When I first became an occupational therapist, friends, family members, and patients asked me questions to construct their understanding of occupational therapy. Do you help people get jobs? Sometimes. Is OT like PT, but for the waist up? Some OTs work in upper extremity rehabilitation, but we’re not PTs for the waist up. So you just help people with ADLs, right? We do help people with activities of daily living (e.g., basic self-care skills like bathing, dressing, toileting, and grooming), but that is not all.
Occupational therapy is a health profession grounded in science that helps people do the things that they want and need to do in life. Occupational therapy practitioners are trained to examine the fit between the person, the environment, and the occupations (or daily activities) that are necessary or meaningful to them. We then work systematically to reduce or eliminate any mismatches between those 3 elements. We provide direct intervention to address person factors (e.g., strength, range of motion, executive functions, coordination, sensory perception, balance), teach skills or remediate skill deficits (i.e., motor skills, process skills, and communication and interaction skills), develop or refine performance patters (e.g., habits and routines), and adapt environments and tasks so that our clients experience greater success with performance and participation.
Occupational therapy practitioners maintain a holistic perspective regardless of their practice setting. It goes against our shared professional values to reduce our work to simply “treating a wrist” or “working on dressing” because our practice emphasizes the occupational nature of humans and the importance of occupational identity. Put simply, occupational therapists see people first and in terms of the activities that they do or don’t do on a daily basis and the reasons why they do or don’t do these things in the first place. We associate health with a person’s ability to engage in the occupations that they find meaningful and we are concerned with issues of occupational balance and occupational justice.
When concepts like occupational identity and occupational balance come into focus, then the scope of occupational therapy becomes clearer. Yet, it can still be difficult for some people to picture how occupational therapy adds value to mental health services.
Individuals with serious mental illness often struggle with engaging in the daily activities that they want and need to do to take care of their health, their families, and their material needs. Because of their mental illness, they may fall into performance patterns (or habits and routines) that don’t support their engagement in these activities. When this happens over a long period of time, the characteristics that make a person who they are (e.g., a caring father, a great baker, a hard worker, a supportive friend) start to get stripped away because the individual no longer engages, or feels capable of engaging, in the occupations associated with their valued roles.
Occupational therapists work with individuals with serious mental illness so that they can gain or regain and maintain function in their everyday lives. What makes OT different that other qualified mental health providers?
1. We like less talking and more doing. OTs use occupation-based interventions. Occupation-based interventions designed around the real life activities that people want and need to do. We receive some basic training in the psychosocial interventions used by other professionals (e.g., cognitive-behavioral therapy), but our real focus is to get people engaged in occupations. We may start with occupations that are novel or “low stakes” for our clients in order to build confidence, but we are always working towards engagement in those occupations that are associated with the person’s identity. Here are some of the areas we might address with clients: Bathing, dressing, grooming, childcare, cleaning, communication skills, community living skills, community mobility, cooking, driving, gardening, grocery shopping, grooming, home management, home repair, home safety, household management, hygiene, independent living skills, ironing, laundry, leisure, life skills, meal planning, meal preparation, medication adherence, medication compliance, medication, management, sleep, self-care, shopping, social functioning, social networking, social participation, technology use, time management, and transportation.
2. We want out of the office. OTs would rather see people in their authentic natural environments (i.e., kitchen, bathroom, workplace, grocery store, bus) than in any other setting. We are always trying to systematically reduce or eliminate any mismatches between the person, the environment, and the occupation. We work with clients to problem solve ways that they can adapt to unexpected situations and apply new skills in authentic contexts.
3. We are focused on time. OTs believe that time-use is associated with occupational balance and imbalance so how people structure their hours and days is of great interest to us. Imbalance, particularly in the severe mental illness population, can point to decreased health and well-being. We study our clients’ performance patterns, help teams to identify the onset of prodromal symptoms, and assist clients in studying their own time-use patterns so they may anticipate when they might begin backsliding. We also help our clients to develop more supportive habits and routines by modifying environments, making recommendations for schedules, and identifying tasks that can be simplified.
Occupational therapists aren’t a substitute for clinical mental health counselors, psychologists, or social workers, but we can add value and a different perspective to mental health teams.