Mental health – An area of high priority in occupational therapy

Mental health problems are prevalent in today’s society, and have been so throughout history. Mental health is also historically at the core of the development of occupational therapy. A special issue of the British Journal of Occupational Therapy where mental health occupational therapy is set in focus is therefore much needed and welcomed. Seven articles have been prioritized for this issue, covering a broad range of topics of relevance for people with mental illness, from evaluation of occupational therapy interventions over naturally occurring everyday activities in the target group, to occupational therapists’ perceptions of methods for therapy and assessment.

A qualitative study from the UK of veterans with mental health problems, who participated in a workshop to enhance everyday occupations and resilience, shows that the participants made occupational goals and started to make lifestyle changes, developed understanding of the impact of occupation on health, and reflected on their recovery journeys (Vaughan-Horrocks et al., 2020). Just as in many other group-based occupational therapy programmes (Lund et al., 2019), the benefits of being in a group were highlighted.

Yet an intervention-focused article addresses the feasibility of conducting a full-scale clinical trial of an intervention developed for people with psychosis (Inman et al., 2021). The study, conducted in the UK, examines a number of possible outcome assessments in a process evaluation, which also includes recruitment and retention of participants, delivery and feasibility of the intervention, and adherence to the intervention. Feasibility studies are utterly important to optimize conditions for a full-scale trial. This was obvious from the study findings, which show that although feasibility in general was concluded, recruitment needed further considerations, as did the tested selection of outcome assessments.

A fairly novel intervention, sensory modulation, is targeted in an Australian qualitative study addressing insights gained by both people with schizophrenia who had participated in sensory modulation and the treating occupational therapists (Machingura et al., 2021). Insights from service users and staff converged, and the findings highlight, for example, an emphasis on both service user education and staff training, using a variety of tools, and that sensory modulation was highly valued.

Another study performed in Australia investigates activity and participation patterns among users of mental health services (Jennings et al., 2020). This quantitative cross-sectional study also sought to identify possible associations between such patterns and demographic characteristics. In line with previous research (Bejerholm and Eklund, 2004, 2006), the findings show that home-based activities and unpaid work were the most common activities. The study also identifies some demographic characteristics with associations to patterns of activity and participation, such as older users being less active in employment and physical activity and female and culturally diverse users being less likely to engage in community activities.

Using virtual reality in social skills training with people with schizophrenia is the subject matter in a two-phase study, where the first is a literature review and the second is based on a focus group composed of occupational therapists trained in mental health and multimedia professionals (Oliveira et al., 2021). The aim of the Portuguese study was to identify guidelines for social skills training based on use of virtual reality. Themes from the literature review and the focus group converged and the authors identified a set of guidelines, pertaining to program structure, software use, targeted skills, barriers for virtual reality use, and virtual reality potential.

When working in assertive community treatment (ACT) teams, occupational therapists tend to work as generalists. This was the incentive for a Canadian qualitative study exploring the ideal practice for occupational therapists working in ACT teams supporting people with severe and persistent mental illness (Lama et al., 2021). Interviews with occupational therapists generated themes that expressed an ideal where the occupational therapist used their specialist practice skills: a practice that involved setting and pursuing occupational goals; organising space for occupational therapy practice; and supporting service users in their recovery to find their best occupational self.

Another study addressing occupational therapists’ views of their practice concerns UK-based occupational therapists’ use of the Model of Human Occupation Screening Tool (MOHOST) (Bugajska and Brooks, 2020). A national survey – addressing the characteristics of usefulness, satisfaction, ease of use and ease of learning – was sent out to occupational therapists working in mental health services to evaluate the use of MOHOST. A majority of therapists scored the MOHOST favourably on all characteristics, finding it valuable in terms of providing an overview of assessed service users and guiding interventions. Downfalls were indicated as well, such as time consumption and inaccessible terminology, suggested as possible to overcome by more importance placed on training.

So, what do we learn from these seven articles? Several ideas for interventions are presented and tentatively evaluated, and since interventions must be seen as the core of occupational therapy this is important knowledge for how to enrich and improve occupational therapy practice in mental health care services. We also get an example of a feasibility study, an important step before making a full-scale trial of intervention outcomes. Another study shows us that demographic factors may have a significant impact on the ability of service users to participate in activities, which suggests that targeted approaches to activity and participation interventions may be warranted for specific groups of service users. Occupational therapists’ reflections on their own practice are important learnings as well, and an insight provided in this special issue is that better use of specific occupational therapy practices would be feasible for occupational therapists working on ACT teams, and possibly also in other multi-professional teams in community mental-health services. Another insight concerns a specific tool, MOHOST, commonly used by occupational therapists in mental health services. It was seen as valuable and useful, but also as weakened by some drawbacks that, however, could be surmounted.

The research presented in this issue is based in the UK, Australia, Canada and Portugal. Being performed in western countries, the research represents important but yet limited aspects of mental health occupational therapy practice. Contributions from other cultural contexts, as well as research on minorities in mainstream cultures, could supplement current knowledge regarding therapeutic encounters and methods. Gender is another topic of great concern for occupational therapy, in mental health services but also in occupational therapy in general. Does the fact that most occupational therapists are female impact on the interventions delivered? Are women and men treated equally in mental health occupational therapy practice? These are only a few of future possible strands for research.

It is encouraging that so much is known already regarding mental health occupational therapy, and the unknown opens exciting and tempting avenues for future research.