SAMEEAH CASSIM, [BSC OT (UWC)] explains that occupational thrapy has its roots in mental health, and treatment involves a holistic assessment which will assist clients in participating fully in their daily lives.
SINCE practising as an occupational therapist (OT), I have encountered many people who have had various thoughts regarding what an occupational therapist is. It is difficult to explain the role of an occupational therapist when the name suggests something to do with employment. It is difficult because the common world does not speak about activities of daily living.
Occupational therapy focuses on the therapeutic use of daily activities (or occupations) with individuals or groups to improve their participation in roles, habits and routines in the home, school, workplace, community or other settings. Furthermore, it involves working with clients who have physical and cognitive impairments, psychosocial dysfunction, mental illness and developmental (or learning) challenges.
OTs are experts in trauma-informed care and the recovery model. Essentially, OTs possess unique knowledge and skills that facilitate effective, holistic mental health interventions. Incorporating skills like sensory approaches and psychosocial techniques help clients effectively function in their daily lives.
Holistic assessment for each client considers various factors, such as:
- Values, beliefs, spirituality, mental function, sensory function etc.
- Performance skills (or motor, process and social interaction skills)
- Environment or context
- Performance patterns (or habits, routines, roles etc.)
As OTs, we work with the client to promote, establish (or restore), maintain or modify tasks to help them participate fully in their daily lives. Mental health is an essential component of all occupational therapy interventions and OTs provide mental health treatment and prevention services for all – children, youth, the aged and people with severe and persistent mental illness.
Did you know that occupational therapy has its roots in mental health? Occupational therapy (OT) originated as a mental health treatment in the early twentieth century, developed to assist returning World War I soldiers suffering post-traumatic stress disorder (PTSD), to help manage their trauma and reorient to civilian life.
The deinstitutionalisation of people with mental challenges meant that OTs began working in community mental health. As mental health services have shifted from the hospital to the community, there has also been a paradigm shift in the service delivery philosophy from a traditional medical model to focusing on the recovery model, and since recovery is a long-term process, clients are encouraged to keep participating in community activities until they are living independently.
OT interventions improve the health outcomes of those with mental health challenges. These interventions are found in areas of education, work, skills training, health, and cognitive remediation and adaptation.
Occupational therapists use several evidence-based approaches within the mental health environment that include:
- teaching coping and self-regulation skills that are useful in a variety of contexts;
- educating people about sensory exploration and implementing sensory approaches for self-regulation;
- utilising cognitive behavioural therapy/ dialectical behavioural therapy approaches to support client participation in desired activities;
- identifying and implementing healthy, positive habits and structure into daily routines;
- supporting the learning and implementation of key skills, which include those related to social competence (like making and keeping friends), coping with anger, solving problems, learning about social etiquette, and following rules;
- evaluating factors that block client success in school, at work, as well as in their home and community;
- modifying the client’s environment to support improved attention, participation and decrease sensory overload at school and/or at work;
- educating parents about important behavioural and psychosocial approaches to enhance their children’s daily functioning;
- reducing restraints and seclusions within the in-patient setting. This is done via comprehensive assessments to determine what facilitates and bars client participation in:
- life tasks
- self-awareness and skills development
- developing attainable goals
- modifying the environment for optimal fit;
- promoting the use of self-regulation and sensory strategies;
- educating a multidisciplinary and interdisciplinary team on prevention techniques.
OTs apply calming strategies with the use of activities of daily living (ADLs) or occupations to aid in optimal mental health. They are experts at applying sensory strategies and coping mechanisms. Clients with mental health challenges have a compromised ability to process sensory input, which can lead to them feeling agitated and unsafe.
After a mental health crisis, hospitalisation is often necessary for stabilisation and treatment. Some of the reasons for hospitalisation include any conversations about suicide or death, self-harm, violence toward others, psychosis symptoms (like hallucinations and delusions) or a complete inability to carry out daily life skills.
The length and severity of a mental health episode vary and so the length of stabilisation also varies. However, most individuals stabilise within a few days of staying in a hospital but, on average, the length of hospitalisation in South Africa is 21 days. Hospital stays may also last longer when placed in psychiatric care than when in a regular hospital. The length of rehabilitation varies according to the individual, their prognosis and how quickly they can stabilise, learn and effectively implement coping skills.