What does an occupational therapist do in mental health services?

Gabrielle Richards: Well occupational therapists are about helping people to help themselves, that’s their primary role, and they focus on occupation which helps support people’s mental well being and their mental health.

It is ‘occupations’ in its widest sense, rather than occupation related to work. It’s what people do... it’s the art of doing, I think is a nice way to encapsulate it... it’s about supporting people doing things.

And this means they work with service users, and their carers, and their families, looking at what’s personally important to them, what sort of things do they want to do, what roles and responsibilites they want to do. They mainly focus on what they call ‘activities of daily living’, which is things like self-care, productivity, things you want to do, leisure pursuits and also work, so really it’s about working with individuals, their hopes and aspirations, through a personal approach, what are the goals that they want to achieve in their life.

And we do work a lot with people with psychosis, and we do all of the above with people with psychosis, starting with, as I’ve said, what people want to do.

They offer practical support, so anything from once again those daily routines – getting out of bed in the morning can be quite tricky for some people, if you’re not very motivated or have ill health – right through to things like getting back into employment. It’s a whole range of what we consider to be daily routines, occupations, and what we do is that we focus on thinking about the environment people are in, the skills they want to achieve, the skills that they have and may want to refresh, or regain, motivation, and also the roles, whether you have a home role, a work role, a friendship role, and you set the goals around that and we support you to achieve them.

Where do occupational therapists work?

Occupational therapists work in the full range of areas of mental health. Obviously you will see occupational therapists working in the community, they will work in inpatient settings. They do tend to work in community mental health teams, but you will see them also in assertive outreach teams, some of the home treatment teams.

There is a role for OTs working in early intervention, keeping people in their jobs, keeping people at school, particularly young people, the adolescents who may have a first onset psychosis... what roles and responsibilities do they have in their life and how might the OT support them to keep them in their lives?

Of course, working in acute settings, people are often very poorly, so it’s about starting that in small steps, so supporting people may be to come to a group, or having a one to one session, or doing a little cooking assessment, for example, about what are those skills, do they have them, can they re-energise them for example?

OTs also work a lot in groups in inpatient settings, so not only just for leisure, but also skills development, so a group might be run around a creative pursuit for example, and they might do that with a multidisciplinary colleague. They might run specific skills-based groups, like a communications development group, or a problem-solving group, for example, a communication engagement group. If you’re feeling a little under confident, you’ve kind of got out of the way of going to the local café, or doing your shopping, your budgeting, those sorts of things, you might need a practical steer, or practical support, to get back to doing those sorts of activities.

You’ll often get OTs who work in inpatient settings then supporting people to get back into the community so they’ll follow that person into the community, on their journey of recovery

It tends to be more on an individual basis, because it is about working with what other people’s goals are. What are your aspirations, what are your hopes? What things do you want to do that’s going to be important to you to maintain or develop your life as you want it to be?

It could be developing a new friendship, it could be getting to a club, for example, it could be doing some volunteering, so it’s working with the individual. Mind you, saying that, OTs do run groups in the community as well. But it tends to be more about what we call the social inclusion activities, what are groups in the community that already exist. I think historically we would have set up our own groups, so you would have people who have mental health difficulties doing a group together, and there’s still a degree of that, because it’s a stepping stone, so you might run a football group, for example, but the ultimate aim might be to actually engage in your local club, in your own right.

OTs will do home visits and spend time with people in their own homes because it is about their environment that you are working in, and supporting them to stay in that environment, so yes, there’s a lot of home visiting, a lot of spending time with people about what they need to do in their own homes to stay there.