The mental health treatment journey requires a collaborative effort by many people — the individual, his or her caregivers, support providers, doctors, nurses, teachers, aides, counselors, therapists, and social workers. This collaborative process allows everyone to work together to reach a specific goal: improving the individual’s quality and enjoyment of life by identifying and meeting appropriate behaviors and skills.
Occupational therapy often is misunderstood in this process. According to the American Occupational Therapy Association, the primary goal of occupational therapy is to support and enable each person’s “health and participation in life through engagement in occupation.”
“Occupation” does not solely mean work. Some examples of occupations include time spent on personal hygiene, preparing a meal, managing finances, painting a picture, attending a community leisure course, and socializing with others. Occupational therapists enhance people’s ability to live meaningful and satisfying lives.
The purpose of occupational therapy can best be described by the profession’s motto, “Occupational therapy: living life to its fullest.” All individuals have a right to live life to its fullest. An occupational therapist can help people consider not only their needs, strengths, abilities, and interests, but also their physical, social, and cultural environment.
Origins of Occupational Therapy
While many commonly think of occupational therapy as physical rehabilitation after injury or illness, it actually has roots in mental health.
Occupational therapy’s emergence can be found as far back as eighteenth-century Europe. At a time when mentally ill people were treated like prisoners, a “moral treatment movement” began to evolve. While the previous treatment model was associated with punishment, brutality and idleness, the moral treatment movement sought to encourage kindness and the therapeutic value of engagement in purposeful activities.
The first occupational therapy treatment model, called Habit Training, began at Johns Hopkins in the early twentieth century. This approach proposed that in mentally ill people, occupational activities such as work, rest and play had become unbalanced. Early occupational therapists introduced therapeutic occupations such as weaving, art, and bookbinding. These goal-directed activities were used to help individuals learn new skills to be productive, and derive therapeutic benefits of a balanced daily schedule.
The occupational therapy profession grew as wounded soldiers returned from World War II, and then surged again in the 1970s with the medical field’s increase in specialized skills and knowledge.
Occupational therapists always have believed in treating the whole person, whether the primary problem relates to physical or mental health. They practice in diverse settings, including hospitals, outpatient clinics, skilled nursing facilities, intermediate care facilities, home health, neonatal intensive care units, community programs and the workplace. Those who work in mental health can do so in residential hospitals, community-based mental health settings and outpatient private practice clinics.
Assessments and Treatments
When working with someone with a mental health condition, occupational therapists employ a variety of assessments. Once the necessary information has been obtained, the therapist creates a personalized occupational profile. This profile is used for goal-setting and treatment planning.
Common areas of assessment include:
- Activities of daily living (e.g., bathing, dressing, eating)
- Instrumental activities of daily living (e.g., driving, money management, shopping)
- Work (paid and volunteer)
- Social participation
- Motor processing skills
- Mental and cognitive processing skills
- Communication and interaction skills
- Habits, roles and routines
- Performance contexts (e.g., cultural, physical, spiritual)
- Activity demands
- Client factors (e.g., difficulties due to body structures or functions)
- Occupational self-assessment
For example, an occupational therapist may assess a client with schizophrenia who is living in a residential hospital in order to help to determine the best placement in the community. The assessment may include standardized evaluation tools, individual interview, and observation to determine ability to function and live alone safely, and identify important roles and occupations. This information is then used to determine the skills, supports, and environmental modifications the person may need to live as independently as possible.
Occupational therapy can be vitally important in the overall mental health treatment process. Following are some common interventions:
- Life skills training
- Cognitive rehabilitation
- Supported employment
- Supported education
- Social and interpersonal skills training
- Life balance intervention
- Modalities such as biofeedback and mindfulness-enhanced therapy
Part of Collaborative Process
As noted in the beginning of this article, occupational therapists collaborate with many other professionals to help individuals on their road to recovery. While the role of the occupational therapist may overlap with other team members, the occupational therapist provides a unique theoretical and clinical contribution to the recovery and treatment team; thus, occupational therapy should be considered a vital part of a comprehensive and integrated treatment program.