Mental Health Occupational Therapy Services

Occupational Therapy is a profession concerned with promoting health and wellbeing through occupation. Occupations are the everyday meaningful activities that people engage in or occupy themselves in.

The primary goal of Occupational Therapy is to identify a person’s strengths and barriers to functioning and in turn enable people to participate in necessary and desired activities (occupations) and fulfill life roles. Occupational Therapists are registered health professionals, with an interest in improving the functional abilities of their clients (client as referred to in this document relates to the person undertaking the service).

 

Overview of Mental Health Occupational Therapy

Mental Health Occupational Therapy is a client-centered approach to gaining an understanding of the various factors relating to a person’s occupations (occupation as referred to in this document relates to tasks) and environment that influence the mental health and subsequent functioning of that client.

Mental Health Occupational Therapy assesses which occupations are most meaningful to their clients. 

This approach enables the client to identify and engage in occupations in both work and home settings. 

Engagement in meaningful and purposeful occupations contributes to the client regaining a sense of achievement, self-esteem and well being that may have been affected by their injury/illness. 

 

Why Mental Health Occupational Therapy?

Mental Health Occupational Therapists work alongside other health professionals and service providers to deliver services in the following ways:

• Assessment of functional ability which involves assessing the client’s ability to manage work and home roles and participate actively in these pursuits. 

• Identification of barriers to a client’s functioning within their usual environments (work and/or home) and developing collaborative strategies to overcome these barriers.
• Interventions to assist clients to overcome practical challenges including independent life skills, home maintenance, self care, leisure and health/fitness goals using focused occupational strategies.

 

Early Indicators of Requirement for Mental Health Occupational Therapy Service

The client expresses:

• An inability to function within their work, home, social or recreational environments.
• Disinterest in managing their self care.
• Reduced coping with ordinary occupations at work or home.
• Reliance upon alcohol to sleep.
• Delayed sleep onset and/or frequent waking during the night.
• Apathy towards engaging in usual activities
• Avoidance of friends and family, preferring to stay at home.
• Not able to self organise.
• Inability to perform usual roles at work and/or home.
• Loss of “breadwinner” role.
• Feelings of inadequacy, failure and loss of respect.

Upon identification of any of the above indicators, the Case Manager may consider a referral for an Initial Assessment to determine mental health occupational therapy requirements for the client.

 

Mental Health Occupational Therapy Assessment

The initial assessment is undertaken at a location negotiated with the client using a range of evidence based assessment tools to determine treatment requirements.  Where appropriate a treatment plan will be formulated and detailed in the Initial Assessment Report.

Components of the Initial Assessment may include:

• The client’s level of function in terms of their work and home roles.
• Determination of the occupational performance components, including how the psychological illness or condition impacts on functioning.
• Whether daily routines can be modified/simplified to improve function.
• If re-organisation and/or modification of the physical environment, use of cues and development of   structure/plan for management of day to day activities is required.
• Exploration of factors motivating a client to engage in activities/occupations.

 

Assessment Tools

Some of the tools which may be used during the Initial Assessment include those drawn from the Model of Human Occupation (Kielhofner 2003) which explores the individual’s motivation to engage in occupations (self care, work and leisure), how they structure their time, the physical and mental skills required to perform occupations, and the influence of the environment on occupation. These include:

Worker Role Interview (WRI)

A semi structured interview designed for use as the psychosocial/environmental component of an initial rehabilitation assessment process for the client.  It is designed to have the client discuss various aspects of their life and job setting that have been associated with past work experience. 

The theoretical framework that underpins the WRI seeks to explain how human occupation is motivated, patterned and performed and how those components interact with the environment.

Client Identified Rehabilitation Issues (Occupational Self Assessment)

The Occupational Self Assessment is designed to capture the client’s perceptions of their own occupational competence and of the occupations they consider important.  

This can provide information on occupational performance areas as a focus for change.

The Model of Human Occupation Screening Tool (MOHOST)

The MOHOST is a screening assessment for a broad range of occupational participation issues.  It consists of 24 items exploring motivation, occupational patterning, skill (motor, process, communication and interaction skills) and environment.

 

Other Assessment Tools

Depression, Anxiety, Stress Scale (DASS-42)

Although not an occupational therapy specific tool, the DASS-42 is a useful 42 item self report designed to measure the three negative emotional states of depression, anxiety and tension/stress.

A four point severity/frequency scale is used to rate the extent to which the client has experienced each state over the last week.

Domestic and Community Skills Assessment (DACSA)

The DACSA (Collister & Alexander 1991) is used to assess a person’s performance of essential tasks for living in the community, through a behavioural rating scale and commenting on qualitative aspects of client’s performance. 

 

Initial Assessment Report

A comprehensive Initial Assessment Report is compiled using the results of the tools administered during the initial assessment. 

Treatment

Upon approval to proceed with the treatment plan, regular consultations will be undertaken during which the identified functions requiring attention will be addressed with particular focus on their affect on the following skills:

• Work and Productivity Skills empower the client to practice and develop skills that enable them to return to work and/or engage in retraining

• Life Skills facilitate enhancement of the client’s independence in managing daily tasks and the prevention of relapse.

• Leisure and Recreation Skills provide opportunities for the client to engage in a range of options to develop interests that they can undertake independently in the community.

• Social Skills underpin the client’s ability to progress in all of the above areas and provides increased confidence to relate with others effectively in a range of settings.

Progress Report

A mid treatment report is provided to the Case Manager detailing progress achieved.  The assessment tools used in the initial assessment are re-applied enabling measurement of progress to be reported.

Outcomes

Following treatment cessation a closure report is generated, again using the same assessment tools to enable measurement of progress to be ascertained.