‘Occupational Therapy and Mental Health’

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World Occupational Therapy day is celebrated on the 27th October every year. In honour of World Occupational Therapy 2016 we provide a summary about Occupational Therapy (OT). This will be a refresher for those we had the pleasure of meeting last year and an introduction to all those who are unfamiliar with Occupational Therapy.

 

What is occupational therapy?

Occupational therapy (OT) is a person centred health profession which aims to promote health and wellbeing through occupation.  OT takes a whole person approach to mental and physical health and wellbeing.  The primary goals of OT are to enable a person to participate in activities of everyday life and to enable people to achieve their full potential. Occupational Therapists (OT’s) are valued health care professionals in many countries, but OT is not yet a familiar profession within Nepal.

Occupation refers to the everyday activities that a person does as an individual, with their family or as part of a community in order to occupy their time.  It includes what people need to, want to or are expected to do and brings meaning and purpose to their lives.  Everyday activities allow a person to live independently and have a sense of identity and include tasks such as self-care, leisure and work.  Lack of access or restricted access to everyday activities may negatively impact on an individual’s health and quality of life.  The use of everyday activities to improve health and quality of life is at the heart of occupational therapy.

(Here is the Audio Interview regarding Occupational Therapy with the writer herself. Click Here.)

What does an occupational therapist do?

At a basic level OT’s use and prescribe activities as a “medicine” and a form of treatment to promote recovery and/or prevention.

OT’s will consider the person, their environment and their occupations.  An OT considers the roles, routines and habits of a person and will determine how to recover, develop and maintain the skills a person needs in order to do what they want or need to do as independently as possible.  OT provides practical support to facilitate recovery and overcome barriers.  Although an OT will consider a diagnosis, symptoms and behaviours, these are not the most important factors.  A person’s ability to participate in an activity is more important.  An OT will look at how a person is able to function and participate in an activity and will adapt an activity or the environment accordingly.  It is important that the person is not set up to fail.

Occupational Therapy and Mental Health

The World Health Organisation (1946) defined health as a state:

“…of complete physical, mental and social well being and not merely the absence of disease or infirmity”

and well being as a state:

“…in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.” World Health Organisation (1999).

These definitions highlight the interaction of mind, body, spirit and social context and as such OT’s are well placed to act as health agents. OT’s take a whole person approach to mental and physical health and wellbeing.

(Here is the link on Interaction on Occupational therapy Psychbigyaan Kurakani on OT from 2016)

 Occupational Therapy at the Organizaton

Since the first volunteer OT visitors in 2015 we have focused on staff training in the concepts of OT in mental health, introducing therapeutic groups, enhancing occupational opportunities within the hospital and in the community, developing in-house activity resources and supporting patients in achieving meaningful roles and routines that are goal focused and person-centred.

Our most recent volunteer Occupational Therapist, amongst other initiatives, has introduced a walking group to Amrita. Patients spend the majority of their time confined to the building and garden compound within Amrita. The walking group is a valuable and supportive opportunity to gradually transition patients back into the community.

We have displayed the protocol below for this group to demonstrate an OT’s approach to mental health and wellbeing and therapy. We have highlighted key concepts.

(Amrita Foundation Nepal, is a Nepalese mental health rehabilitation hospital based in Boudha, Kathmandu. Amrita Foundation Nepal is a non-governmental organisation that provides residential rehabilitation and treatment for adults with mental health needs and learning disabilities. From time to time UK qualified occupational therapists offer volunteer support either in person or remotely.)

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Evidence

Exercise can contribute to improvements in mood, alertness, concentration, sleep patterns and psychotic symptoms.  Walking has been shown to decrease anxiety and depression and improve psychological wellbeing as well as physical fitness.  It helps not only to improve social skills but also assists with integration into the community.  It has a key role to play as a preventative and therapeutic intervention.  It is one of the easiest and most inexpensive forms of physical exercise.  It can be done almost anywhere and by almost anyone; it can easily be incorporated into a daily routine.

 Aim

To support social inclusion and community integration

To increase confidence in use of transport

To increase self-esteem and confidence when out in the community

To provide stimulation and engage patients in physical activity

To improve mood and reduce symptoms of illness

 Target group

Inclusion:          Individuals who are working towards discharge

Exclusion:         Individuals who are at an active risk of harming themselves or others

                             Individuals who are at an active risk of aggressive or threatening behaviour

                             Individuals who are at an active risk of absconding

 Assessment

Referral from psychologist and staff

Risk assessment for individuals to be completed on the day by staff

 Structure of group

When:                                         Tuesday afternoon         1500-1600         ladies

                                                     Wednesday afternoon    1500-1600         men

Where:                                        To be decided in advance by group leader

Duration:                                   60 minutes (can be longer if using transport)

Number of patients:                Maximum 3:1 member of staff

Number of sessions:                Ongoing

Closed or open group:            Open

Resources required:                None although money for fares will be needed if using transport

 

Initially, walk to and around the Stupa (as many times as the patients agree on) and then back.  Allow patients to adjust to being outside of Amrita.  The Stupa allows for patients to walk along and also to cross a busy road and then provides a more peaceful environment on arrival.  It also allows for patients who are religious to pray.

 As the group progresses, provide choice to patients where possible on where they would like to go.  Gradually build up confidence in being outside and work towards using transport to go to places further afield.

 Review and Evaluation Process

Patients who attend are to debrief with psychologist after every session

Attendance to be monitored

Engagement in the group and individuals’ motivation will indicate group success

Group to be discussed and reviewed by Multi Disciplinary Team (MDT)

Our challenge to you

We urge you on World Occupational Therapy day and beyond to:

1: challenge the ongoing stigma surrounding mental health

2: spread the word about the power of activity as a therapeutic tool in the recovery process and prevention of mental health both for your own mental health and well being and,  for those of you who work or study in the field of mental health, that of your patients.

References:

Alexandratos K, Barnett F, Thomas Y (2012) The impact of exercise on the mental health and quality of life of people with severe mental illness: a critical review. British Journal of Occupational Therapy, 75(2), 48-60.

Richardson CR, Faulkner G, McDevitt J, Skrinar GS, Hutchinson DS, Piette JD (2005) Integrating physical activity into mental health services for persons with serious mental illness. Psychiatric Services, 56(3), 324-31.

Wilbur J, Zenk S, Wang E, Oh A, McDevitt J, Block D, McNeil S, Ju S (2009) Neighbourhood characteristics, adherence to walking, and depressive symptoms in midlife African American women. Journal of Women’s Health, 18(8), 1201-10.

For additional information please visit:

www.amritafoundationnepal.org

http://www.wfot.org

or contact the writers on on:

info@theablespace.com

 

 

Amanda Peacock and Siobhan Mcdiarmid

About this Author

Amanda Peacock and Siobhan Mcdiarmid are the occupational therapists based in the UK.

Amanda Peacock and Siobhan Mcdiarmid – who has written posts on Psychbigyaan Network Nepal.


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