Occupational Therapy and Mental Health

Original Editor - Sehriban Ozmen

Top Contributors - Sehriban Ozmen and Vidya Acharya  

Introduction

Mental health is critically important to everyone and the need in this area is high globally. Although this page is mainly focused on occupational therapy (OT) for people with mental disorders, OT practitioners have an important role in the prevention of mental illness as well as recovery from a mental disorder. They can service all individuals with or without mental health or behavioural problems to develop and maintain positive mental health through facilitating participation and engagement in occupations, and meaningful and necessary activities of daily life.

Assessment Tools

Some of the assessment tools used in OT research on mental health are listed below:

• Role Checklist: It is a tool that collects data about an individual's participation in ten occupational behaviours (student, worker, volunteer, caregiver, home maintainer, friend, family member, religious participant, hobbyist/amateur, participant in organizations, and additional "other" category for the role not listed) and perception of their value in them.
• Interest Checklist: It is a tool that collects data on an individual's strength of interest and participation in 68 activities, mainly focused on leisure interests.
• Disorder specific outcomes: Such as the Montgomery Asberg Depression Rating Scale, the Calgary Depression Scale for Schizophrenia, the Brief Psychiatric Rating Scale, the Beck Depression Inventory or the Hamilton Depression Rating Scale.
• Measurement instruments to assess executive function: Trail Making Test Parts A and B, the Brief Assessment of Cognition in Schizophrenia, the Behavioural Assessment of the Dysexecutive Syndrome, the N-Back Task and the Executive Function Performance Test
• Mini Mental State Examination
• Health-related outcome measures: 36-Item Short-Form Health Survey (SF-36) Questionnaire, the General Health Questionnaire and the Manchester Short Assessment of Quality of Life.

Interventions

OT interventions in mental health are diverse, they can fall into one of these categories:

• Psychosocial intervention
• Psychoeducational intervention
• Cognitive intervention
• Exercise intervention

The common OT approaches/ interventions for psychiatric disorders are:

• Cognitive Behavioral Therapy (CBT),
• Group Therapy,
• Contingency Management,
• Relapse Prevention Model,
• Central Coherence Technique,
• Reminiscence Technique,
• Peaceful Coexistence Technique,
• Interpersonal Therapy (IPT),
• Interpersonal and Social Rhythm Therapy (IPSRT),
• Modeling,
• Conditioning,
• Flooding,
• Systematic Desensitization,
• Art Therapy,
• Narrative Approach,
• Milieu Therapy,
• Relaxation Techniques,
• Stress Management,
• Vocational Training,
• Model Of Human Occupation (MOHO),
• Sensory Diet, Psychodynamic,
• Structural tasks,
• Expressive activities,
• Functional living skills,
• Psychoeducation,
• Social Skills Training,
• Vocational Training.

Evidence

According to a scoping review study focused on OT interventions for adults with severe mental illnesses (SMI) including mostly schizophrenia as well as bipolar disorder, major depressive disorder and obsessive-compulsive disorder, it was concluded that

• Psychosocial interventions improved the symptoms of the disease and social and work reintegration

• Psychoeducational interventions not only improved disease management, but also increased social abilities such as non-verbal techniques, and acquired significant activity such as reading
• Cognitive interventions improved cognitive functions and processing strategies
• Exercise interventions compensated cognitive impairment, which is common in psychiatric disorders, and increased the ability of participants to work as a part of a team

A literature review of OT interventions in mental health including 50 studies divided the interventions into seven themes:

1. in the area of employment or education,
2. involving psychoeducation,
3. using creative occupations and activity,
4. addressing time use or occupational balance, in the area of skills development,
5. lifestyle modifications, and occupational engagement,
6. using group or family approaches and
7. using animals or animal-assisted approaches

Some of the positive outcomes reported in the study were:

• facilitation of employment,
• further educational attainment,
• improvements in psychiatric symptoms,
• quality of life and social functioning.

However it also specified that the evidence is generally at a low level according to Cochrane criteria, only supported employment is evidence-based and there is no firm evidence base for many of the OT interventions used in mental health services, research is still growing on them.

Resources

Occupational Therapy’s Distinct Value in Mental Health

Occupational Therapy in Mental and Behavioral Health

Occupational Therapy Addressing Mental & Behavioral Health in Non-Psychiatric Settings

American Occupational Therapy Association - Occupational Therapy Service Outcome Measures for Certified Community Behavioral Health Centers (CCBHCs)