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.     

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.     

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.     

Experience of spirituality, mental illness and occupation: A life-sustaining phenomenon

Background and Aim:  This article provides an overview of a phenomenological investigation of spirituality with six people who have experienced mental illness. The study aimed to gain a greater understanding of the phenomenon of spirituality and its relationships to occupation and the experience of mental illness.
Methods and Results:  Participants were interviewed and the interviews were audiotaped and transcribed verbatim. Findings emerged through multiple readings and gradually constructed meanings from the data. Spirituality was found to be: unique to each participant, a journey through life, vitally important to participants, manifested as 'spiritual occupations', the foundation of meaningful doing, important socially as well as individually, and was found to support participants in coping with mental illness. This article focuses on the 'meta', integrative theme of spirituality as life sustaining. It concludes with the notion that spirituality is essential to the participants and is a significant aspect of their occupational behaviour.
Conclusion:  It is recommended that occupational therapists give themselves a 'licence' to discuss spirituality in practice and that they commit to learning more about how spirituality is a part of the lives of their clients.     

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.     

Evaluation of an employment program for people with mental illness using the Supported Employment Fidelity Scale

Background: The Individual Placement and Support (IPS) model aims to achieve open employment for people with mental illness. The Supported Employment Fidelity Scale (SEFS) is a 15-item instrument that evaluates the extent to which a service follows the IPS principles of best practice. This paper describes the IPS model and an evaluation of a specialist employment program for people with mental illness using the SEFS.
Methods: The SEFS enabled a quantitative assessment of service provision against the criteria of evidence-based practice principles. Data were collected from multiple sources. In addition, a literature review was conducted, and personnel engaged in implementation of the IPS model at other Australian employment programs were consulted.
Results: The program achieved a score of 59 of a possible 75 on the SEFS, which is described as fair supported employment.
Discussion: Analysis of the 15-scale items resulted in the identification of strengths, areas for further development, and a set of recommendations.
Conclusions: The program was operating substantially in line with evidence-based practice principles and had considerable scope for further development. Issues arising from the evaluation, areas of applicability of the SEFS and the underlying literature, and implications for occupational therapy are highlighted.     

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.     

Motivations of Persons with Psychiatric Disabilities to Work in Mental Health Peer Services: A Qualitative Study Using Self-Determination Theory

Introduction Individuals with psychiatric disabilities have low rates of employment and occupational rehabilitation success. Mental health peer services are a new occupational modality that opened a promising occupational path: persons with serious mental illnesses employed to provide support to others with psychiatric conditions. However challenges to successful peer work exist. Work motivation is central to understanding and supporting peer workers, yet little is known about sources of motivation to work as mental health peer providers. The aim of this study was to identify what drives individuals to mental health peer work using self determination theory (SDT). Methods Motivations of 31 mental health peer workers were explored as part of a larger study. A theory driven approach was employed to emerging qualitative data using SDT concepts: external motivation and internally regulated motivations derived from basic needs (autonomy, competence, relatedness). Results External motivations included generic occupational goals and getting away from negative work experiences. Internal motivations corresponded with SDT basic needs: autonomy met-needs was reflected in having freedom to disclose and finding that work accords with personal values; competence met-needs was reflected in using personal experience as a resource to help others; and relatedness met-needs were reflected in having opportunity to connect intimately and reciprocate with consumers. Conclusion This study identified external and internal motivations of persons with psychiatric disabilities to work as peer providers—a novel occupation in mental health. Employing personal experience and enabling peer contact emerge as major motivational tenets of mental health peer work. According to SDT instrumental occupational goals are considered more external than satisfaction of basic psychological needs. The study demonstrates the applicability of SDT in the design of autonomy supported environments to promote work engagement and sustenance of mental health peer providers.     

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.     

Increasing the occupational therapy mental health workforce through innovative practice education: A pilot project

Aim:  This paper describes the evaluation of a pilot trial of two innovative placement models in the area of mental health, namely role emerging and collaborative supervision. The Queensland Occupational Therapy Fieldwork Collaborative conducted this trial in response to workforce shortages in mental health.
Method:  Six occupational therapy students and eight practice educators were surveyed pre- and post-placements regarding implementation of these innovative models.
Results:  Students participating in these placements reported that they were highly likely to work in mental health upon graduation, and practice educators were positive about undertaking innovative placements in future. An overview of the placement sites, trials, outcomes and limitations of this pilot trial is provided.
Conclusion:  Though limited by its small sample size, this pilot trial has demonstrated the potential of innovative placement models to provide valuable student learning experiences in mental health. The profession needs to develop expertise in the use of innovative placement models if students are to be adequately prepared to work with the mental health issues of the Australian community now and in the future.     

Profile of cognitive problems in schizophrenia and implications for vocational functioning

Aim:  This literature review attempts to profile specific areas of cognition that have shown unique and consistent evidence of dysfunction among people with schizophrenia. In addition, their impact on vocational functioning is illustrated, so as to highlight the importance of managing these cognitive difficulties in vocational rehabilitation.
Methods:  Literature search was carried out on seven key cognitive domains identified by the National Institute of Mental Health in the USA. Their impact on vocational function was also reviewed.
Results:  It is found that attention, declarative and working memory, reasoning, problem-solving and social cognition are areas of impairment that have great impact on vocational functioning. Attention and memory problems affect learning of new work tasks. Executive function is particularly crucial in determining supported and open employment outcomes, as executive dysfunction cannot be easily compensated. Lastly, social cognition plays a major role in determining the success of workplace social exchanges.
Conclusion:  Occupational therapists need to have a good understanding of the profile of cognitive problems among people with schizophrenia, in order to tailor our intervention according to their cognitive strengths and difficulties. Several cognitive remediation strategies and programs have been designed specifically for people with mental illness. Equipping ourselves with skills in conducting such programs will augment our expertise in vocational rehabilitation.     

Diversity in occupational therapy: Experiences of consumers who identify themselves as minority group members

Background/Aim:  The occupational therapy profession is in need of self-examination in view of the extent to which culturally constructed meanings of occupation guide its work within an increasingly diverse practice environment.
Methods:  Semistructured interviews were completed with 14 individuals who defined themselves as minority group members in order to gain an understanding of their experience of the occupational therapy process.
Results:  Five themes emerged: the importance of social location, the need for safety and acceptance, avoiding omissions, understanding differences in occupation, and the face of discrimination.
Conclusions:  Cultural and sexual identities influence occupational choices and interface with the social location of the therapist to influence the therapeutic process. Despite holistic and client-centred values, the comprehensive nature of occupational therapy is not experienced by clients of minority groups. Practice models are needed that provide directives for the establishment of alliances with minority clients and that highlight the significance of exploring occupational choices, experiences of oppression and the impact of the therapists' culture on the therapeutic process.     

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.     

Distress among rural residents: Does employment and occupation make a difference?

Objective:  This study investigates the relationship between levels of mental health and well-being (in terms of self-reported levels of distress) with employment and occupational status of rural residents, to better inform the provision of mental health services to those in greatest need in rural communities.
Method:  A stratified random sample of community residents in rural and remote New South Wales with over-sampling of remote areas as first stage of a cohort study. Psychological distress was measured using Kessler-10, inclusive of additional items addressing functional impairment (days out of role). Occupational data were classified using Australian and New Zealand Standard Classification of Occupations categories.
Results:  A total of 2639 adults participated in this baseline phase. Among them, 57% were in paid employment, 30% had retired from the workforce, 6% were permanently unable to work and 2% were unemployed. The highest levels of distress and functional impairment were reported in those permanently unable to work and the unemployed group with rates of 'caseness' (likely mental health disorder) varying from 57% to 69%, compared with 34% of farmers and farm managers and 29% of health workers ( P <  0.01).
Conclusion:  The rural unemployed suffer considerable psychological distress and 'disability', yet they are not the target of specific mental health promotion and prevention programs, which are often occasioned by rural adversity, such as drought, and delivered through work-based pathways. Policy-makers and health service providers need to consider the needs of the rural unemployed and those permanently unable to work and how they might be addressed.     

Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Objective:  The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice.
Design:  Self-report questionnaires and semistructured in-depth telephone interviews.
Participants:  Graduates ( n =  15) from the first cohort of occupational therapists from James Cook University, Queensland.
Main outcome measure:  The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice.
Results:  Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice.
Conclusions:  Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements.     

Musculoskeletal disorders and comorbid depression: implications for practice

Background:  The physical demands of work have a substantial impact on the incidence of work-related musculoskeletal disorders. Depression is often associated with work-related injuries and may influence a person's success or otherwise return to work. There is pressure for occupational rehabilitation providers to produce good return-to-work outcomes in a timely and financially responsible manner. The aim was to examine current evidence for any added impact of depression on return-to-work prospects among people with work-related musculoskeletal disorders.
Methods:  A review of the literature was conducted to determine the extent to which depression comorbid with musculoskeletal disorders affected labour force participation and the outcomes obtained in occupational rehabilitation.
Results:  Australian population level data show that people of working age with depression comorbid with musculoskeletal disorders have extensive labour force disadvantage and reduced return-to-work outcomes when participating in occupational rehabilitation.
Conclusions:  Although more research is needed, there is already sufficient evidence to support the introduction of systems and practices to detect and integrate treatment for comorbid depression in order to prevent occupational rehabilitation failure.     

Generational attitudes of rural mental health nurses

Objective:  To determine how attitudes of rural mental health nurses differ across generations.
Design:  Survey.
Setting:  Mental health services in rural New South Wales.
Participants:  Practising mental health nurses.
Main outcome measures:  Survey responses.
Results:  Survey response rate 44%. A total of 89 mental health nurses, clustered in inpatient units and community health centres, responded. Of these nurses, 4 were veterans, 52 baby boomers, 17 Generation X and 5 Generation Y.
Conclusions:  There are significant differences in how mental health nurses from different generations view their work, and in what is expected from managers. Managers need to modify traditional working styles, allowing greater flexibility of employment. They must also accept lower staff retention rates, and facilitate the development of younger staff.     

The contributions of persons in the work environment to the self‐identity of persons with mental health problems: a study in Israel

This study explores the contribution of others in the workplace to the self‐identity and job integration of persons with severe mental health problems. Thematic content analysis of in‐depth, semi‐structured interviews conducted in 2009 with 15 Israelis with severe mental health problems who work in a variety of frameworks (protected and supported employment and open market) revealed three main themes: (i) dissatisfaction with the protected work settings in which they were initially employed; (ii) the importance they attributed to their relationships with others in their workplace; and (iii) the change in self‐identity they underwent from persons defined by their mental health problems to persons who had worth, abilities and being beyond their illness. The findings underscore the important role of managers and colleagues in integrating persons with mental health problems at work and in strengthening the self‐identity of those individuals.