Dilemmas in professional collaboration with consumers.

Abstract

The unprecedented shifts in the delivery of behavioral health services have bad an impact on the practice of occupational therapy, as on all health professions. Occupational therapy practitioners with foresight about the exodus from hospital-based practice have been working in the cornmunity fbr many years. However, as the 2 1 st century approaches, all health care providers are required to make yet another paradigm shift directly related to the emerging societal emphasis on personal power, autonomy, seif-direction, and seW-responsibility (1). This ftx:us on autonomy, and the resulting changes in roles and boundaries, is especially seen in psychiatry. The patient is viewed as a competent mdividual and as his or her own agent of change; practitioners are asked to see the patient less as a patient or client and more as a colleague. This column will explore the challenges of the shift as occupational therapy practitioners have confronted them. The hope is that it will stimulate all health care providers to reflect on the need ftr thoughtful, well-reasoned responses to circumstances that may threaten traditional understandings of practice roles and relationships as well as on the meaning of autonomous function, stigma , and empathy.