Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice

ABSTRACT

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Abstract

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.     

Japanese occupational therapy in community mental health and telehealth

Help for people with mental health problems in Japan has traditionally centred on inpatient medical care. In a revision of the Mental Health Welfare Law planned for 2001, responsibility for the support of people with mental health problems will be transferred from central government to local government. Furthermore, local government will, in turn, delegate administrative tasks to a 'community life support centre'. We believe that such a centre could be linked to a university with a telehealth network. Connection to the network could benefit people with mental health problems living at home. We also believe that occupational therapists are ideally positioned to play a significant role in community life support centres. With the expected sustained growth in Japanese occupational therapy, it could become a key profession in the rehabilitation of people with mental health problems.     

Creative arts in occupational therapy: ancient history or contemporary practise?

This paper is primarily concerned with the use of creative arts by occupational therapists in adult mental health rehabilitation. A review of relevant literature within and beyond occupational therapy suggests that creative arts have therapeutic value. The first section considers the more traditional, psychodynamic framework for creative arts in mental health. This underpinned much therapeutic creative art work between the 1960s and 1980s. The second section draws on a broader, more eclectic framework of theorising and research. This offers a rationale for the use of creative arts in their own therapeutic right. It is hoped that this will stimulate thinking among occupational therapists about retaining and promoting creative arts within their practice. Copyright © 1998 Whurr Publishers Ltd.     

Exploring Arising Moments and Mindfulness in Occupational Therapists Working in Diverse Clinical Practice Areas

ABSTRACT

An online survey was conducted with 72 Canadian occupational therapists to (1) explore if and how occupational therapists were aware of “arising moments” in clinical practice, which are moments that give rise to emotions, sensations, and thoughts, and (2) to examine therapists’ responses to questions related to mindfulness. Participants described arising moments through an open-ended survey question. Framework analysis was used to develop key themes and subthemes. A modified Philadelphia Mindfulness Awareness (PHLMS) subscale with two additional survey questions “understanding of living in the moment and being present, and awareness of mindfulness” (sum = PAM) were used as indicators of mindfulness. There were significant differences in the means of PHLMS mindfulness among therapists working in diverse practice areas (F = 3.63, p = .009). Posthoc analysis revealed that therapists working in mental health had higher mean PHLMS-mindfulness scores than in all other groups. There were no significant differences in PAM mindfulness among the practice areas (ANOVA, F = 2.15, p = .08). However, posthoc tests showed that the participants in the mental health practice area had a significant difference with one group, general physical health. Findings have implications for practice in occupational therapy and education about mindfulness in occupational therapy.     

Perceptions of occupational therapists practising in rural Australia: A graduate perspective

Background:  The difficulty in recruiting and retaining health professionals into rural and remote areas of Australia is well recognised. This study explored the perceptions of occupational therapists practising in rural locations regarding the essential skills necessary for rural practice and the ability of undergraduate education to prepare them for rural practice.
Methods:  A qualitative study using a phenomenological approach was conducted using semistructured in-depth interviews. Participants included occupational therapists who were graduates of James Cook University, who were practising in rural areas in Queensland and Victoria, and academic staff.
Results:  This study demonstrates that it is important for universities to develop both a mindset in their graduates for rural practice, as well as developing broader skills in addition to core discipline-specific skills. While subjects developing core occupational therapy skills are at the centre of undergraduate education, the importance of developing a broader understanding of rural health issues and skills in public health, primary health care and health promotion was emphasised.
Conclusion:  The development of specific skills to become competent rural practitioners and to cope with the challenges of rural practice can be strengthened through initiatives at the undergraduate level. Ongoing commitment from all universities across Australia to include rural curriculum content has the potential to improve recruitment and retention of occupational therapists and other health professionals into rural Australia.     

Clinical reasoning and the occupational therapy curriculum

Several reasoning styles are used by occupational therapists when they evaluate clients' problems. This study investigated the influence of the occupational therapy curriculum in Hong Kong on therapists' clinical reasoning styles. Two groups of therapists with different clinical experience were recruited. Through interviews with the therapists after identifying clients' problems using the Canadian Occupational Performance Measure, their clinical reasoning styles were explored. The local occupational therapy curriculum was analysed to isolate the components that influence clinical reasoning. Results showed that more experienced therapists use conditional reasoning that considers clients' needs in their future lives whereas junior therapists use procedural reasoning that focuses on clients' disabilities. The analysis of the occupational therapy curriculum indicated that it prepared the students with an equal emphasis on theoretical and clinical subjects and fieldwork practice. The present curriculum was useful in providing educational preparation for novice therapists. However, the period of fieldwork practice can be lengthened to allow adequate maturation of clinical reasoning skills. Problem‐based learning can be incorporated to facilitate students' problem‐solving and self‐directed learning skills. Copyright © 2000 Whurr Publishers Ltd.     

The Australian Health Care Agreement 1998–2003: Implications and strategic directions for occupational therapists

Funding for public health services in Australia is provided to the States and Territories from the Commonwealth. Contractual obligations for how these monies are allocated are detailed in the Australian Health Care Agreement 1998 –2003, which has replaced the Medicare Agreement 1993–1998. Key issues identified in the new Agreement, which will impact on occupational therapy services, include arrangements for mental health services, palliative care initiatives, casemix, health system reform, and private health insurance. Particular implications stem from the proposed reforms to the health system. These include the quality agenda, outcome-based funding and evidence-based practice. Other themes identified include future opportunities for occupational therapists working in health services and the imperative to form collaborative partnerships with consumers and other health care providers. The Australian Health Care Agreement is analysed and suggestions given for strategic directions for occupational therapists to consider.     

Developing and Implementing a Senior Community Based Fall Prevention and Home Safety Program

Occupational therapists are primary candidates in taking a proactive role in meeting the community dwelling senior citizen's safety, environmental, and cognitive needs through the development of community based programs in conjunction with aging organizations. The purpose of this paper is to provide recommendations to occupational therapists in developing, implementing, and marketing a senior community based fall prevention and home safety program in conjunction with a Council on Aging and occupational therapy outpatient private practice.     

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.     

The influence of fieldwork on the preferred future practice areas of final year occupational therapy students

The student fieldwork experience has been recognised as an important influence on the areas of occupational therapy practice pursued by clinicians after graduation. The recruitment patterns of graduate occupational therapists is a key issue, especially in clinical areas such as rural practice and mental health. This study aimed to investigate the future practice preferences of 50 final year occupational therapy students from two occupational therapy schools in New South Wales, in relationship to their fieldwork experience, using a focus group and a survey. General physical dysfunction was the most popular area of future practice for this group. Results suggested that fieldwork influenced students through the programme content, the timing of placements, supervision, and students' personal responses to their experiences. The study also demonstrated that students use the fieldwork experience to guide their decision to enter an area of practice.     

A case against generalisation of mental health occupational therapy in Australia

Background/aim: In 2009, the World Federation of Occupational Therapists International Advisory Group on Mental Health conducted a global survey that yielded data on mental health occupational therapy practice. The Australian dataset reflected aspects of the current situation of the Australian mental health occupational therapy workforce. Of particular interest were resource availability, workforce recruitment and retention, and perception of the future of mental health occupational therapy. Methodology: Using a cross‐sectional survey design, quantitative and qualitative data were gathered electronically over a one‐month period. Manual analysis indicated themes common to mental health occupational therapists across a framework of professional areas. Results: Findings suggested that role blurring negatively affected workforce retention. Workforce recruitment and retention were complicated by resource shortages. Some Federal Government initiatives were perceived as only partially beneficial to the profession. Conclusions: Survey respondents believed that mental health occupational therapy was a potential growth area particularly where occupational therapy specific skills were retained.     

Application of occupational therapy in the treatment of depression

Depression as a major social and public health problem is a challenge for clinicians and occupational therapists throughout the world. This theoretical paper is based on a literature review and the author's experience as an occupational therapist in mental health in Finland, working with severely long-term depressed patients. The basic concepts of a cognitive–behavioural model are introduced and evaluated. The relationship of depression, mourning and suicide is discussed and a model for occupational therapy intervention acting.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.