The announcement of the Mental Health Inquiry – with its focus is on restoration, generated a few thoughts I wanted to share about investing in new mental health disciplines to support the current stretched workforce.
In particular the potential that my own discipline of recreation therapy has to offer to mental health services.
I believe that a central issue in the current state of our mental health services is one of resourcing – including the supporting of training.
The existing mental health system is relying on overstretched resources without investing in additional allied health input (New Zealand’s two recreation therapist degree programmes closed down nearly a decade ago). I believe that government provision needs to be made for allowing budding professionals time to develop as effective practitioners and by supporting the teaching programmes in the respective disciplines.
My thoughts are based on my own experience as a New Zealand recreation therapy degree graduate and my time as a recreation therapy student intern working in the United States as part of an established multi-disciplinary team based in a mental health setting. (Following my internship I sat and passed the US professional exam set by the National Council for Therapeutic Recreation Certification or NCTRC.)
That experience has helped me reflect on how health systems are structured, and this notion of ‘building capacity’ in the health workforce.
Some history about recreation therapy
The recreationtherapy.com website traces the origins of recreation therapy back to Hippocrates and points to people like Florence Nightingale, Dorothea Dix, Jane Addams and Joseph Lee as figures that recognised the value of recreational activity as therapeutic for populations they served.
Benjamin Rush, ‘the father of US psychiatry’ who signed the US Declaration of Independence, also recognised the therapeutic value of recreation activities for people with mental illness. His nephew William Rush Dunton Jr trained as a physician, and maintained an interest in the healing potential of occupational activities for patients throughout his career and wrote the 1918 textbook on Occupational Therapy for Nurses. He went on in 1936, in collaboration with Dr John Eisele Davis, to define recreation therapy as:
“Any free, voluntary and expressive activity; motor, sensory or mental, vitalized by the expansive play spirit, sustained by deep-rooted pleasurable attitudes and evoked by wholesome emotional release; prescribed by medical authority as an adjuvant in treatment.”
This definition is one of many but is important as it characterises the profession as having an important allied health role. This role continues with more than a third of the about 15,000 certified recreational therapists in the United States currently work in behavioural health settings.
Background to recreation therapy training in New Zealand
Recreation therapy (also known as ‘therapeutic recreation’ or ‘recreational therapy’) was first established in Aotearoa New Zealand in 1998 at the Eastern Institute of Technology (EIT).
This was through the efforts of a Kiwi, Dr Glenda Taylor, who had a PhD from Texas Women’s University and had taught at Grand Valley State University (Michigan) for 11 years.
A degree programme was established at EIT in 1999, and at the Southern Institute of Technology (SIT), Invercargill in 2001. These programmes were established following consultation with health and human service professionals, organisers and community groups who saw a role for recreation therapy.
The two teaching programmes ran for close to a decade, with support from an Australian lecturer and the input of a range of American-based lecturers. It’s estimated that twelve classes graduated from the two programmes between 2001 and 2008, with graduates progressing into a range of areas (including the mental health and addictions treatment sector). Programme closures were primarily due to a combination of government funding constraints and declining enrolments. Despite the closures the content of the recreation therapy degrees remain relevant and I believe New Zealand RT degree graduates can help make a difference to client’s mental health outcomes and help build the profession.
For the profession to become firmly established in Aotearoa there would need to be not only sustainable teaching programmes re-established but also a rigorous national body to oversee the profession, and for the profession’s graduates to meet the Health Practitioners Competence Assurance (HPCA) Act requirements brought in by the last Labour government in 2004. These HPCA regulations are compatible with the US’s stringent NCTRC criteria to ensure the safety of therapist clients. This would need sustained commitment and support from stakeholders (government, tertiary institutions, social agencies, and prospective students) to establish and sustain the profession in Aotearoa New Zealand.
To this graduate such a move could support the restoration of the mental health/addictions sector and falls inside the purpose and scope of the Mental Health Inquiry. Meanwhile some of my classmates from the RT degree programmes report being employed as activity coordinators and/or being asked to sit the diversional therapist level four qualification despite already having a level 7 degree qualification in recreation therapy.
Recreation therapy and diversional therapy related but distinct
What’s in a name? This was a topic of discussion while training as recreation therapists.
A significant point of difference is that when the ‘TR’ (therapeutic recreation) teaching programmes were being set up diversional therapy or ’DT’ was already well established.
According to its website the Society of Diversional Therapists New Zealand (NZSDT) began following a group of diversional therapists meeting in 1989-90 to discuss promoting their role – often working with elderly people in care – and the need for a recognised qualification, which led to the society being informed in 1992 and a level four certificate being lodged on the Qualifications Framework in 1996. According to Careers NZ, the number of diversional therapists grew from 822 in 2006 to 1,008 in 2013. This growth is due to an ageing population, and increasing numbers of people with disabilities in supported living. A diversional therapy degree was looking to start in Unitec Auckland in 2018 but appears to be on hold. In Australia, there is collaboration between the two disciplines where the respective titles are the major difference.
There is a significant crossover in content, principles, practice and in the populations served between diversional therapists and recreation therapists but I regard recreation therapy as a distinct, but related field to diversional therapy.
The society’s website talks about recreational therapists coming under its umbrella but this reflects the current scenario where DT is the established profession. But I think there’s good reason why recreation therapy could aspire to being more independent in this country.
A US recreation therapy leader emphasises to graduates that ‘recreational therapy is a lot more than diversion!’ and says:
“A designation as a diversional therapist implies a lack of clinical intent and expertise on the part of recreational therapists that is demeaning to them… most recreational therapists dislike being thought of as ‘diversional therapists’… Through the years, recreational therapists have had to defend themselves from the unfair charge that they offer nothing more than diversion for clients…”
This resembles the distinction that Josef Pieper made about leisure not existing for the sake of work. Rather, leisure transcends the everyday sphere of work to be ‘the basis of culture’. Similarly, leisure can be said to transcend diversion, and is a core component of the profession known as recreation therapy.
In my view, that’s an important distinction that contains why this profession is vital to contemporary society. Personally, I would prefer to be identified by the title ‘recreation therapist’, acknowledging those who’ve contributed to the body of TR knowledge both in the past and present. This stance is also consistent with the American Therapeutic Recreation Association (ATRA) position that the use of leisure and recreation modalities in designed intervention strategies is a unique feature of RT/TR that makes it different from other therapies.
Preparing this opinion piece generated a lot of material about the links between recreation therapy and human development, socio-economic and physiological findings that I wanted to include, but that would have turned this piece into a book chapter.
But to conclude I would say that recreation therapy does offer value as a distinct allied health profession and should be included in future health planning. But to flourish, it needs to be nourished.
Shaun Cavanagh is a recreation therapist who graduated with a New Zealand degree in recreation therapy that is no longer offered. He is currently completing a postgraduate Diploma in Public Health via the University of Otago, and administers the Recreation Therapy NZ Facebook page on a voluntary basis while working part-time outside the health sector.