My name is Esther Dark; I am a UK-based Occupational Therapist currently performing in community mental health care. In the UK, there has been a shift in the way we treat mental health illness from institutionalised care, to a greater emphasis of working with patients in their local communities (NHS Long Term Plan, 2019) through more joined-up integrated care (RC Pysch, 2017). The community plays a crucial role in mental health recovery, yet it is often undervalued, underfunded and unrecognised. Which is why national frameworks are being implemented to transform and modernise community working (National Collaborating Centre for Mental Health, 2019), including initiatives such as social prescribing, cohesive working between primary and secondary care and prioritising the physical health care for people with severe mental health illness.
Occupational Therapists and Occupational Scientists consider the human experience to be motivated by meaningful activity, and in its absence acts as a major threat to health and wellbeing. Thus, the primary role of an Occupational Therapist is to work with patients to achieve engagement in activities which that individual views as important and meaningful in their lives.
Occupational Therapists have been recognised as ideally placed and suited to assess the needs of older adults in mental health settings because of their holistic approach, which takes into consideration an individual’s cognitive, social, physical and psychological spheres (Abenderstern et al, 2016).
Prior to commencing my maternity leave, I was working within community mental health services and am soon to start a new senior role in an intensive recovery intervention service within the community for older adult mental health care. I love community working as there is so much scope to work in an occupation-focused way, as the resources available to me are the patient’s own environment and my interventions are not directed by institutional influences or a pre-designed therapy timetable. These types of interventions often seen in inpatient settings can create more barriers through red tape and box ticking; however, those directed by the patients themselves, lead to more meaningful outcomes. I also thrive from the element of surprise in my role – no day is the same – and every patient has a different story, with their own unique set of circumstances.
The variety within my role identifies with Finlay’s (1997) reflection that summarising OT practice is difficult, as our profession is so “diverse: we can be involved in so many different areas, working with individuals impaired psychologically and physically” (p.1). However, the impossibility to describe one’s role has led to a fractured front in the profession as Michetti and Dieleman (2014) state “How can occupational therapists advocate for their roles within CMHTS when they cannot agree what that role should be?” (p.231). We have to stay united – with occupation always centralised and at the fore of our interventions if we are to gain greater recognition in our practice. Furthermore, as research identifies and I have discovered in my own experience, cooperative strategies amongst clinicians can help counteract against role conflict, role incompatibility and role ambiguity (Hughes, 2001). This for me means taking every opportunity I can to undertake joint working – this reaps multiple benefits; as it promotes occupational therapy’s unique role to my colleagues and clarifies understanding.
As previously stated, my role varies greatly; on some days, I can be involved in evaluating and adapting a patient’s environment to enable them to engage in their occupations, or it can be community mapping to increase their social engagement or supporting patients through graded exposure to embrace their occupations with greater confidence.
So, what does a typical day look like? Much of my role is undertaking detailed, comprehensive assessments to understand all aspects of an individual’s functioning, which then leads to a collaboration with the patient in what goals they want to prioritise to enable their recovery. In my area of practice, I seek to maintain function in their occupations, and possibly, even improve in some cases. Risk is always at the fore as my focus is to prevent admission to hospital and deterioration – this is always a fine balance to tread – as therapists we want to take a risk-enablement perspective to enable choice (RCOT, 2017).
Some challenges I face include undertaking generic practice and often the unbalanced ratio between occupation-focused work versus generic working; a concern raised previously within the profession, which has led to increased stress amongst practitioners (Harries and Gilhooly, 2003). Conversely, I personally enjoy working generically as I am expanding my skillset, learning about medication management and mental health reviews. My team value occupational therapy and understand the nature and scope of my practice, making their referrals to occupational therapy appropriate and meaningful.
To counteract the potential loss of an occupational lens, I always use a model in practice – usually the Model of Human Occupation – as it enables me to conceptualise my patients in an occupation focused way and stay true to my profession. I am also trained in sensory integration and take great interest in understanding a patient’s sensory needs and understanding the link between mental health and ageing with their sensory system and how to enable occupation through this.
I am incredibly passionate about Occupational Therapy’s role within the community – their holistic and creative approach – and take such joy in my day to day working.
Author: Esther Dark
Abenderstern, M., Tucker, S., Wilberforce, M., Jasper, R and Challis, D (2016) Occupational therapists in community mental health teams for older people in England: Findings from a five-year research programme, British Journal of Occupational Therapy, 80 (1), 20-29
Finlay, L (1997) The practice of psychosocial occupational therapy. 2nd
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Harries P and Gilhooly K (2003) Generic and specialist OT case- work in CMHTs. British Journal of Occupational Therapy, 6 6(3), pp.101–109.
Hughes, J (2001) Occupational Therapy in Community Mental Health Teams: A Continuing Dilemma? Role Theory Offers an Explanation, British Journal of Occupational Therapy, 64 (1), pp. 34-40
National Collaborating Centre for Mental Health (2019) The Community Mental Health Framework for Adults and Older Adults, NHS Accessed here: https://www.england.nhs.uk/wp-content/uploads/2019/09/community-mental-healt h-framework-for-adults-and-older-adults.pdf Accessed on 13/10/2020
NHS Long Term Plan (2019) Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan- version-1.2.pdf Accessed on 13/10/2020
Michetti, J and Dieleman, C (2014) Enabling occupational therapy: moving beyond the generalist vs specialist debate in community mental health, British Journal of Occupational Therapy, 77 (5) pp. 230-233
Onyett S, Pillinger T, Muijen M (1995) Making community mental health teams work. London: The Sainsbury Centre for Mental Health.
RC Psych (2017) Mental Health and new models of care, lessons from the vanguards, Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/pol icy/policy-mh-new-models-care-kings-fund-may-2017.pdf?sfvrsn=ba37b2d5_2 [Accessed on 13/10/2020]
RCOT (2017) Embracing risk; enabling choice, Guidance for Occupational Therapists, Royal College of Occupational Therapists, Available from: https://www.rcot.co.uk/practice-resources/rcot-publications/downloads/embracing-r isk [Accessed on 15/10/2020]