Occupational therapy in mental health is a specialist service that plays a central role in supporting employees who have been suffering from mental health conditions. It facilitates their return to work and, where appropriate, contributes to re-establishing a dialogue between employees and employers when relationships have become difficult.
This brief article illustrates the main features of occupational therapy in mental health, highlighting how the availability of this form of rehabilitation and treatment should be considered by HR managing mental health situations at work and insurance claims assessors processing mental health claims.
What is occupational therapy?
Occupational therapy (or OT) is a healthcare specialist form of rehabilitation and treatment aimed at individuals or groups whose poor physical or mental health interferes with or prevents them from carrying out activities and routines in their personal and professional life. It focuses on aspects of individual functioning including self-care, productivity through work, education, and a range of meaningful activities, including leisure.
What is occupational therapy in mental health?
A small number of occupational therapists specialise in working with people suffering from mental health conditions.
The core objective of occupational therapy in mental health is to help people develop a clearer picture of how their mental health problems interfere with their capacity to engage effectively with work and make adequate use of their physical and mental resources.
The psychological work carried out jointly by occupational therapists and their patients is grounded in ordinary reality and focuses on patients’ engagement in everyday activities.
Occupational therapists base their work on the notion that there is a direct link between activities carried out by people in their day-to-day life and their state of mental health. This includes the view that occupations give structure to a person’s life, as well as meaning and purpose. This, in turn, contributes to a person’s capacity to develop and strengthen their sense of identity, as well as connect healthily with others.
In contrast, mental health conditions may lead individuals to experience a loss of role, for example after prolonged absences from work and associated changes in their home and social life. Their daily routines, such as their ordinary sleep schedule, self-care and diet regime, may have been negatively affected and their days may have become devoid of meaning. In addition, individuals suffering from mental health conditions may struggle to face and let go of distorted perceptions of themselves and others, including unrealistic expectations from their employer, colleagues, insurers, and treating clinicians.
Individuals may also become entrenched in an unhealthy self-perception as an ill or chronically-disabled persons, looking to HR, colleagues or insurers as a source of perpetual care – discarding in the process the relevance of their own capabilities.
Similarly, some people may misconstrue their employer’s responsibility to make reasonable adjustments as to their wishes and expectations, rather than on the evidence-based existence of a mental health condition and related disability. They may for example, expect to be granted a new role that is not in keeping with the post for which they were recruited, or they may demand to be allocated to a line manager of their choosing, for reasons that may have little or nothing to do with an alleged disability.
Occupational therapy in mental health: assessment
An occupational therapy in mental health assessment focuses on the evaluation of:
The individual’s role and routines are reviewed in detail: what does the person actually do during the week, how often, when, what support do they need, and are the underlying reasons for their routines?
Their abilities are assessed, such as their ability to perform tasks requiring differing levels of mental and physical health, as well as their ability to process information, concentrate, problem-solve, negotiate and communicate.
The assessment also evaluates the ability of individuals to engage with processes. This includes how individuals interact with occupational therapists during the assessment process, as well as occupational therapists’ own experience of relating with the individuals they assess.
Occupational therapists ask themselves a range of questions –
– Is the individual motivated to get well?
– What is their belief in their abilities (past and future)?
– Are their belief and self-assessment grounded in reality?
– How do they describe relationships and experiences at work?
– What is their ability to accept and take on board the feedback of others?
– Do they put up a defensive wall of words around them, or are they able to consider other people’s perspectives?
– Are they able to consider the value and objectives of processes with a degree of insight?
– Do they have the ability to persevere, as well as cope with change?
Their work history is reviewed in detail –
– What paid and unpaid work have they done in the past?
– What have their responsibilities been?
– How do they choose jobs?
– What are their previous experiences in the workplace?
– What has been their ability to accept support and use it when it was offered?
Occupational therapists also take into account the physical and social environment in which individuals live and operate, as key to their ability to engage in activities.
At Grespi, occupational therapists also look at the individual’s social environment, and in particular consider how a person’s past and current relationships may affect their ability to engage in their occupations, their work role and duties and how they relate to colleagues.
Occupational Therapy in Mental Health: the report
Information gathered from the assessment consultation is processed, consolidated and laid out in an Occupational Therapy in Mental Health Assessment Report. The report identifies core features of the assessment and formulates an intervention plan.
The report covers a range of areas, including:
• Fitness to attend employment-related meetings and fitness to work.
• Employment status – employment history, current goals in their role at work, the value they place on work.
• Functional ability to perform the duties of their work role.
• Tolerance for work – the employee’s capacity to continue enduring work demands and pressures without adverse reaction, including their tolerance of the social environment in the workplace.
• Relationships at work. A range of questions are addressed, including –
– What are the employee’s relationships at work like?
– Are relationships a source of support or a barrier to returning and/or staying at work?
– Is there a named person at work who could act as a link between employee and employer and provide support for the return to work process?
– Are work processes sufficiently clear?
– Do the work processes and environment provide a degree of psychological containment?
• Motivation to return to work – to what extent does the employee feel loyal to the company, has an emotional investment in being part of it and experience a sense of duty towards it?
• Activity levels and physical and mental endurance.
• Mental ill-health condition and/or disability. Evaluation of the historical, present and likely future impact of mental health conditions, as experienced by individuals, on their ability to work. Also, if the individual has recently recovered from an episode of mental illness, are they likely to relapse?
• Work environment. Questions are addressed regarding the social and physical environment at work –
– Are reasonable adjustments required?
– Which expectations are in place regarding working conditions (e.g., working hours, role, duties)?
– What is the employer’s view of the individual’s capacity to perform in their role, operate as a team player and be part of the company?
• Intervention plan. The intervention plan depends on various features, including: the primary objective(s) of the intervention (e.g., facilitating the individual’s return to work, or their attendance of employment-related meetings; or the process of employer and employee parting ways); the individual’s own perspectives about work; how they view their professional future and what they intend to do about it; realistic evaluation and recommendations on reasonable adjustments; evaluation of risk factors that may interfere or disrupt the individual’s ability to return to work and remain engaged with work.
Most importantly, the 0ccupational therapy in Mental Health Assessment Report provides action-based recommendations which are relevant to the individual concerned, as well as to HR managers and claims assessors, who, respectively face the task of managing effectively mental health situations at work (HR) and processing mental health insurance claims (claims assessors).
Occupational therapy in mental health: rehabilitation and treatment
Occupational therapy in mental health intervention aim at helping individuals define and work towards personal goals and objectives, particularly with regard to occupation.
As such, these interventions differ from symptoms-focussed psychological treatments such as CBT or psychotherapy treatments based on introspective psychological work.
Instead, Grespi’s occupational therapists draw on their psychological understanding of the individual’s conscious and unconscious difficulties and cognitive and behavioural processes for the specific purpose of helping them address psychological obstacles and achieve goals in their everyday life – particularly regarding occupation – and to remain on track with realising their objectives.
The vocational rehabilitation aspect of this approach therefore aims to build on a thorough understanding of psychological difficulties experienced by individuals, for the purpose of facilitating the process of returning to work, remaining in work or moving in the direction of alternative and meaningful occupational activities.
The vocational rehabilitation process may include:
Individuals attend occupational therapy in mental health sessions (normally one or two sessions) for the purpose of preparing for return to work meetings with their employer, possibly following long absences on sick leave. Sessions focus on how individuals may want to discuss details of the return to work process with their employer: their roles and duties at work, reasonable adjustments (including, where appropriate, those related to the physical work environment), appropriate levels of work-based support, timeframe.
Where appropriate, the occupational therapist may undertake a mediation role, for the purpose of facilitating dialogue between employer and employee. This may be required in situations where conflicts or a breakdown in the employer-employee relationship have resulted in an unhealthy state of impasse.
Support may be required in the form of a limited set of (mostly, five to eight) occupational therapy sessions when individuals need the support of occupational therapists to settle back at work or face performance management or disciplinary processes.
Time-limited support may be required, as agreed by employer and employee, to help individuals redirect their career and look for other forms of employment.
Follow-up occupational therapy consultations may be required to: evaluate individuals’ continuing fitness for work; review the settling-back-at-work process; assess their capacity to face performance management and/or disciplinary processes; and consider further recommendations on reasonable adjustments or work-based support.
Summary
Occupational therapy in mental health is a specialist healthcare provision which can have a substantial effect on optimising return to work prospects and help resolve stuck mental health-related situations in the workplace or in processing mental health claims.
As with any specialist input, it is crucial that occupational therapy in mental health assessments and treatments are provided by occupational therapists with many years of training and experience in specialist mental health services.
At Grespi we are of the view that specialist assessments and interventions work best when they are based on the thorough psychological understanding of each individual and are delivered by occupational therapists in mental health within the context of a multidisciplinary team service model.
In practice, this approach typically involves the occupational therapy intervention being provided following a psychiatric assessment and delivered either as a standalone intervention or in tandem with other forms of treatment.
The emphasis put by occupational therapy in mental health assessment and interventions on ordinary day-to-day activities and occupational experiences grounded in reality, makes the discipline of occupational therapy in mental health an invaluable tool in helping individuals fulfil their occupational potential and achieve their goals.
Occupational therapy in mental health is also a very effective healthcare resource for HR and claims assessors facing the task of helping employees and claimants reacquire a capacity to work, with realistic and achievable objectives and a clear timeframe.
Paula Godfrey
Occupational Therapist in Mental Health
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