Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments that develop, recover, or maintain clients’ activities of daily living. The therapist helps clients not only to improve their basic motor functions and reasoning abilities, but also to compensate for permanent loss of function. The goal of occupational therapy is to help clients have independent, productive, and satisfying lives.
The World Federation of Occupational Therapists provides the following definition of Occupational Therapy: “Occupational therapy is as a profession concerned with promoting health and well being through engagement in occupation.” Occupational therapists use careful analysis of physical, environmental, psychosocial, mental, spiritual, political and cultural factors to identify barriers to occupation. Occupational therapy draws from the fields ofpsychology, sociology, anthropology, and many other disciplines in developing its knowledge base.
Occupational therapy processAn Occupational Therapist works systematically through a sequence of actions known as the occupational therapy process. There are several versions of this process as described by numerous writers. Creek has sought to provide a comprehensive version based on extensive research. This version has 11 stages, which for the experienced therapist may not be linear in nature. The stages are:
Areas of practice in occupational therapyThe role of Occupational Therapy allows OT’s to work in many different settings, work with many different populations and acquire many different specialties. This broad spectrum of practice lends itself to difficulty categorizing the areas of practice that exist, especially considering the many countries and different healthcare systems. In this section, the categorization from the American Occupational Therapy Association is used. However, there are other ways to categorize areas of practice in OT, such as physical, mental, and community practice (AOTA, 2009). These divisions occur when the setting is defined by the population it serves. For example, acute physical or mental health settings (e.g.: hospitals), sub-acute settings (e.g.: aged care facilities), outpatient clinics and community settings.
In each area of practice below, an OT can work with different populations, diagnosis, specialities, and in different settings.
Occupational therapy during WWI: bedridden wounded are knitting.
According to the American Occupational Therapy Association (AOTA), occupational therapists work with the Mental Health population throughout the life span and across many treatment settings where mental health services and psychiatric rehabilitation are provided (AOTA, 2009). Just as with other clients, the OT facilitates maximum independence in activities of daily living (dressing, grooming, etc.) and instrumental activities of daily living (medication management, grocery shopping, etc.). According to the American Occupational Therapy Association, OT improves functional capacity and quality of life for people with mental illness in the areas of employment, education, community living, and home and personal care through the use of real life activities in therapy treatments (AOTA, 2005).
Geriatric, Adult, Adolescents, and Children with any kind of mental illness or mental health issues. These conditions include but are not limited to: Schizophrenia, substance abuse, addiction, dementia, Alzheimer’s, mood disorders, personality disorders, psychoses, eating disorders, anxiety disorders (including post-traumatic stress disorder, separation anxiety disorder) (Cara & MacRae, 2005), and reactive attachment disorder (children only) (Lambert, 2005).
Typical issues that are addressed are as follows: Helping people acquire the skills to care for themselves or others including; keeping a schedule, medication management, employment, education, increasing community participation, community access (grocery store, library, bank, etc.), money management skills, engaging in productive activities to fill the day, coping skills, routine building, building social skills, and childcare (Cara & MacRae, 2005).
In the UK, the College of Occupational Therapists (COT) have published Recovering Ordinary Lives, which details the strategy for OTs in mental health up to 2017, and makes explicit the goals that have been set for the profession, in line with government directives (COT 2006).
Areas that Mental Health OT’s could work in are as follows:
Services typically include:
Theoretical FrameworksOccupational Therapists use a number of theoretical frameworks to frame their practice. Note that terminology has differed between scholars. Theoretical bases for framing a human and their occupation being include the following:
Frames of Reference/Generic modelsFrames of reference or generic models are the overarching title given to a collation of compatible knowledge, research and theories that form conceptual practice. More generally they can be defined as “those aspects which influence our perceptions, decisions and practice”.
Occupational Therapy Frame of References/Models:
Recent literature has also called for occupational therapy to address the political nature of who occupational therapists are and what they do (Kronenberg & Pollard, 2005). Profession specific models of occupational therapy have also been critiqued for being biased towards a western, ableist and generally unrepresentative of the most occupationally deprived groups
Occupational therapy and ICFThe International Classification of Functioning, Disability and Health (ICF) is a framework to measure health and ability by illustrating how these components impact one’s function. This relates very closely to the Occupational Therapy Practice Framework as it is stated, “The profession’s core beliefs are in the positive relationship between occupation and health and its view of people as occupational beings”. The ICF is also built into the 2nd edition of the practice framework. Activities and participation examples from the ICF overlap Areas of Occupation, Performance Skills, and Performance Patterns in the framework. The ICF also includes contextual factors (environmental and personal factors) that relate to the context in the framework. In addition, body functions and structures classified within the ICF help describe the client factors as described in the OT framework
Further exploration of the relationship between occupational therapy and the components of the ICIDH-2 (revision of the original International Classification of Impairments, Disabilities, and Handicaps (ICIDH); later becoming the ICF) was conducted by McLaughlin Gray. First, the ICF is an international framework and provides an opportunity for the occupational therapy field to become better known across the globe. Second, the ICF provides occupational therapists with a global language to describe their expertise to the larger international health care community. The ICF uses a positive, holistic language emphasizing skills, capacities, and strengths of an individual rather than focusing on one’s deficits and disabilities. This is similar to the outlook of occupational therapists. Third, the ICF includes environmental and personal contextual factors which are incorporated into the theory behind occupational therapy. It is important to take into consideration an individual’s personal, environmental, and occupational factors to develop an effective intervention. The last notable application of the ICF to occupational therapy is the recognition of cultural patterns in occupation. Culture has significance on an individual’s activities and participation and it is important to keep this in mind when treating an individual.
Although the ICF can be very useful for occupational therapists, it is noted in the literature that occupational therapists should use specific occupational therapy vocabulary along with the ICF in order to ensure correct communication about specific concepts. The ICF might lack certain categories to describe what occupational therapists need to communicate to clients and colleagues. It also may not be possible to exactly match the connotations of the ICF categories to occupational therapy terms. The ICF is not an assessment and specialized occupational therapy vocabulary should not be replaced with ICF terminology. The ICF is an overarching framework for current therapy practices.