Mental Health Occupational Therapy Research Articles

Are professional counsellors and psychotherapists prepared to make a greater contribution to the Australian mental health workforce? A comparison of training content and mental health standards

ABSTRACT Objective Professional counsellors and psychotherapists present a potential workforce to contribute to the alleviation of Australia’s mental health crisis. However, a major hurdle for the endorsement of these professions to received public health rebates has been the question whether their training programs meet required standards. Method This discussion paper presents a synthesis of the mental health practice standards of cognate professions receiving rebates for focussed psychological strategies (counselling psychology, mental health accredited social workers, mental health occupational therapy). Secondly, this paper presents a desk review of accredited counselling and psychotherapy training courses and compares these programs with these standards. Results The comparison showed that current content of counselling and psychotherapy training is preparing graduates for practice that is consistent with many mental health standards, including: competence in working with mental health conditions; attending to quality improvement; awareness and responsiveness to diversity; and, working within a client-centred and recovery focused framework. The level of preparation for two standards (knowing and complying with mental health systems and standards; enhancing care through collaboration, service integration and teamwork) is less clear. Discussion These results suggest that according to several indicators, counsellor and psychotherapist training already prepares professionals to work according to current standards. For other standards, recommendations for updates to training programs and credentialling pathways are discussed.

A Cognitive Behavioral Approach to Improving Performance and Satisfaction in Meaningful Occupations in the Outpatient Mental Health Occupational Therapy Setting

This retrospective study explored the efficacy of integrating a cognitive behavioral frame of reference into outpatient occupational therapy treatment to improve performance and satisfaction in meaningful occupations in patients living with a mental health condition. Forty-eight medical records of patients aged eight to 78 years old were included in the study. The records included first and second administrations of the Canadian Occupational Performance Measure (COPM). This study strongly demonstrates that the incorporation of a cognitive behavioral approach into treatment for those living with a mental health condition creates positive, clinically significant change over time.

Goal setting in mental health: a scoping review to inform occupational therapy practice

Purpose Goal setting is a crucial aspect of client-centered practice in occupational therapy (OT) for mental health conditions. However, it remains to be seen how goal-setting has been delivered in mental health, particularly the OT process. The purpose of this scoping review was to explore the nature and extent of goal setting delivered in mental health and informed OT practice. Design/methodology/approach The authors followed the guidelines of Arksey and O’Malley (2005) and searched three databases using key search terms: “mental disorder,” “goal setting,” and “occupational therapy” and their synonyms. Findings After excluding duplicate records, the authors initially screened 883 records and resulted in 20 records in total after the screening process. Most of the identified articles used goal-setting delivered by both a health professional and a client (n = 14), and focused on people with schizophrenia or schizoaffective disorder (n = 13), but three interventions were delivered by occupational therapists. Further research needs on goal-setting in mental health OT, exploring the reliability and validity of different goal-setting strategies and investigating the effectiveness of goal-setting for promoting behavior change and client engagement across various mental health conditions and settings. Research limitations/implications The scoping review has some limitations, such as not investigating the validity and reliability of goal-setting strategies identified, and excluding conference papers and non-English articles. Originality/value This scoping review presents a mapping of how goal-setting has been delivered in mental health and informed OT practice. The findings suggest limited research in OT and highlight the need for more studies to address the evidence gap in individualized client-centered OT.

Characteristics of natural environment use by occupational therapists working in mental health: a scoping review protocol.

The objective of this review is to identify and characterize the use of the natural environment/outdoor space by occupational therapists working in mental health care. Research has shown that the natural environment is beneficial for our health and can be used to help people who are experiencing mental health problems. Occupational therapists are well placed to assess and utilize the environment when treating people with mental health problems; however, the use of the natural environment/outdoor space by occupational therapists working in mental health is unclear. This scoping review will include both primary research and gray literature relating to the use of the natural environment/outdoor space in mental health occupational therapy practice. The review will be limited to studies published in English. There will be no geographical or age restrictions. Embase (Ovid), MEDLINE (Ovid), CINAHL (EBSCO), PsycINFO (ProQuest), AMED (EBSCO), Trip Database, Emcare (Ovid), and OTSeeker will be searched for studies. Unpublished studies and gray literature will be searched using GreyNet and National Grey Literature Collection, alongside professional magazines and websites. Titles and abstracts will be screened by 2 independent reviewers for assessment against the inclusion criteria, followed by a full-text review and data extraction. Any disagreements will be discussed with a third reviewer. Data will be extracted using a data extraction tool developed by the reviewers, and presented in tabular format, accompanied by a narrative summary describing how the results relate to the review objective and question.

Universal Brief Mental Health Screenings for First-Year Medical Students: A 6-Year Retrospective of the Keck Checks Program.

Medical students are at elevated risk for mental health difficulties and may struggle to ask for help. Innovative outreach programs are warranted to reduce barriers and ensure that students receive the professional care they need and deserve. This article provides a 6-year retrospective of the Keck Checks program, a well-established initiative that offered universal 15-minute mental health screenings to every first-year medical student at the Keck School of Medicine of the University of Southern California from fall 2016 to fall 2022. This early detection program was designed to combat barriers to seeking mental health care by normalizing the concept of all students meeting with a psychologist early in their academic careers. The Keck Checks program showed promising feasibility, with a single full-time clinician successfully hosting appointments for entire classes of first-year medical students (mean of 189 students per class) during approximately 4 months, in addition to other work duties. Participation rates were high, with 715 eligible students (76.3%) choosing to attend their Keck Check. Students were frequently referred to follow-up services during the Keck Check, including mental health care (n = 360 [50.4%] referred), occupational therapy (n = 72 [10.1%] referred), and academic support services (n = 60 [8.4%] referred). Next steps include possible expansion of similar programs to medical students in years 2 to 4, residents, and physicians, as well as understanding the effect of brief mental health screenings on long-term help-seeking, adherence to mental health treatment plans, and general educational or professional success. Brief, universal mental health screenings are a relatively low-cost, high-impact approach for medical schools to consider in supporting the mental health of their student body.

Nurturing mental health and well-being using ordinary farms

Purpose This practice piece aims to review an occupational therapy led pilot programme – social farming as an intervention option in an adult community mental health setting in Ireland. It will also reflect on the practical implications of delivering the natural surroundings based programme through the COVID-19 pandemic and plans for the future development of such programmes in adult mental health services. Design/methodology/approach The Occupational Circumstances Assessment Interview Rating Scale (OCAIRS) was used to measure occupational participation (Forsyth, 2005). This was administered with participants’ pre and post their participation in the 10-week programme. An internal questionnaire was developed to further capture both the participant and farmer experiences of the social farming programme. Findings Whilst improvements were noted in a number of OCAIRS domains, it was difficult to identify small changes over a short period of time. The main domains of change were habits, roles, interests and personal causation. The success of the social farming placements was also reflected in the internal questionnaire. The pilot programme has resulted in the further development of the social farming programme and securing of funding for placements for five years. Originality/value It would be beneficial to consider other standardised assessments that assess quality of life and occupation for future placements. It is also beneficial to consider practical implications in delivering a social farming programme, particularly to those with barriers to transport. It is hoped this paper will contribute to the growing knowledge of social farming as a meaningful therapeutic intervention in mental health occupational therapy practice.

"Metacognitive Reflection and Insight Therapy" (MERIT) for the Occupational Therapy Practitioner.

Background. Metacognitive Reflection and Insight Therapy (MERIT) is a manualized, evidence-based approach that supports occupational participation through its focus on the inter-related constructs of meaning making, positionality, and self-definition (Lysaker et al., 2020). MERIT's core tenets parallel the fundamentals of occupational therapy, making it an ideal guiding methodology for mental health occupational therapy practice. Purpose. We outline key constructs of MERIT and detail how occupational therapy practitioners can apply MERIT to support occupational engagement. Key Issues. Few manualized, evidence-based interventions exist to guide occupational therapy mental health practice (Kirsch et al., 2019). Detailing MERIT and its application in occupational therapy is an important first step in future studies of its feasibility, acceptability, and effectiveness in this context. Implications. MERIT provides a clear methodology for delivering mental health occupational therapy services that is amenable to large-scale hybrid implementation and effectiveness studies, thereby supporting practice and rigour in research.

An innovation on clinical placement for occupational therapy mental health during the COVID-19: A mixed-methods feasibility study.

The COVID-19 pandemic altered the health profession's education. Educational activities were shifted to online, and clinical placements were compromised in certain countries. A mixed-methods study included 17 undergraduates undergoing a mental health placement. The first 3 weeks of clinical placement applied online case-based learning in written and in video format. The last 2 weeks involved hybrid remote and physical onsite clinical placement. SPICES model utilizing various active learning activities, case studies and client attendance, facilitator engagement, discussion and feedback were implemented. A self-administered System Usability Scale (SUS), e-learning preference level, focus group discussion, and reflective writing was conducted at the end of each week and the students' final marks were compared with the past cohort who attended conventional physical clinical placement. Two-way mixed ANOVA indicates no significant interaction was found on the SUS (p = 0.062, = 0.062) and preference scores (p = 0.285, = 0.079) according to week and practical site. There was no significant difference in the final mark among the online and onsite placement of the current cohort (p = 0.350, d = 0.47). The current cohort reported better marks than the previous cohort who attended conventional placement (p = 0.006, d = 0.99). Qualitative findings show positive responses where online activities have minimal restriction on the learning process. This innovative approach is acceptable for substituting conventional clinical learning during this restricted situation.

Costing the outpatient rehabilitation services: time-driven activity-based costing approach

BackgroundConsidering the importance of healthcare services costing in resource allocation, the aim of this study is to calculate the cost of rehabilitation services in an outpatient rehabilitation clinic in Tehran, Iran.MethodsThe data for this study were categorised as financial data and information about the process of rehabilitation services. The first category was extracted from the financial documents and the second was obtained by observation of patient flow and interviews with the clinic staff in 2016. The cost of rehabilitation services has been estimated using the time-driven activity-based costing approach.ResultsThe findings show that the cost of physical occupational therapy in the Asma rehabilitation center was $18.79 per unit of service. This amount for speech therapy services was $17.23 to $19.40, taking into account the difference in the quality of the service delivered. The cost of mental health occupational therapy service was between $19.46 and $23.57. Comparing the cost of these services with the government’s tariffs makes it clear that there is a huge gap.ConclusionThe limited number of patients referred to the center makes the cost of one unit of rehabilitation services much higher than the official tariffs. This is true for almost all similar institutions and makes the profitability of small rehabilitation institutions extremely unstable. Therefore, proper marketing for rehabilitation services by promoting patient referral links with larger healthcare centers and reallocation of resources to the formation of integrated rehabilitation complexes can play a significant role in their profitability.

A Scoping Review of the Use of Rasch Analysis Methodology to Strengthen Self-Report Occupational Therapy Mental Health Measures

Self-report measures can be used to accurately assess client outcomes, providing evidence for the effectiveness of occupational therapy. Rasch analysis, a psychometric research methodology, is increasingly being used to validate self-report measures, however, the extent of its use within mental health occupational therapy is unknown. To address this, a scoping review that included twenty articles published between 2001 and 2019 was conducted. This review quantifies the increase in use of Rasch analysis in this field and finds heterogeneity in the analysis techniques implemented. As the use of Rasch analysis increases, it offers benefits to strengthen self-report measures within mental health occupational therapy.

Exploring the professional experiences of mental health occupational therapists during a period of COVID-19

Purpose: The COVID-19 pandemic has brought about disruption in the way health-care professionals carry out their day-to-day practices across communities. The purpose of this research paper is to explore the professional experiences of occupational therapists working in community and rehabilitation mental health settings during a period of the COVID-19 pandemic and to help gain an understanding of how their day-to-day work practices have been affected. Design/methodology/approach: A qualitative phenomenological research study explored the lived experiences of ten occupational therapists working within Health Service Executive community and rehabilitation mental health services during the COVID-19 pandemic. Participants included eight community mental health occupational therapists and two rehabilitative mental health occupational therapists. Data was collected through semi-structured interviews and analysed using reflexive thematic analysis. Findings: Three themes were identified: holding on to what we do;technology: friend and foe;and COVID as a catalyst to clarify the occupational therapy role. These themes capture the community changes, challenges and frustrations experienced by the occupational therapists while striving to provide quality mental health occupational therapy services during the pandemic. Originality/value: The findings demonstrate the adaptive nature of the profession, the importance of traditional observation methods of community-based care, the experiences with telehealth approaches and an opportunity to clarify misconceptions of aspects of the profession’s role in relation to employment-related issues and occupational therapy group work within such mental health settings. © 2021, Brendan Culleton.

Leisure in mental health occupational therapy interventions: a qualitative investigation

Mental health care has been shifting from treating mental illness to health promotion. Occupational therapists aligned with the new paradigm can include leisure in their recovery-oriented interventions helping mental health patients live a meaningful and satisfactory life. The aim of this paper is to determine the common perceptions of leisure among occupational therapists who practice in mental health settings, and to understand how they implement leisure as an intervention when working with individuals with severe mental health disorders. A qualitative methodology was used to explore Occupational Therapy perceptions of leisure. Through snowball sampling 5 occupational therapists from a metropolitan city in the Midwest of the United States of America to complete a semi-structured interview were recruited. American Occupational Therapy Association Practice Framework (3rd edition) guided the thematic analysis. Three themes emerged, including Concepts of Leisure, Occupations, and Leisure as Therapy. Theme definitions, examples and implications are discussed. Although occupational therapy practitioners in mental health consider leisure important, it is underutilized in their interventions. The professional’s perspectives of leisure influences how they include it in their practice.

Occupational Therapy in Mental Health via Telehealth during the COVID-19 Pandemic.

The COVID-19 pandemic has brought about changes in mental health occupational therapy. Research into these changes and the associated risks of relapse is insufficient. To explore the changes that have taken place in forms of occupational intervention (face-to-face and online) during the pandemic, and to analyze their association with subsequent relapses, a multicenter retrospective cohort study was carried out of 270 patients with mental disorder diagnoses under follow-up in day hospitals during 2020. Our results show that the frequency of face-to-face occupational therapy interventions decreased during lockdown and subsequently recovered. Interventions via telehealth increased during lockdown and have since been continued to a greater extent than before lockdown. Patients who received occupational intervention via telehealth relapsed less in the following six months (10.7% vs. 26.3%; χ2 = 10.372; p = 0.001), especially those who received intervention via videoconferencing (4.2% vs. 22%; χ2 = 5.718; p = 0.017). In conclusion, lockdown subsequent to the COVID-19 outbreak led to a reduction in face-to-face occupational therapy interventions, putting people with prior mental disorders at risk, while the implementation of telehealth tools helped reduce relapses.

Clinical Utility and Validity of the Occupation-Centered Intervention Assessment for Occupational Therapy Mental Health Practice

Clinical Utility and Validity of the Occupation-Centered Intervention Assessment for Occupational Therapy Mental Health Practice

Identifying occupational therapy outcome measures supportive of recovery-orientated mental health services in Ireland

Purpose No occupational therapy outcome measures have been designed specifically for recovery-orientated services.This paper aims to identify occupational therapy outcome measures relevant to mental health practice and assess them against recovery principles adopted by Irish Mental Health Services. Design/methodology/approach A narrative review methodology was used to appraise outcome measures against CHIME recovery principles. Findings A systematic search across 13 databases identified eight well-established outcome measures commonly used within occupational therapy mental health literature. The included outcome measures were appraised using a recovery alignment tool. Practical implications All outcome measures connected to some recovery processes. Those using semi-structured interview formats and notably the Canadian Occupational Performance Measure (COPM) had the strongest alignment to recovery processes. Originality/value This is the first known review which provides some validation that the included outcome measures support recovery processes, yet the measures rely heavily on therapist’s skills for processes to be facilitated. It recommends that ways to better support the process of partnership in occupational therapy mental health outcome measures be explored and further research be undertaken.

Promoting Occupational Therapy Mental Health Research: Proceedings From the 2017 AOTF Mental Health Planning Grant Collective.

Although occupational therapists were once integrally involved in mental health practice, the percentage of therapists presently working in this clinical area is low. In 2017, the American Occupational Therapy Foundation convened a planning grant collective (PGC) to generate research to support populations with serious mental health challenges. The PGC's primary mission was to identify key research areas in which occupational therapists and colleagues could work collaboratively to demonstrate evidence for occupational therapy services supporting mental health community participation. Participants included 21 members from six professions and three program officers from federal funding establishments. The PGC identified seven overarching research concepts, three broad areas of research inquiry, and eight possible studies addressing occupational therapy's contribution to research promoting community participation and health outcomes for people with mental illness. This article provides a summary of the PGC proceedings so that researchers can collaboratively implement identified research topics.

Approved mental health professionals: A jack of all trades? Hybrid professional roles within a mental health occupation

This article presents findings from the Hybrid Identities Project that investigated the professional role and identities of ten multi-professional Approved Mental Health Professionals (AMHPs) from social work, mental health nursing and occupational therapy backgrounds as hybrid professionals. Hybrid professionals are professionals of a mixed origin who work across several roles and areas of expertise within public services. AMHPs have a legal role within the Mental Health Act 1983 (2007) in England and Wales to plan the assessment of individuals who require care and treatment for a mental disorder. An intrinsic case study approach was undertaken with data generated through semi-structured interviews that examined professional hybridisation, illustrated through AMHPs’ enactment of eight hybrid roles. The article contributes to empirical understandings of AMHP professional practice through advancing ideas about role hybridisation within a previously under-researched mental health occupation.

Occupational therapy interventions in mental health: a scoping review of recent evidence

Background/Aims Studies investigating the effect of occupational therapy in mental health are few. This scoping review aims to identify, present and assess studies that have investigated the effect of occupation- and activity-based/focused interventions performed by occupational therapists in mental health. Methods The scoping review involved searching six databases, covering articles from 2003 to 2018. ‘The Matrix Method’ was used to describe and synthesise the content of the included studies. The Oxford Level of Evidence was used to rank the evidence, and The Critical Appraisal Skills Programme was used to assess the quality of the study. Results A total of 21 original studies and 4 systematic reviews were included in this review. Interventions, approaches, programmes, training, and activities such as cooking, artwork, crafts, pottery, sports, calligraphy, horticulture, and music, organised individually or in groups, were investigated in the included studies. Individualised occupational therapy showed clinically significant improvements in social functioning and cognition, promising results were found on supported employment and education. Conclusions Few high-quality studies that have investigated the effect of occupation-and activity-based/focused interventions performed by occupational therapists in mental health were found. This scoping review highlights the importance of future high quality studies to support evidence-based practice within mental health occupational therapy.

Capabilities for recovery-oriented practice in mental health occupational therapy: A thematic analysis of lived experience perspectives

IntroductionRecovery in mental health is both a policy imperative and a contested concept with individual and systemic elements. Occupational therapy research and pre-registration education have no...

Occupational Therapy and Criminal Court Mental Health Initiatives: An Important Emerging Practice Setting

Occupational therapy is well equipped to help people with mental illness in criminal justice contexts. Criminal court mental health initiatives, meanwhile, have emerged as a “rehabilitative response” to disproportionate numbers of people with mental illness caught in the criminal justice system. These initiatives—namely, mental health courts and mental health diversion—belong to a family of problem-solving courts animated by the theoretical concept of therapeutic jurisprudence. Occupational therapy is on the periphery of these developments, but this article argues that the growing emergence of these initiatives presents an important and expanding new area of practice for occupational therapy.