of the Occupational Performance History Interview from the perspectives of mental health consumers and occupational therapist case managers in community mental health settings.
Methods:  This qualitative study, based on naturalistic inquiry, involved 10 participants: four occupational therapists who interviewed six mental health consumers, using the Occupational Performance History Interview. All participants participated in follow-up interviews or in focus groups to gain an understanding of their perspectives of this experience. Transcribed data were analysed using the constant comparative method.
Results:  Consumer participants valued telling their occupational stories. Occupational therapist participants described the interview as supporting them to be more occupationally focused within their case management roles.
Conclusion:  The findings suggest that the Occupational Performance History Interview can potentially enhance client-centred and occupationally focused practice in community mental health case management.     

Queensland extended care services for people with severe mental illness and the role of occupational therapy

Background:  People with serious mental illness in Queensland who require extended rehabilitation may be treated in extended inpatient mental health services. Two of these extended inpatient services, hospital and community-based 'Extended Treatment and Rehabilitation Units (ETRUs) and Community Care Units (CCUs)', are described, including the aims, objectives, philosophy and service delivery.
Methods:  A quality project involving occupational therapists working in these settings, as well as a consumer and carer, provides different perspectives concerning these relatively new health services in Queensland.
Results:  Two main occupational therapy roles were identified: case management and occupational therapy-specific roles (including assessment and intervention). The consumer and carer perspective is also presented.
Conclusion:  These services provide a positive option for people with high levels of functional disability as a result of mental illness and also for their carers. They provide environments with many exciting opportunities and challenges for occupational therapists working in mental health.     

Developing a worker role: Stories of four people with mental illness

Background and Aims:  Work plays an important role in adults' well-being, irrespective of health status. Vocational rehabilitation can enable people with mental illness to return to open employment. A narrative approach was used to explore how individuals with a mental illness made sense of their work-related experiences.
Methods and Results:  Four Clubhouse members in open employment for at least 6 months completed in-depth, semistructured interviews, from which narratives were created to reveal events, significant persons and actions that assisted these individuals to resume work. Woven into the participants' stories were four 'impelling forces' contributing to a sense-of-self as a worker. These impelling forces were: support from significant others, the personal meaning of work, experiences within the Clubhouse programme, and the ongoing struggle with illness. Implications for occupational therapy practice are discussed.
Conclusion:  The findings of this study urge occupational therapists and others to provide opportunities to provide on-going support to people with a mental illness who seek paid employment.     

Occupational performance modification and personal change among clients receiving rehabilitation services for rheumatoid arthritis

Background:  A client's personal process of change is recognised as an important element in the rehabilitation process that may affect the acceptance and outcome of recommended occupational therapy self-management interventions. Recent research has examined the transformative process of changing underlying values, beliefs, feelings and knowledge, collectively known as meaning perspectives, in clients receiving rehabilitation for various chronic conditions.
Aim/methods:  This article presents the findings of a Grounded Theory Qualitative retrospective study of 10 adults diagnosed with rheumatoid arthritis receiving occupational therapy to modify their daily living environment and activities to maximise the quality of life and occupational performance. They were interviewed twice in a semidirected manner.
Results:  Two personal change processes were identified for two different courses of the illness: progressive adaptation during a course of gradual steady development of symptoms without remission, and complex adaptation that led to transformation during a course of acute development of symptoms with periods of remission.
Conclusion:  Implications for more effective and efficient occupational therapy interventions are suggested.     

The association between leisure motivation and recovery: A pilot study

Background and aims:  Recovery from mental illness may be facilitated by participation in activities that provide meaning and purpose in the lives of consumers. Leisure participation can be a major source of enjoyment as well as mental and physical well-being.
Methods and results:  This study examined the association between consumers' motivation to engage in leisure and their self-reported perception of recovery in a sample of 44 Clubhouse members. The Leisure Motivation Scale and the Recovery Assessment Scale were used to measure the association between leisure motivation and recovery. The results indicated a statistically significant association between leisure motivation and recovery.
Conclusion:  These findings have implications for service delivery within mental health settings, as occupational therapists may be able to design leisure-based programs more effectively if they can understand the needs and motives for participation. More emphasis should be placed on supporting consumers to re-integrate and be socially included within the community through leisure-based initiatives.     

The effect of first year mental health fieldwork on attitudes of occupational therapy students towards people with mental illness

Background and Aims:  Despite recent initiatives to reduce stigma towards people with mental illness, negative attitudes persist both in the community and among health professionals. Fieldwork experience has been identified as the most powerful way of modifying the attitudes of health professional students. Research to date suggests that later placements tend to have a more positive effect on attitudes than do earlier placements. However, inconsistencies within the literature suggest that it is the nature of the fieldwork experience that is the critical factor. We set out to investigate whether a program of fieldwork that included a tutorial component would bring about positive attitudinal change in first year occupational therapy students.
Methods:  We conducted secondary analysis of data collected from first year students before and after first year fieldwork experience in mental health settings. Student statements were rated to identify positive versus negative attitudes, and attitudinal themes were analysed.
Results:  Quantitative analysis revealed that students made significantly more statements reflecting positive attitudes following fieldwork than they did before. From pre- to post-fieldwork, attitudinal themes changed from: people with mental illness as different, fear of people with mental illness, and a deficit focus of mental illness, to: the 'ordinariness' of people with mental illness, students' understanding of people with mental illness, and an enabling approach to people with mental illness.
Conclusions:  A program of fieldwork that includes a structured tutorial component can bring about positive changes in the attitudes of first year students towards people with mental illness.     

Validity and reliability of the MEDYN questionnaire for evaluation of functioning in mental health clients receiving occupational therapy

Background:  A number of questionnaires are currently available for measuring functionality of mental health clients; however, they are complex, clumsy to use and impossible to compare to each other. There is a clear need for a simple and straightforward tool that uses quantitative measures. We formulated a questionnaire based on occupational, behavioural and cognitive theories to assess the functioning of psychiatric inpatients receiving occupational therapy.
Methods:  Thirty-one patients hospitalised in a closed and an open ward and receiving occupational therapy were monitored during 4 weeks. Clinicians completed the questionnaire for each patient on a weekly basis.
Results:  Interrater reliability was found to be generally high with correlations among the raters in the closed ward being higher than among those in the open ward. Both cognitive and general/social functioning improved over time and the improvement was associated with type of illness and duration of treatment.
Conclusions:  The MEDYN questionnaire is a valid and reliable objective tool for functional assessment of this subgroup of patients.     

A survey of recruitment and retention issues for occupational therapists working clinically in mental health

Background:  Mental health services Australia-wide have difficulty recruiting and retaining clinical occupational therapists.
Methods:  A survey of occupational therapists to identify factors that could influence their retention or loss from clinical mental health practice was undertaken.
Results:  Typically, respondents were female, aged 30 years or younger, working full-time at a grade 2 or 3 level, and had worked entirely in mental health. The main positive aspects that respondents identified about their positions were the 'social/emotional environment', 'aspects/nature of their roles', and 'using occupational therapy skills'. The main position constraints were 'insufficient time/workload' and 'insufficient use of occupational therapy skills/generic nature of work'.
Conclusions:  Recruitment and retention strategies are required to retain occupational therapists in clinical mental health positions.     

Approach to treatment of mental illness and substance dependence in remote Indigenous communities: Results of a mixed methods study

Objective:  To develop and evaluate a culturally adapted brief intervention for Indigenous people with chronic mental illness.
Design:  A mixed methods design in which an exploratory phase of qualitative research was followed by a nested randomised controlled trial.
Setting:  Psycho-education resources and a brief intervention, motivational care planning (MCP), were developed and tested in collaboration with aboriginal mental health workers in three remote communities in northern Australia.
Participants:  A total of 49 patients with mental illness and 37 carers were recruited to a randomised controlled trial that compared MCP ( n =  24) with a clinical control condition (treatment as usual, n =  25).
Intervention:  The early treatment group received MCP at baseline and the late treatment group received delayed treatment at six months.
Main outcome measures:  The primary outcome was mental health problem severity as measured by the health of the nation outcome scales. Secondary measures of well-being (Kessler 10), life skills, self-management and substance dependence were chosen. Outcome assessments were performed at baseline, six-month, 12-month and 18-month follow up.
Results:  Random effects regression analyses showed significant advantage for the treatment condition in terms of well-being with changes in health of the nation outcome scales ( P <  0.001) and Kessler 10 ( P =  0.001), which were sustained over time. There was also significant advantage for treatment for alcohol dependence ( P =  0.05), with response also evident in cannabis dependence ( P =  0.064) and with changes in substance dependence sustained over time.
Conclusions:  These results suggest that MCP is an effective treatment for Indigenous people with mental illness and provide insight into the experience of mental illness in remote communities.     

Inpatients' perspectives of occupational therapy in acute mental health

Background:  Research into service users' views of occupational therapy in acute mental health is extremely limited. This collaborative study by the South West London and St George's Mental Health NHS Trust and the Brunel University (UK) obtained inpatients' perspectives of occupational therapy.
Methods:  Service users and occupational therapists were involved in designing a self-report questionnaire and, following training, in recruiting participants and collecting data.
Results:  Sixty-four (28.6%) inpatients responded and most had met an occupational therapist who had explained the purpose of the intervention. The most frequent group interventions were arts and crafts, relaxation, community meetings, cookery, sports and gym, with the latter two rated as the most beneficial. There was much less choice about individual goals and interventions. A highly significant and positive correlation was found between occupational therapy meeting the needs of individuals and it improving the inpatients' daily functioning and quality of their admission.
Conclusions:  Occupational therapists need to provide more individual interventions and more fully involve inpatients in deciding on individual goals. Group interventions, which are meaningful, relevant and with an occupational focus, are most beneficial. Further research examining the effectiveness of cookery and sport and gym and establishing the benefits of engaging in group and individual interventions in acute wards is warranted.     

Effects of occupational therapy intervention on activities of daily living and awareness of disability in persons with intellectual disabilities

Aim:  The purpose of this study was to evaluate the effects of an occupational therapy intervention program on activities of daily living (ADL) ability and awareness of disability.
Methods:  Six persons with intellectual disabilities participated in the study, which was based on a single-case design. Assessment of Motor and Process Skills and Assessment of Awareness of Disability were used as evaluation tools.
Results:  Activities of daily living performance improved in five of the six participants after implementation of the program, with improvement across both motor and process skills. However, no clear improvement in awareness of disability was found following implementation of the program.
Conclusion:  It may be concluded from this study that persons with intellectual disabilities can benefit from occupational therapy interventions to improve ADL ability, even in the absence of any change in their awareness of disability.     

Investigation into the occupational lives of healthy older people through their use of time

Background/aim:  Older people are one of the largest groups using health-care services; therefore, it is important for occupational therapists to have an understanding of their occupational lives. Temporality is a key element of occupation, yet little research exists regarding older people and time use, despite the considerable temporal adjustments taking place at this lifestage. The aim of this study was to identify the occupational lives of healthy older people through the activities they undertake in a 24-hour period.
Method:  Data analysis of time-use diaries from 90 older UK residents (aged 60–85 years) who considered themselves to be healthy was undertaken, using 15 activity codes and three pre-coded terms: necessary, enjoyable and personal.
Results:  The participants spent most of their time sleeping and resting (34%), followed by performing domestic activities (13%), watching television, listening to the radio or music, or using computers (11%), eating and drinking (9%) and socialising (6%). Enjoyable activities occupied most of their time (42% of the day), followed by necessary (34%) and personal activities (16%).
Conclusion:  These data contribute to the growing evidence base regarding older people as occupational beings, indicating that they are a diverse group of individuals who are meeting their needs with dynamic, positive activities. This highlights the importance of a client-centred approach to occupational therapy, as it enables the clients to have choice, control and diversity in their activities when meeting their needs.     

Towards facilitating change in service delivery: An illustrative example

Background:  The management of change in organisations is a challenge facing many occupational therapists in practice today. This article presents an example of a program implemented to facilitate the process of change in paediatric service delivery. It presents the principles and design of the program, as well as the program's implementation and resultant findings.
Methods:  The principles and process of organisational change laid the foundation of the program and were utilised as measurement of changes occurring in the perceptions of participants. Interviews and online focus groups were utilised as data-gathering methods.
Results:  The findings of the study illustrate the process of change that participants were undergoing.
Conclusions:  The article provides an example of how managers can facilitate change in service delivery by using the principles of organisational change and adult learning. Recommendations are made for application of similar change management processes in other organisations and the future use of the online discussion medium as research tool and in practice.     

Injured workers' perspectives of their rehabilitation process under the New South Wales Workers Compensation System

Aim:  Occupational injury and the process of rehabilitation can impact significantly on an individual's life. Research on the perspectives of injured workers, and their perceptions of the occupational therapy role, is limited.
Method:  A qualitative, phenomenological study explored the experiences of six injured workers, from a large regional area health service, who had undergone occupational rehabilitation within the NSW Workers Compensation System. Data were collected through the use of in-depth, semistructured interviews and were analysed inductively.
Results:  Injured workers have a limited knowledge and understanding of the rehabilitation process, feel unsupported throughout the process, have unsatisfying return-to-work duties and often experience negative attitudes from key stakeholders.
Conclusion:  The results highlight the opportunity for occupational therapists to increase their role within occupational rehabilitation; however, they need to adopt a more holistic approach to their practice.     

Correlates of comorbid mental disorders in a regional community-based sample

Objective:  The common coexistence of psychiatric disorders has been identified as a significant factor contributing to the disability associated with mental illness. Identifying indicators to the development of coexisting disorders has potential clinical implications. This study aimed to investigate the correlates and impact of coexisting disorders in a rural setting.
Design:  Cross-sectional analyses of data from a cohort interviewed in two phases.
Setting:  A regional community sample in Northern New South Wales, Australia.
Participants:  A total of 1407 participants were interviewed and 968 were re-interviewed at follow up.
Main outcome measures:  Multinomial logistic regression modelling compared subjects with multiple psychiatric disorders with those with a single disorder for sociodemographic characteristics, measures of personal and social vulnerability, psychological distress, functional disabilities and help-seeking behaviours.
Results:  Participants with coexisting disorders were more likely to be male, report a history of severe childhood assault and had higher levels of neuroticism, psychological distress and help-seeking behaviour.
Conclusions:  The findings suggest the role of early developmental factors on the complexity and severity of adult mental illness in a rural setting and the significant clinical consequences of comorbidity.     

A framework for systematically improving occupational therapy expert opinions on work capacity

Aim:  To present an evidence-based framework to improve the quality of occupational therapy expert opinions on work capacity for litigation, compensation and insurance purposes.
Methods:  Grounded theory methodology was used to collect and analyse data from a sample of 31 participants, comprising 19 occupational therapists, 6 medical specialists and 6 lawyers. A focused semistructured interview was completed with each participant. In addition, 20 participants verified the key findings.
Results:  The framework is contextualised within a medicolegal system requiring increasing expertise. The framework consists of (i) broad professional development strategies and principles, and (ii) specific strategies and principles for improving opinions through reporting and assessment practices.
Conclusions:  The synthesis of the participants' recommendations provides systematic guidelines for improving occupational therapy expert opinion on work capacity.     

What older people do: Time use and exploring the link between role participation and life satisfaction in people aged 65 years and over

Objectives:  Data on time use and role participation can provide rich information that can help occupational therapists better understand older people's lives. This study aimed to (i) describe the time use and role participation of community-dwelling people aged 65 years and older, (ii) analyse whether time use and role participation changed with increasing age, and (iii) determine if there is a link between maintenance of role participation and life satisfaction in older age.
Methods:  Using a cross-sectional design, interviews including the Activity Configuration, Role Checklist and Life Satisfaction Index-Z were used to collect data on 195 participants (mean age 75 years, 58.5% female).
Results:  Participants spent most of their time on sleep (8.4 h/day), solitary leisure (4.5 h/day), instrumental activities of daily living (3.1 h/day), social leisure (2.7 h/day) and basic activities of daily living (2.6 h/day). The most common roles were friend (96.4%), family member (95.4%) and home maintainer (87.2%). Participants aged 75 years and older spent significantly more time on solitary leisure and less time on paid work and transport compared to those aged 65–74 years. Role maintenance was significantly related to greater life satisfaction in participants aged 75–84 years.
Conclusion:  Older people's occupations and roles are diverse, and increasing age does not appear to reduce occupational or role engagement. The value of roles is not always reflected in the amount of time devoted to them and facilitating continued participation in valued roles may be important for older people's life satisfaction.