Spotlight on occupational therapy in mental health

In March 2007, the Australian Occupational Therapy Journal published a Special Issue on mental health. The editorial of this Special Issue was written by Professor Terry Krupa (Krupa, 2007). In her editorial, Krupa recalled a conversation she had over dinner with John Strauss, a renowned psychiatrist and mental health researcher. Strauss is described as a supporter of occupational therapy while being provocative in his desire to push the mental health field to be more inclusive of diverse perspectives to better support recovery. On this particular occasion, Strauss asked the following question ‘So Terry, when is occupational therapy going to stop being a handmaiden to psychiatry?’ (Krupa, 2007, p.2).

Strauss’s argument was that our profession failed to demonstrate the link between occupation and improved mental health while having made this link a central part of our philosophical, theoretical, and ideological underpinnings. Do we, as Strauss argued, position our interventions as ‘secondary to biomedical treatments that are directed to the ‘real work’ of ameliorating illness’ (Krupa, 2007, p.2)?

Fifteen years on from that editorial, let’s put the spotlight on occupational therapy in mental health and explore some of the strategies and interventions that are available to mental health occupational therapists to promote and embed the link between occupation and improved mental health in their practice.

Action over inertia is a manualised intervention designed for people with a severe and enduring mental illness and who are experiencing significant occupational imbalance and occupational disengagement (Krupa et al., 2007). The focus of Action over Inertia is on occupational time use to support people re-engage in occupations that bring meaning and purpose and facilitate occupational engagement.

Formulation has been used in mental health by psychologists for several years (Brooks & Parkinson, 2018). Formulation has been described as ‘an iterative and collaborative process, taking the form of a working hypothesis based on a shared psychological understanding between the psychologist and person in need of support’ (Mayers & Agnew, 2019, para. 6). Occupational therapists further developed the process of formulation into an occupational formulation that integrates occupational therapy frameworks and concepts to make sense of a person’s specific circumstances (Brooks & Parkinson, 2018, Parkinson & Brooks, 2021, Parkinson et al., 2011). Interpreting results from assessment procedures with an occupational therapy lens will ensure that goal setting, completed collaboratively with each client, will remain occupation focussed.

The Victorian Mental Illness Awareness Council (VMIAC) is run by consumers and for consumers of mental health services. It is the peak Victorian body for people with a lived experience of mental ill-health. In 2019, VMIAC co-created their collective vision for mental health services to answer their needs and support their recovery and dreams. The Declaration includes eight topics: the lived experiences of participants, social change, concepts to shape the mental health system, people and values, places and services, actions and supports, access, and participants life outcomes (VMIAC, 2019). Occupational therapists have clearly been identified as an important group of people those with lived experience of mental ill-health want to work with. In the words

of those who developed the Declaration, occupational therapist can contribute to creating ‘the kind of society, systems, services, places and supports that matter’ to consumers of services (VMIAC, 2019, p.2).

These are only a few examples of changes in occupational therapy in mental health that occurred since John Strauss had that conversation with Terry Krupa. There are other initiatives in which that promote the link between occupation and improved mental health. Organisations like the Centre for Mental Health Learning that employ a Statewide Mental Health Occupational Therapy Educator support the development of the occupational therapy mental health workforce and can contribute to ensuring an ongoing focus on occupation-based interventions in mental health. The Thinking Ahead Mental Health project led by Occupational Therapy Australia is another initiative centred around developing knowledge and strategies that will support a dynamic and occupation-focused workforce driving a contemporary mental health system. Provocative questions, like the one posed to Terry Krupa, challenge how we think about our discipline, what we do and why we do it. They promote further reflection and advancement of our profession and ultimately, enhance the occupational therapy experiences and health outcomes of our clients and their supports.

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