Many people associate occupational therapy with pediatric services or physical rehabilitation. They are surprised to find occupational therapists also working in mental health settings.
If you or a loved one is seeing a mental health OT, learning about their role can help you advocate for the best care.
The History of Occupational Therapy in Mental Health
Occupational therapy has its origins in mental health. At one point, the majority of OTs worked in mental health settings. In the past decade, the number of OTs in the United States working in mental health has dropped. (You were right to associate OT with physical rehab and pediatrics.)
However, new shifts in mental health care delivery may be opening the door for more OTs to re-enter this field.
What OTs Bring to the Mental Health Treatment Team
The training of an OT requires holistic approaches well suited for work in mental health settings. In addition to their training in physical well-being, occupational therapists are also trained in:
- Cognitive assessment
- Sensory strategies
- Therapeutic alliances
- Group process
- Participation in activities of daily learning (ADLs)
- Socio-emotional skills
As in other OT settings, the ultimate focus of occupational therapy is to assist clients in participating in daily activities as independently as possible.
Interventions Mental Health OTs Provide
Here is a snapshot of common mental health OT interventions:
Lead Groups
Occupational therapists are trained in the group process. Examples of groups led by an occupational therapist may include:
- Life skills
- Job readiness
- Therapeutic cooking
- Money management
- Wellness recovery action plans (WRAP)
- Therapeutic leisure
- Nutrition
- Sensory groups
- Independent living
Provide Calming and Grounding Strategies
Occupational therapists believe that participation in daily activities (aka occupations) is vital to mental health and well-being. Your occupational therapist may help you utilize familiar activities as coping mechanisms, such as listening to music, playing cards, writing, doodling, cooking, or cleaning.
OTs are also fluent in sensory strategies. A person’s sensory system helps process information from the environment. For individuals with mental health conditions, their ability to process this information may be compromised, which can lead to feeling agitated and unsafe.
Sensory strategies activate an individual’s basic processing systems (vestibular, proprioceptive, deep pressure touch) to aid in processing information, helping individuals feel grounded and calm. Sensory strategies may prove effective for people who may not be at a state to benefit from talk therapies.
Sensory Rooms
OTs are part of a larger movement to create sensory rooms on mental health units. Sensory rooms are places where individuals can go to feel safe. The rooms often have tools to help de-escalate and relax. The use of this simple concept has helped drop seclusion and restraint levels dramatically on some units.
Assess Discharge Preparedness
OTs have a battery of assessments that they can use to assess discharge preparedness in a standardized way. This information can help your treatment team understand what amount of care you will need at discharge and gauge your treatment progress.
Address Physical Wellbeing
One important qualification that sets occupational therapists apart from other qualified mental health professionals is their background in physical rehabilitation. Mental health issues are often overlaid with issues of physical health. In a mental health setting, you may find an OT addressing general strengthening, adjusting wheelchairs, recommending adaptive equipment, or any other task that is within the scope of occupational therapy.
Advocate for Safe Independence
Ultimately, your OT will seek to assist you in participating in daily activities. If your mental health condition is compromising your ability to participate in daily activities, speak to your occupational therapist about your concerns. If they do not have the tools to assure that your needs are being met, they can serve as an advocate and assist in getting you the necessary help.
Specializations in Mental Health
Many OTs are competent in trauma-informed care and the recovery model, either through their schooling, workplace training or independent study. Some OTs go on to earn the certification of Certified Psychiatric Rehabilitation Practitioner (CPRP).
At the Johns Hopkins Department of Physical Medicine and Rehabilitation, our occupational therapists specialize in helping patients with mental health disorders. Our occupational therapists are experts in performing behavioral health assessments, which offer insight into a patient’s condition. They have strong observation and creative problem-solving skills, and understand human development and function across different diagnoses.
Why Choose Johns Hopkins
Patients may have challenges in the areas of planning tasks, organizing, problem solving and decision making. They may also have difficulties with controlling emotions, which can make it difficult to function and be independent in society. Occupational therapy can help improve on or compensate for these challenges. Our occupational therapists use standardized and nonstandardized screening and assessments to make recommendations for treatment, which may include:
- Patient and caregiver education
- Practicing life management skills
- Adapting tasks or environment to become more independent
- Developing coping mechanisms to deal with emotional problems
Psychiatric Occupational Therapy Team
Our psychiatric occupational therapy team works closely with patients with mental illness. Our therapists help these patients improve their function in work, play, leisure, social life, self-care and community living skills. Our team is highly trained in assessing these skills and making recommendations for treatment and safe discharge.
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Bobby Walsh, DBH, OTR/L, BCMH | Team Lead
AOTA Board Certification in Mental Health
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Tess Spence, MS, OTR/L | Clinical Specialist
Helping Patients Enjoy Life to the Fullest
Our occupational therapists are trained to identify difficulties in performing daily activities. They help address these underlying problems through the activities listed above. Our team can work with patients and their loved ones to improve these and other life management skills:
- Creating and following a productive daily schedule
- Taking care of personal hygiene
- Managing one’s own health
- Navigating the community and using public transportation
- Organizing and following a medication regimen
- Interacting appropriately in work or social situations
- Working or volunteering
- Planning and cooking healthy meals
- Managing budget and finances
Developing Habits That Are Important to You
Habit training was the first occupational therapy treatment model. It was introduced by Eleanor Clarke Slagle, with input from psychiatrist Adolf Meyer, when both worked at Johns Hopkins in the early 1900s. Habit training focuses on balancing activities in the areas of work, rest and play, which can be unbalanced in people with mental health disorders. When occupational therapy was fairly new, habit training was heavily focused on arts and crafts. Now, our updated approach emphasizes meaningful activities rooted in independent living and quality of life.
Request an appointment with one of our mental health occupational therapy experts to discuss how we can help you or your loved one.
Locations and Referrals
Our psychiatric occupational therapy team is based in The Johns Hopkins Hospital and offers both inpatient and outpatient services, as well as partial hospitalization. Contact us if you are looking to make an appointment or refer a patient.
As of recent, the role of occupational therapy within PrairieCare has transitioned from the inpatient setting to a solely outpatient consultation basis. The purpose of this blog is to identify the role of occupational therapy in the mental health setting and to highlight the plethora of evidence-based approaches with children and adolescents.
What is Occupational Therapy (OT)?
To start, the profession of occupational therapy is defined as “the therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of enhancing or enabling participation in roles, habits, and routines in home, school, workplace, community, and other settings” (American Occupational Therapy Association [AOTA], 2014, p. S1). To put it more simply, occupational therapists help individuals get back to doing what they want to do. Occupational therapists can work with individuals with physical injuries, cognitive impairments, psychosocial dysfunction, mental illness, and developmental or learning disabilities. Occupational therapists evaluate the whole individual by looking at the transaction between client factors (values, beliefs, spirituality, mental function, sensory function, etc.), performance skills (motor skills, process skills, social interaction skills), environment/context, and performance patterns (habits, routines, roles, rituals) in order to promote, establish/restore, maintain, or modify the task to enable participation in desired life activities. In addition, occupational therapists can focus on prevention of the potential barriers to participation in desired activities (AOTA, 2014).
Occupational therapists working in the mental health settings focus on enabling individuals to re-engage in meaningful occupations through a variety of skill sets such as skills development, establishing positive habits and routines, setting therapy goals, using cognitive-behavioral techniques (CBT), and understanding underlying physiological influences (AOTA, 2016b). Specifically, occupational therapy within the setting of child and adolescent mental health focuses on those underlying physiological influences and teaching patients to identify and utilize self-regulation strategies in order for patients to get back to participating in meaningful occupations such as going to school, being with friends, and participating within the family system (AOTA, 2016a). In addition, occupational therapists can work with individuals with sensory processing disorders (SPD) and social-emotional learning dysfunction, which are commonly seen within the child and adolescent setting of mental health (AOTA, 2016b).
What approaches do OT’s use with clients/patients?
The following evidence-based approaches support the profession of occupational therapy within this child and adolescent mental health setting. These evidence-based approaches include:
- Providing education on coping skills and self-regulation skills to use in a variety of contexts
- Providing education on sensory exploration and implementation of sensory approaches for self-regulation
- Incorporating yoga and movement interventions to provide sensory input and achieve self-regulation
- Utilizing CBT approaches to facilitate participation in desired activities
- Identifying and implementing healthy, positive habits and structure into daily routines
- Providing education and implementation of skills related to social competence, such as making and keeping friends, coping with anger, solving problems, learning about social etiquette, and following school rules
- Evaluating factors interfering with success in school, home, community, etc.
- Modifying the environment to support improved attention, participation and decrease sensory overload in the classroom
- Providing parents with education on behavioral and psychosocial approaches to enhance the child’s daily functioning
- Reducing restraints and seclusions in the inpatient setting by conducting comprehensive assessments to determine facilitators and barriers to participation in life tasks, promoting the use of self-awareness and skills development, collaborating with the client to develop attainable goals, modifying the environment for optimal fit, promoting use of self-regulation and sensory strategies, and educating the interdisciplinary team on prevention techniques.
Overall, it is clear that occupational therapists have the distinct knowledge and skill sets to provide effective, holistic interventions within the mental health setting. There is strong evidence to support the incorporation of occupational therapy skills such as sensory approaches and psychosocial techniques within psychiatric settings to facilitate daily life functioning.
Alison Tonsager, Occupational Therapy Student
Madonna Mitzel, MS, OTR/L, Outpatient Occupational Therapist
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1– S48. doi: 10.5014/ajot.2014.682006
