More focus needs to be placed on helping mental health clients participate in daily life – not just reducing symptoms, argues the occupational therapists’ national association.

The call for greater emphasis on measuring people’s mental health recovery on how well clients can do what they want and need to do, is made in the association’s submission to the Mental Health and Addiction Inquiry.

Occupational Therapy New Zealand – Whakaora Ngangahau Aotearoa (OTNZ-WNA) is the professional association for the country’s around 2700 occupational therapists which this week are celebrating Occupational Therapy Week leading up to World Occupational Therapy Day on October 27.  About half of occupational therapists work in district health boards and the remainder in the NGO, private and education sectors.

Harsh Vardhan, co-president of OTNZ-WNA, said occupational therapists’ work is basically to help people to be independent in their day to day occupations. Not just occupation in the job sense but all the things people do, for example, if working with a young child it may be helping them to play or to tie their shoelaces, while for the elderly it may be helping them to continue gardening or do the weekly grocery shop.

“It’s basically whatever keeps us occupied throughout the day in a meaningful way.”

In mental health the focus of occupational therapists is on “getting people back to doing what they want, need and must do, to get well and stay well”.

Vardhan said the association heard from therapists working in mental health around the country that while talking therapies are evidence-based, well-used treatments in mental health they were not suitable for all mental health clients. Also despite the focus on increasing access to talking therapies the waiting lists still remain long.

The OTNZ-WNA submission to the Mental Health and Addiction Inquiry the association argues that there is an over-emphasis on talking therapies (like psychotherapy, psychological therapy and counselling) at the cost of ‘doing’ therapies like those provided by occupational therapists.

“The Government has been investing in talking therapies, but comparatively there has been minimum investment in ‘doing’ therapies,” said Vardhan.

He said an example of a ‘doing’ therapy was when he worked with a 16-year-old with depression who wanted to buy more computer games but was too anxious to leave the family home on his own to go shopping.

Vardhan worked with the boy on a ‘doing’ action plan spread over several months that started with them on the first visit researching online the bus route to the closest mall. The next visit Vardhan and the boy drove behind the bus on its journey to the mall, on the third visit the pair took a trip on the bus together, the fourth visit the boy travelled on the bus on his own with Vardhan following in the car and, after several months of gradual desensitisation to his fears the boy was able to make the trip alone.

Vardhan said not only did occupational therapists want to see greater emphasis on ‘doing’ therapy their inquiry submission also called for a re-look at how mental health services monitor and measure client’s progress.

“People measure their own health and wellbeing by what they can and can’t do, our health service needs to focus on outcomes that are related to the persons’ participation in occupations rather than symptoms they are experiencing,” says the submission.

Vardhan said a lot of emphasis was placed on reducing mental health symptoms but what a person ‘does’ and their health and wellbeing were closely woven together.  “When a person’s mental wellbeing is compromised, what they do, and how they go about their day starts to unravel,” he said.

He said mental health client having delusions or hallucinations can be more worried about the whether they can still go grocery shopping or have a swim than they are by the actual symptoms. “So if we want to measure the success of any mental health programme, for example, we have to look at measuring functional outcomes, like what the client can or cannot do, and their quality of life.”

The association says occupational therapists can shift the focus in mental health from ‘what is the matter with’ patients to ‘what matters’ to them. It says currently occupational therapists are being used to do generic mental health roles. “Without having opportunity to work at the top of their scope and develop their skills, occupational therapists risk losing their professional identity, and the impact for service users is that the access to occupational therapy is significantly restricted,” it argued.

1 COMMENT

  1. Harsh Vardhan is right : more “doing” than just “talking” therapies are needed in mental health. Let us just pause a minute and establish what we here mean by “mental health” – and the role of occupational therapy. I am confident that Vardhan by this means mainly functional and organic dementia (??). There may be areas within the neuroses where OT can be helpful – but generally speaking, I doubt OT can be of much assistance within the endogenous depressions (possibly, though, in reactive depressions).

    And let us agree : not only do we need less “talk-therapy” in the cases of functional and organic dementia – we actually need none at all, simply because it is here quite inefficient. These illnesses are chronic, incurable – so, eo ipso, talk-therapy in any shape or form is useless in a clinical situation. OT is of proven assistance here – but, sadly, no longer recognised as it used to be. .

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