Editor's note: This text-based course is a transcript of the webinar, OT In Mental Health: Understanding The Role Of The Occupational Therapy Practitioner, presented by Cynthia Hoskins, DBH, MOT, OTR/L, CCTS-I.
*Please also use the handout with this text course to supplement the material.
Learning Outcomes
- As a result of this course, participants will be able to identify common mental health challenges and their impact on areas of occupation.
- As a result of this course, participants will be able to distinguish between a basic and a comprehensive assessment.
- As a result of this course, participants will be able to
- evaluate and apply evidence-based strategies to improve patient functional outcomes and recognize the first steps for the OTP’s role in addressing mental health.
Introduction
Good afternoon, everyone. No matter where you are in the world, good afternoon, good morning, or good evening. I want to start by thanking each of you for joining me today. Before we dive into our discussion, I would like to give you a moment to review this disclosure. I won’t be reading it aloud, but please take a minute to look it over, and then we’ll begin.
Addressing Mental Health in Occupational Therapy
I’m thrilled to bring today’s topic to you: mental health in occupational therapy. This is a subject that’s incredibly relevant as we move toward an integrated healthcare model. This model doesn’t just focus on physical disabilities or the traditional medical model but also incorporates behavioral health. It’s essential for us as OT practitioners to understand our role within this framework and recognize what we can contribute to the care of individuals facing mental health challenges and mental illnesses.
By the time we finish today, my goal is for you to walk away with a clearer understanding of several key areas. First, you’ll gain insight into some of the mental health challenges and disorders that may surface in the clinical setting and impact daily functioning and occupational performance. Secondly, I want you to be able to differentiate between basic and comprehensive assessments. A basic assessment may only skim the surface, whereas a comprehensive one includes all the necessary components, digging deeper into the full scope of the client’s needs.
I will also provide you with some tools and strategies—though we won’t delve into each tool in great detail, as that would require a session of its own. The idea is to equip you with some foundational tools that you can include in your clinical toolbox. Furthermore, I will share a list of evidence-based strategies that you can apply across various clinical settings to address the mental health challenges your clients may face. These strategies are not exhaustive, but they will give you a strong starting point.
Lastly, I want to make sure you leave here with a solid understanding of the first steps we, as OT practitioners, can take to engage with and address mental health challenges in our practice.
Perceptions of Mental Health
Now, let’s start with a question. I’d like you to drop your answer in the chat. What is your current perception of mental health? When someone mentions the term “mental health,” whether as a practitioner or in general, what thoughts come to mind?
I see responses like depression, lack of support, lack of funding, and overwhelming systems. Others mention limited resources, lack of awareness, substance abuse, and trauma. These are all incredibly valid points, and they highlight the fact that mental health is a vast, complex issue with many layers and challenges.
What this tells me is that there’s a particular mindset we need to adopt as practitioners. We need to focus on reconnecting occupational therapy with mental health, recognizing that mental health challenges are pervasive and that they often lie within our scope of practice. Our role as OT practitioners is not limited to addressing physical limitations but extends to addressing emotional, psychological, and social challenges as well.
Self-Awareness in Mental Health Practice
Let’s dive a little deeper into this idea of self-awareness. Why do you think self-awareness is important when working with clients who face mental health challenges? I’d love to hear your thoughts in the chat.
I see some great responses: therapists can be triggered, maintaining boundaries, avoiding bias, seeing each person as an individual, staying client-centered. Absolutely. These are all critical reasons why self-awareness matters. I’ve learned from my experience working in specialized mental health settings that our therapeutic use of self can significantly influence how a client responds to us. It’s essential to know where we are mentally and emotionally so that we can provide the best possible care and avoid unintentionally bringing our own challenges into the therapeutic space.
The Scope and Impact of Mental Health Challenges
Here are some staggering statistics that highlight the scope of the mental health crisis: one in five adults in the U.S. lives with a mental illness. People with chronic physical conditions are more likely to experience mental illness. Those with mental illness also tend to die, on average, 25 years sooner than those without. And perhaps most alarming, over half of adults with mental health conditions never seek treatment.
Given these statistics, it’s almost certain that we, as occupational therapy practitioners, will encounter clients facing mental health challenges—whether or not they have sought out specialized mental health care. It could be a youth struggling with behavioral challenges, an adult dealing with anxiety and depression, or someone grappling with the effects of trauma.
OT's Historical and Current Role in Mental Health
As many of you know, occupational therapy has deep roots in mental health. Our profession began during World War I, where we worked as reconstruction aides, helping individuals rebuild their lives after the war. We were at the forefront of the humanistic movement, advocating for treating people with dignity and respect and shifting care from asylums to community-based settings.
Today, occupational therapy practitioners work across a wide range of settings—pediatric, school-based, home health, acute care, inpatient psychiatry, and community settings, to name a few. We are uniquely positioned to address mental health challenges across the continuum of care. Whether you’re working in acute care or home health, we must take a whole-person approach, recognizing that emotional and mental health challenges are just as important as physical limitations when it comes to functional outcomes.
Mental Health and Behavioral Health: Clarifying the Language
It’s also important to distinguish between mental health and behavioral health. Mental health refers to emotional and cognitive well-being, while behavioral health focuses on specific behaviors and habits that impact our environment. As occupational therapy practitioners, we need to address both. Understanding the nuances in language helps us better identify and address the needs of our clients.
Recognizing Mental Health Challenges and Mental Illnesses
There’s a spectrum of mental health challenges that clients might face. These could range from an unexpected move or the loss of a loved one to a new diagnosis or injury. While these may not always lead to a diagnosable mental illness, they can still significantly impact a person’s mental health. At the other end of the spectrum, we have clinical mental illnesses such as depression, bipolar disorder, PTSD, and schizophrenia. It’s important to recognize that mental health challenges, if left unchecked, can evolve into more severe conditions.
Clinical Presentation and Areas of Occupation
As OT practitioners, we need to be attuned to the clinical signs of mental health challenges—whether it’s a client isolating themselves, showing emotional lability, experiencing poor judgment, or displaying impulsive behaviors. These signs could be indicative of deeper issues that are impacting their daily functioning.
We also need to recognize how mental health challenges affect areas of occupation, including ADLs and IADLs, sleep, socialization, work, and leisure. A comprehensive assessment will help us identify these areas and determine where intervention is needed.
Establishing the OT Practitioner’s Approach
When beginning the assessment process, we start by thoroughly reviewing the occupational profile and background of our clients. Observational skills are critical here, as clients may not always openly share that they’re struggling with anxiety, depression, or a history of trauma. We must create a safe environment, ask for permission before delving into sensitive topics, and actively listen to our clients.
Once the initial assessment is complete, we move on to a more comprehensive approach. This includes formal assessments, screenings, and a thorough exploration of the client’s history. It’s essential to identify the areas of occupation that are impacted by their mental health challenges and collaborate with the client to set personal, meaningful goals for their recovery.
Basic vs. Comprehensive Assessments
When distinguishing between a basic and comprehensive approach, the basic approach tends to focus on surface-level issues, often only addressing physical limitations and basic cognitive skills. In contrast, a comprehensive approach digs deeper, considering the client’s emotional and mental health, executive functioning, and broader context, such as their cultural background and support systems.
For example, if you’re working with a client who is emotionally dysregulated, it’s crucial to understand the root cause. This might require looking beyond their current symptoms to explore their psychosocial history, family dynamics, or even their experience with trauma.
Evidence-Based Strategies and Interventions
Occupational therapy practiitioners can apply a variety of evidence-based strategies to improve outcomes for clients with mental health challenges. These might include group therapy, psychoeducation, vocational skills training, mindfulness, and expressive arts. We can also teach clients coping strategies, emotional regulation techniques, and grounding activities to help them manage their symptoms more effectively.
Each of these interventions plays a role in improving the quality of life for our clients, promoting mental, emotional, behavioral, environmental, physical, and spiritual health.
Conclusion: Key Takeaways and Final Thoughts
As occupational therapy practitioners, we have a crucial role to play in the functional outcomes of clients with mental health challenges. Our work extends beyond addressing physical impairments to include the emotional and mental health of our clients. We must incorporate this into our practice across all settings—whether we’re working in home health, acute care, or community settings.
Our goal is to promote health and well-being, prevent further decline, and support our clients in their recovery journey. To do this effectively, we must maintain a client-centered approach, recognizing that each individual’s needs and experiences are unique.
As we conclude, I want to leave you with this quote that resonates deeply with the essence of our profession: “Do what you can with what you have, where you are.” As occupational therapy practitioners, we excel at meeting people where they are, utilizing their strengths, and working with the resources available to help them achieve their goals.
Exam Poll
1)How many adults live with mental illness in the US?
Most people got B, one in five; that is correct. One in five adults in the US deal with some type of mental illness. Those are some staggering statistics that we need to keep in mind.
2)A common mental illness impacting functioning is...
It's C, both A and B. Both anxiety and depression are the two most common mental illnesses that impact millions of people.
3)What is an example of a mental health challenge?
It is D, all of the above. All of these are stressors.
4)All of the following are components of a comprehensive assessment EXCEPT:
All of the following are components of a comprehensive assessment, except C.
5)What is included in the first steps of assessment for the OTP?
It's all of the above. I always start with the interview and the occupational therapy profile. Active listening is key—I can't stress that enough. I administer any necessary screening tools, but one of the reasons I prioritize the interview is that it gives me direction on which assessments or screening tools to use. Once I've gathered that information, I choose the most relevant assessments, focusing on the areas of occupation and other domains that are impacted. It's all about considering the specific needs during the interview and then using that insight to guide the assessment process.
Thank you for your attention today, and I look forward to answering any questions you may have.
Questions and Answers
Has you heard of the Clubhouse International model of community mental health resources?
Yes, I have heard of the Clubhouse International model. It is a community of individuals who have struggled with the same mental illness, and they work together in a supportive environment to improve their outcomes. If you would like more details, feel free to email me, and I can provide additional information.
What should be treated first, emotional disturbances or psychological issues alongside OT interventions?
My suggestion would be to address both at the same time. You often don’t know which one is driving the other—emotional or psychological disturbances can impact physical limitations, and vice versa. A whole-person approach is best to ensure that all aspects are being treated simultaneously rather than prioritizing one over the other.
How have you seen the field of mental health and occupational therapy change over time?
I’ve seen significant changes over my 30 years of practice. The focus used to be more on the medical model, which caused us to lose ground in mental health. However, I believe we are now moving in the right direction. In Texas, for example, there is greater recognition of mental health as a pervasive issue, and occupational therapy practitioners are increasingly seen as having a crucial role in addressing it. We are beginning to circle back to our roots, where mental health was a central focus of our practice.
What do you think are the pros and cons of the current direction in occupational therapy and mental health?
The pros are that we are finally recognizing the importance of mental health and incorporating it back into occupational therapy practice, which aligns with our origins. The con is that we lost a lot of ground over the years by focusing too much on the medical model. But overall, we are headed in the right direction by reengaging with mental health.
What is your advice for OT practitioners engaging in mental health practice today?
My advice is to take a whole-person approach, addressing both the physical and emotional aspects of a client’s well-being simultaneously. We need to reconnect with the roots of occupational therapy, where mental health was a primary focus. It's essential to remember that we have a significant role in this area, and we must continue to move forward in addressing mental health within our therapeutic process.
References
Link to the references.
Citation
Hoskins, C. (2024). OT in mental health: Understanding the role of the occupational therapy practitioner. OccupationalTherapy.com, Article 5734. Available at www.occupationaltherapy.com
