Occupational Therapy Practice in Community Mental Health: Four Case Examples

Maggie Armstrong, Washington University in St. Louis

Occupational therapy practitioners have a long history of providing mental health services and have a distinct value in promoting full, productive lives through mental health promotion, prevention, and intervention (American Occupational Therapy Association [AOTA], 2015; Burson et al., 2017). Despite confidence in this role, the percentage of therapists working in mental health decreased from 5.2% in 2000 to 2.4% in 2015 (AOTA, 2015). Students may be interested in pursuing work in this area, but the role of occupational therapy outside the medical model is often unclear. To provide insight into this practice area, this article presents four examples of occupational therapy practitioners working in community mental health in the U.S.

1. Community Re-Entry

Claire Daaleman, MOT, OTR/L, and Christine Hayes, MOT, OTR/L, work for Occupational Therapy Transition and Integration Services (OTTIS) to provide occupational therapy services to individuals experiencing incarceration both before and after their release (Jaegers et al., 2020). This continuity of services is unique; many other re-entry programs offer their services either while people are incarcerated or after they’re released, but not both. Pre-release, Smith and Johnson provide a 6-week group program that covers areas of career exploration, coping skills, social skills and communication, employment, and community living skills. They also provide one-on-one sessions to address goals on an individual level. This programming allows clients to plan for community transition, develop communication and parenting skills, manage mental and physical health, and develop employment-seeking skills. Post-release, clients are seen on an individual basis once per week, with decreasing frequency as they integrate into the community. This support allows clients to attain employment and housing, manage finances, and develop supportive networks while engaging in healthy occupations.

2. Transitional Housing

Lindsey Segal, OTA, carries a lot of responsibilities at a transitional housing center as one of four full-time employees and the only occupational therapy assistant. When clients enter the center, Williams works with them to identify goals and barriers they face to reach independent living. This intake process is used to develop a treatment plan implemented by the team. On a daily basis, Williams is running both group and individual programming. Group activities include grocery shopping, cooking, IADLs, and a weekly outing. Individual meetings build off of the group material based on client needs. These activities and skills help to increase productive participation in the community, such as writing a résumé to get a job. In addition to this, Williams is also responsible for continuously re-assessing clients and monitoring their overall health.

3. Director of Programming

As a program director, Stephanie Schmidt, OTR/L, supervised both a transitional housing and a day program for individuals with HIV experiencing homelessness. She was responsible for the success of the clients and overall program. She noted that there are differences working with this population compared with individuals with other mental health concerns. This community of people with HIV is a very close social group, and Brown found that she frequently worked to manage relationships between individuals. When working with her groups, she needed to be aware of who was building a relationship, who had just broken up, who was having sex, and who had an attitude toward someone else. While difficult family relationships contribute to homelessness for a variety of clients, those with HIV are more likely to experience family rejection due to their sexual behavior, particularly among groups with more traditional social or religious cultures. Because of this, Brown emphasized that it is essential for practitioners to understand the social lay of the land and really work to understand the person first.

4. Comprehensive, Recovery-Based Organization

Greg Seymour, OTD, OTR/L, works for a large organization that takes a recovery-based treatment approach to mental illness and substance use disorders. After intake, clients are assigned to a team based on the intensity of care and supports needed to maintain independence in the community. While this organization provides a plethora of services, Davis leads a team that specifically addresses physical wellness. Davis and his three other team members use a method called wellness coaching in order to help clients identify and achieve goals of healthy living. Addressing one goal at a time, the team is there to support the individual in eliminating barriers and creating change. For example, if a person’s goal is to eat a serving of vegetables four days a week, Davis may help the client make a week-long plan to address saving money. Once that is achieved, they may next address transportation to a grocery store. Davis and the client evaluate how the plan is going each week and what needs to be done next. With this method, Davis and his team are able to promote success in the healthy daily living of their clients.

Future Directions

Despite strong satisfaction with their work, these therapists did identify various barriers or difficulties they faced in community-based mental health. Lack of funding was a common theme. This challenge resulted in both a lack of materials to run programs and a lack of therapists to efficiently reach goals. Occupational therapy practitioners were noted as an underutilized resource within organizations in part due to higher salary benchmarks than unskilled workers. Additionally, the organization providing re-entry services before and after incarceration had unique barriers of the lack of an electronic medical record system and decreased access to ADL or IADL activities due a lack of materials in the jails or prisons. Importantly, all therapists noted the struggle of watching how the social system fails people, particularly those with mental illness, because of a lack of supports. This can often be the hardest part of the job, and it takes an emotional toll on the therapist.

As future practitioners, students interested in mental health should take note of the roles of current practitioners and identify barriers as potential areas of growth. Students can use key elements of OT practice, such as our holistic lens and creativity, to address these barriers and support our clients. Additionally, students should develop strong advocacy skills for themselves, their clients, and the overall profession. This advocacy is key to increasing the involvement of occupational therapy in mental health and increasing success for our clients.

References

American Occupational Therapy Association (2015). 2015 AOTA salary and workforce survey. Retrieved from https://www.aota.org/Education-Careers/Advance-Career/Salary-Workforce-Survey/work-setting-trends-how-to-pick-choose.aspx  

Burson, K., Fette, C., & Kannenberg, K. (2017). Mental health promotion, prevention, and intervention in occupational therapy practice. American Journal of Occupational Therapy, 71, 1–19. https://doi.org/10.5014/ajot.2017.716S03

Jaegers, L. A., Skinner, E., Conners, B., Hayes, C., West-Bruce, S., Vaughn, M. G., …Barney, K. F. (2020). Evaluation of the jail-based occupational therapy transition and integration services program for community reentry. American Journal of Occupational Therapy, 74, 7403205030. https://doi.org/10.5014/ajot.2020.035287

Maggie Armstrong is a third-year OTD student at the Washington University School of Medicine Program in Occupational Therapy. During her time in the program she has helped to lead a student-run career fair, established a preliminary program to support neurodiverse students entering college, and participated in three musicals put on by the medical school. Maggie has many interests within the field of occupational therapy and is excited to see where her future career takes her.