This article offers an overview of Wilcock's theories, from the field of occupational science, and relates them to the community care of people with severe mental health problems. Wilcock's occupational risk factors — imbalance, deprivation and alienation — are described and are seen to be reinforced both by the adaptive nature of this client group's problems and by the difficulties experienced by community-based services as they evolve to address the unfolding complexity of clients' needs. The potential for chronicity to be compounded and deepened in this way is highlighted, with particular reference to vocational and social disability, and the possible implications of a wider acknowledgement of occupational risk factors are discussed in relation to day-to-day practice and service configuration.
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References
1.
AvisonWR (1996) Social networks as risk and protective factors for onset and recurrence of mental disorders. Current Opinion in Psychiatry, 9, 149–52.
2.
BartlettHAshleyAHowellsK (1996) Evaluation of the Sonning common health walks scheme. Oxford: Oxford Centre for Health Care Research and Development, Oxford Brookes University.
3.
BaumCMLawM (1997) Occupational therapy: Focusing on occupational performance. American Journal of Occupational Therapy, 51(4), 277–88.
4.
BeardJHPropstRNMalamudTJ (1982) The Fountain House Model of Psychiatric Rehabilitation. Psychosocial Rehabilitation Journal, 5(1), 47–53.
5.
BeckerTThornicroftGLeeseMMcCronePJohnsonSAlbertMTurnerD (1997) Social networks and service use among representative cases of psychosis in South London. British Journal of Psychiatry, 171, 15–19.
6.
BloomfieldR (1999) GPs prescribe a walk. Time Out, 6–13 January, 43.
7.
BrewerPGadsdenVScrimshawK (1994) The Community Group Network in Mental Health: A model for social support and community integration. British Journal of Occupational Therapy, 57(12), 467–70.
8.
BryantW (1995) The Social Contact Group: An example of long-term group work in community mental health care. British Journal of Occupational Therapy, 58(5), 214–18.
9.
ClarkFWoodWLarsonE (1998) Occupational science: Occupational therapy's legacy for the 21st century. In: NeistadtMCrepeauEB, eds. Willard and Spackman's occupational therapy. 9th ed.Philadelphia: Lippincott, 13–21.
10.
CooperJSartoriusN (1997) Cultural and temporal variations in schizophrenia: A speculation on the importance of industrialisation. British Journal of Psychiatry, 130, 50–55.
11.
CraikCChacksfieldJDRichardsG (1998) A survey of occupational therapy practitioners in mental health. British Journal of Occupational Therapy, 61(5), 227–34.
12.
CreeganSWilliamsFLR (1997) Supportive employment for individuals with chronic schizophrenia: The case for a National Health Service community-based workshop. Occupational Therapy International, 4(2), 99–115.
13.
CreekJ (1998) 1998 AOTMH Lecture: Identifying good practice in occupational therapy. Mental Health OT, 3(2), 14–20.
14.
CursonDAPatelMLiddlePFBarnesTRE (1988) Psychiatric morbidity of a long-stay hospital population with chronic schizophrenia and implications for future community care. British Medical Journal, 297, 819–22.
15.
DalgardOSTambsK (1997) Urban environment and mental health. British Journal of Psychiatry, 171, 530–36.
16.
DawkinsR (1996) River out of Eden. London: Orion.
17.
Department of Health (1990) The Care Programmes Approach for people with a mental illness referred to specialist psychiatric services. HC (90) 232/LASSL (90) 11. London: DH.
18.
Department of Health (1996) Building bridges: A guide to arrangements for inter-agency working for the care and protection of severely mentally ill people. London: DH.
19.
Department of Health (1999) The national service framework for mental health. London: DH.
20.
DurhamT (1997) Work-related activity for people with long-term schizophrenia: A review of the literature. British Journal of Occupational Therapy, 60(6), 248–52.
21.
EmersonHCookJPolatajkoHSegalR (1998) Enjoyment experiences as described by persons with schizophrenia. A qualitative study. Canadian Journal of Occupational Therapy, 58(5), 214–18.
22.
FalloonIRHShanahanWJ (1990) Community management of schizophrenia. British Journal of Hospital Medicine, 43, 62–66.
23.
FieldDTaylorS (1998) Conceptualising chronic illness. In: FieldDTaylorS, eds. Sociological perspectives on health, illness, and health care. Oxford: Blackwell Science, 3–20.
24.
FinlayL (1997) The practice of psychosocial occupational therapy. 2nd ed.Cheltenham: Stanley Thornes.
25.
FreemanH (1993) The history of British community psychiatry. In: DeanCFreemanH, eds. Community mental health care — international perspectives on making it happen. London: Royal College of Psychiatrists, 1–17.
26.
GolledgeJ (1998a) Distinguishing between occupation, purposeful activity and activity, part 1: Review and explanation. British Journal of Occupational Therapy, 61(3), 100–105.
27.
GolledgeJ (1998b) Distinguishing between occupation, purposeful activity and activity, part 2: Why is the distinction important?British Journal of Occupational Therapy, 61(4), 157–60.
28.
HollowayFFaulknerA (1994) Psychiatric hospital reprovision and the longstay patient: Clinical outcome and the user perspective. Journal of Mental Health, 3, 241–48.
29.
JonesB (1993) Sleeper, wake! Ten years on. Journal of Occupational Science: Australia, 1(1), 11–16.
30.
KeableD (1997) The management of anxiety: A guide for therapists. New York: Churchill Livingstone.
31.
KielhofnerG (1997) Conceptual foundations of occupational therapy. 2nd ed.Philadephia: FA Davis.
32.
KielhofnerGBurkeJ (1977) Occupational therapy after 60 years: An account of changing identity and knowledge. American Journal of Occupational Therapy, 31(10), 675–89.
33.
KielhofnerGForsythK (1997) The Model of Human Occupation: An overview of current concepts. British Journal of Occupational Therapy, 60(3), 103–10.
34.
KieslerCA (1992) Some observations about the concept of the chronically mentally ill. In: KesslerMGoldstonSEJoffeJM, eds. The present and future of prevention. London: Sage, 55–66.
35.
LangfordCPHBowsherJMaloneyJPLillisPP (1997) Social support: A conceptual analysis. Journal of Advanced Nursing, 25, 95–100.
36.
LeffJTriemanN (1997) Providing a comprehensive community psychiatric service. In: LeffJ, ed. Care in the community: Illusion or reality. Chichester: Wiley.
37.
LittlewoodRLipsedgeM (1997) Aliens and alienists: Ethnic minorities and psychiatry. 3rd ed.London: Routledge.
38.
LloydCSamraP (1996) Healthy lifestyles: A community programme for chronically mentally ill people. British Journal of Occupational Therapy, 59(1), 27–32.
39.
LockieDM (1989) The influences upon the management of mental health services this century. British Journal of Occupational Therapy, 52(1), 21–22.
40.
Mental Health Foundation (1993) Mental illness: The fundamental facts. London: Mental Health Foundation.
41.
MitchellRETrickettEJ (1980) Task force report: Social networks as mediators of social support. Community Mental Health Journal, 16, 27–44.
42.
MorganS (1996) Helping relationships in mental health. London: Chapman and Hall.
43.
MounterCIlottI (1997) Occupational science: A journey of discovery in the United Kingdom. Journal of Occupational Science: Australia, 4(2), 50–55.
44.
NolanP (1995) Survey of the social networks of people with severe mental health problems. Journal of Psychiatric and Mental Health Nursing, 2, 131–42.
45.
OrmstonC (1999) The national service framework for mental health: Worth waiting for?Occupational Therapy News, 7(12), 10–12.
46.
OxleyC (1995) Work and work programmes for clients with mental health problems. British Journal of Occupational Therapy, 58(11), 465–68.
47.
PerkinsRBuckfieldRChoyD (1997) Access to employment: A supported employment project to enable mental health service users to obtain jobs within mental health teams. Journal of Mental Health, 6(3), 307–18.
48.
RyanPFordRCliffordP (1991) Case management and community care. London: Research and Development for Psychiatry.
49.
SladeMPowellRStrathdeeG (1996) Current approaches to identifying the severely mentally ill. Social Psychiatry and Psychiatric Epidemiology, 32, 177–84.
50.
StevensAPriceJ (1996) Evolutionary psychiatry: A new beginning. London: Routledge.
51.
StewardB (1997) Employment in the next millennium: The impact of changes in work on health and rehabilitation. British Journal of Occupational Therapy, 60(6), 268–72.
52.
St JohnW (1998) Just what do we mean by community? Conceptualisations from the field. Health and Social Care in the Community, 6(2), 63–70.
53.
ThornicroftGTansellaM (1999) The mental health matrix — a manual to improve services. Cambridge: Cambridge University Press.
54.
WarnerR (1994) Recovery from schizophrenia: Psychiatry and political economy. 2nd ed.New York: Routledge.
55.
WatkinsJ (1996) Living with schizophrenia — an holistic approach to understanding, preventing and recovering from ‘negative’ symptoms. Melbourne: Hill of Content.
56.
WhitefordG (1995) A concrete void: Occupational deprivation and the special needs inmate. Journal of Occupational Science: Australia, 2(2), 80–81.
57.
WhitefordG (1997) Occupational deprivation and incarceration. Journal of Occupational Science: Australia, 4(3), 126–30.
58.
WiersmaD (1996) Measuring social disabilities in mental health. In: ThornicroftGTansellaM, eds. Mental health outcome measures. Berlin: Springer-Verlag, 111–22.
59.
WilcockAA (1993a) A theory of the human need for occupation. Journal of Occupational Science: Australia, 1(1), 17–24.
60.
WilcockAA (1993b) Editorial. Journal of Occupational Science: Australia, 1(1), 1–2.
61.
WilcockAA (1995) The occupational brain: A theory of human nature. Journal of Occupational Science: Australia, 2(1), 68–73.
62.
WilcockAA (1998a) An occupational perspective of health. Thorofare, NJ: Slack.
63.
WilcockAA (1998b) Occupation for health. British Journal of Occupational Therapy, 61(8), 340–45.
64.
WilcockAA (1998c) A theory of occupation and health. In: CreekJ, ed. Occupational therapy: New perspectives. London: Whurr.
65.
WilcockAA (1999) Reflections on doing, being, and becoming. Australian Occupational Therapy Journal, 46, 1–11.
66.
WilcockAAChelinMHallMHamleyNMorrisonBScrivenerLTownsendMTreenK (1997) The relationship between occupational balance and health: A pilot study. Occupational Therapy International, 4(1), 17–30.
67.
YerxaEJ (1993) Occupational science: A new source of power for participants in occupational therapy. Journal of Occupational Science: Australia, 1(1), 3–10.
68.
YerxaEJ (1994) Dreams, dilemmas, and decisions for occupational therapy practice in a new millennium: An American perspective. American Journal of Occupational Therapy, 48(7), 586–98.
69.
YerxaEJ (1998) Health and the human spirit for occupation. American Journal of Occupational Therapy, 52(6), 412–18.
