Occupational Therapy in Mental Health: A Vision for Participation

844 Pages·2019·19.261 MB·English

by  Catana Brown, Virginia C Stoffel, Jaime Munoz

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Occupational Therapy
in Mental Health
A Vision for Participation
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Occupational Therapy
in Mental Health
A Vision for Participation
EEddiittoorrss::
Catana Brown, PhD, OTR, FAOTA
Associate Professor
School of Occupational Therapy
Touro University–Nevada
Las Vegas,Nevada
Virginia C. Stoffel, PhD, OT, BCMH, FAOTA
Chair,Associate Professor
University of Wisconsin–Milwaukee
College of Health Sciences
Department of Occupational Therapy
Milwaukee,Wisconsin
AAssssoocciiaattee EEddiittoorr::
Jaime Phillip Muñoz, PhD, OTR/L, FAOTA
Associate Professor
Department of Occupational Therapy
Duquesne University
Pittsburgh,Pennsylvania
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Library ofCongress Cataloging-in-Publication Data
Occupational therapy in mental health:a vision for participation/editors,Catana Brown,Virginia C.Stoffel;
associate editor,Jaime Phillip Munoz.
p. ;cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8036-1704-9
ISBN-10: 0-8036-1704-6
1. Occupational therapy. 2. Mentally ill—Rehabilitation. I. Brown,Catana. II. Stoffel,Virginia C.
III.Munoz,Jaime Phillip.
[DNLM: 1. Mental Disorders—therapy. 2. Occupational Therapy—methods. 3. Patient
Participation. WM 450.5.02 0148 2011]
RC487.0252 2011
616.89’165—dc22
2010008001
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To Alan
—TB
To Bob
—GS
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Foreword
This is a text we have all been waiting for—a contemporary This book advances the practice ofoccupational therapy,
occupational performance, client-centered, and evidence- reframing much ofpractice from group skill training to a life
based approach to occupational therapy in mental health. skill and occupational approach that fosters participation.It
People, regardless of their diagnosis, are individuals with also integrates knowledge from the behavioral,environmen-
roles,goals,hopes,and aspirations to live life to the fullest. tal,and occupational sciences.
Mental illness touches each of us. It is so prevalent today, I can’t finish this foreword without saying a few words
with problems ranging from developmental disabilities and about the editors.Tana Brown and Ginny Stoffel have ded-
autism to eating and substance-related disorders,from per- icated their careers to a vision ofoccupational therapy as a
sonality and mood disorders to schizophrenia. People we far-reaching helping science that,within its practice guide-
know and love have these conditions, and they require the lines,can be shaped and applied to benefit people in new
knowledge and skills that occupational therapists and occu- ways and in broader areas ofneed.This textbook is a result
pational therapy assistants can provide to help them manage of their vision.They are both passionate about their pro-
their condition in home, family, work, and community fession and about the people who will benefit from the
activities.The overall objective ofoccupational therapy is to knowledge they have compiled.I can’t help but think that
enable participation,and that is the focus ofthis book. our earlier leaders in mental health—Dr. Adolph Meyer,
The editors and chapter contributors have employed a Dr.William Dutton, and Eleanor Clark Slagle, to name a
contemporary approach to their effort by organizing the text few—who knew the power of occupation and stressed the
with a person-environment-occupation approach; such an importance of engagement in an enabling environment,
approach situates the book in most contemporary models would be pleased to see this work come to a format that
being developed in occupational therapy today. They want would guide clinicians to make a difference in the everyday
the learner to understand the lived experience ofpeople with lives of people with mental challenges who require the
mental illness and have used a very personal and innovative skills of an occupational therapist. This book should be
approach called PhotoVoice, using narratives of persons required reading for all occupational therapists who work
with mental illness to give the reader lived experiences.They with people experiencing vulnerabilities due to health and
also use first-person narratives written by people with men- situational circumstances.
tal illness or their family members or service providers.They
use Evidence-Based Practice boxes to support the practice of Carolyn Baum, PhD, OTR/L, FAOTA
occupational therapy. These approaches support a very Professor ofOccupational Therapy
personal level of learning and are actually a gift to the pro- and Neurology
fession, as we are being called upon to support the health Washington University School ofMedicine
and participation of all our citizens and to do it using St.Louis,Missouri
evidence that will direct resources to approaches known to
be effective.
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Preface
Occupational therapy has its roots in mental health prac- China,England,and Sweden.The international authorship
tice, with its founders including individuals who worked offers a broader point of view of occupational therapy in
in psychiatry at the prestigious Johns Hopkins Hospital mental health.
and Sheppard and Enoch Pratt Hospitals. However, the
role of occupational therapy as a health care and service
profession is broad in scope.Occupational therapists work Guiding Principles
with individuals and populations with both physical and
psychiatric disabilities, as well as individuals without Several philosophical principles guide the tone and content
disabilities who struggle with occupational performance ofthe book:
problems.All age groups,from newborns to older adults,
■ The person-environment-occupation model is used as
and a variety of settings, including medical, educational,
the organizing structure for the text.Each is examined in
community, and industry, are served by occupational
a comprehensive manner to ensure that the learner will
therapists.
have a strong grounding in client-centered,occupation-
Mental health occupational therapy is one important area
based practices that promote full participation in the
of specialized practice, and occupational therapists who
everyday lives ofpersons with mental illness and others
work primarily as mental health practitioners must acquire
struggling with psychosocial issues.
specific knowledge and abilities. Yet an appreciation for
■ The lived experience of mental illness and recovery is
the wholeperson,which includes mental health issues,is so
highlighted so that the learner develops a full appreci-
integral to our practice that it is essential for occupational
ation for the real people who will be future recipients
therapists in all practice areas to develop competencies asso-
of occupational therapy services. Recognition of the
ciated with mental health practice.It is safe to assume that all
whole person—the individual’s state of physical,emo-
people deal with mental health issues at some point in their
tional, spiritual, and mental health—and the need to
lives and that individuals who have challenges related to
address co-occurring conditions are emphasized.
occupational performance will almost certainly experience
■ Occupational therapy interventions are grounded the-
mental health concerns,be it anxiety,depression,ineffective
oretically and in the evidence based on occupational
coping,or some other challenge.
therapy and mental health literature.
Participation is the primary goal ofoccupational therapy;
■ Active learning strategies are incorporated into the text
that is,occupational therapists work to support individuals
to emphasize self-reflection and the experiential appli-
in their efforts to engage in all aspects of everyday life.This
cation oflearning.The reflective nature ofthese activ-
textbook strives to be visionary in providing established as
ities is useful for promoting the development ofthera-
well as newly emerging practices for occupational therapists
peutic engagement as a skill.
working in mental health,hence the title Occupational Therapy
■ The text utilizes a client-centered,optimistic,recovery-
in Mental Health: A Vision for Participation.
oriented perspective that empowers clients to be in
This comprehensive textbook provides both a breadth
control of their own lives and therapists to recognize
and depth ofinformation related to mental health practices.
their unique contribution in promoting full participa-
There is content presented in this text that is essential for all
tion in daily life.
occupational therapists regardless ofpractice area,as well as
more specific information relevant to occupational thera-
pists who specialize in mental health practice. This text is
Organization Using the
primarily intended for entry-level occupational therapy
students,but it is also a useful reference book for practicing
Person-Environment-Occupation
therapists. As occupational therapy curricula vary greatly,
the comprehensive nature ofthe text and its intuitive orga- Framework
nizational structure make it applicable across multiple
occupational therapy courses, including courses with a Occupational Therapy in Mental Health: A Vision for Par-
focus on mental health and those organized around specific ticipation is organized around the person-environment-
client factors,areas ofoccupation,and environments. occupation (PEO) model. There are several conceptual
As an edited text, Occupational Therapy in Mental models in occupational therapy that we could have se-
Health: A Vision for Participationutilizes experts within the lected,but the PEO model was chosen for its simple but all
field to author chapters on their particular area ofexpertise. encompassing structure. This does not mean that PEO is
The numerous contributors and the breadth of the text the only model used in this textbook;many other models
resulted in several areas in which significant and relevant are described and referenced throughout the text when
content for occupational therapy is published for the first relevant.The model works well as a framework for the text
time.In addition,the contributors come from six different because it addresses the full practice domain of occupa-
countries, including the United States, Canada, Australia, tional therapy in mental health and gives equal attention
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viii PREFACE
to person, occupation, and environment factors. The text assessments,and (3) interventions aimed at creating a sup-
is divided into four parts: portive environment.
The “Practice Setting”section is devoted to the places that
Part 1Foundations
occupational therapists work,including settings with either
Part 2The Person
a primary or secondary focus on mental health practice.
Part 3Environment
Some of these settings are emerging areas of practice that
Part 4Occupation
have received little attention in previous texts.Each chapter
includes a general description of the setting with informa-
Part 1: Foundations
tion on the needs of the population served. The role of
occupational therapy is discussed, including assessments
The introductory section provides information on overarch-
and interventions common to those settings.
ing issues in mental health occupational therapy. The first
chapter,on recovery,sets the tone for the text by acknowl-
Part 4: Occupation
edging the expertise and point ofview ofthe individual with
mental illness. In addition, the recovery model promotes
Few occupational therapy texts attempt to comprehensively
optimism and hope that individuals with psychiatric disabil-
address areas of occupational performance.This part of the
ities can achieve their occupational wants and needs.Other
text covers the more familiar occupations of work,self-care,
chapters in Part 1 provide further perspective and back-
and leisure, along with some areas of occupation that have
ground for mental health occupational therapy practice that
been neglected,such as sleep and spirituality.Attention is paid
is (1) person centered,(2) occupation based,(3) grounded
to the character or purpose ofdifferent occupations across the
in theory, (4) supported by evidence, and (5) cognizant of
lifespan.Many of these chapters include descriptions of spe-
the historical roots ofoccupational therapy in mental health.
cific assessments and intervention models and techniques.
Part 2: The Person
Special Features
Part 2 is further divided into “Diagnosis” and “Client
Factors” sections. It is important for occupational thera-
Educators and students alike find special features to be useful
pists to thoroughly understand the conditions of the indi-
in helping the learner comprehend and retain new informa-
viduals with whom they work.Therefore,major psychiatric
tion as well as envision how it will apply to practice.Occupa-
diagnoses are presented with a focus on symptoms, etiol-
tional Therapy in Mental Health: A Vision for Participation
ogy, medications, and impact on occupational perform-
includes several unique features:
ance.Although occupational therapy practice is not driven
by symptomatology,practitioners can better understand the
experience ofthe individual with a mental illness ifthey are PhotoVoice
aware of symptoms the person may be experiencing. In
This feature includes photographs with accompanying nar-
addition, a working knowledge of psychiatric diagnoses is
ratives that utilize the PhotoVoice methodology.PhotoVoice
useful when participating on a multidisciplinary treatment
was developed by Caroline C.Wang and Mary Ann Burris as
team.
a means for marginalized people to have their voices heard.
Because occupational therapy assessment and interven-
Its goal is social action and influence.PhotoVoice follows a
tion are not based on diagnosis, the chapters in Part 2
particular structure in which the group involved in the proj-
include minimal information on assessment and interven-
ect identifies a particular mission or message to convey,
tion. More thorough explanations are included in other
brainstorms about images,takes photographs,and discusses
chapters ofthe text,with equal attention given to assessment
the significance of the photos. Then, the person who took
and intervention targeting client factors,environments,and
the photo writes a narrative that describes its meaning.
occupations.For easy reference,see the Index ofAssessments
The PhotoVoice methodology typically involves identifying
and Index ofInterventions.
a target audience.In this case,the audience is the reader ofthis
The “Client Factors”section addresses skills and abilities
textbook. Each of the editors of the text held separate Pho-
that are important for occupational performance. These
toVoice groups with individuals with mental illness.The pur-
chapters provide detailed content about the skills addressed,
pose was to collect photos and narratives that convey the con-
theories related to those skills,and specific information on
tent ofthe text from the perspective ofthe individuals with the
particular diagnoses associated with impairments in those
lived experience ofmental illness.This was a powerful experi-
skill areas.
ence that goes far beyond the confines ofthis text;however,we
hope readers will find the PhotoVoice features particularly use-
Part 3: Environment
ful to illustrate the rich information we can accumulate when
Part 3 is also divided into two sections:“Lived Environment” we listen to the people we serve as occupational therapists.
and “Practice Settings.”Although recognized as important
by occupational therapists,the environmental component of The Lived Experience
the PEO model has received the least attention.The “Lived
Environment”section ofthe text aims to correct this neglect First-person narratives reflect the chapters’ major con-
by providing the mental health practitioner with (1) an cepts and allow the reader to gain an understanding ofthe
explicit understanding of the environment and its impact lived experience. We have taken care to maintain each
on occupational performance, (2) specific environmental writer’s unique voice.Most of these narratives are written
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PREFACE ix
by individuals with a psychiatric disability, but a few are Resources
written by family members or service providers. In some
cases, an interview was conducted to help the individual Most chapters includes information on resources that
tell his or her story.The Lived Experience and PhotoVoice the student and instructor can use to augment the text
features reinforce the importance of the person-first, and utilize in practice. Examples of resources include
client-centered philosophy of the book. books, assessment or intervention manuals, videos, and
websites.
Evidence-Based Practice
A Note About the Cover
Although research evidence is an important component of
each chapter,evidence is also highlighted in Evidence-Based
Practice boxes.A primary purpose ofthis feature is to distill The image chosen for the cover is significant as well as
important research in a particular content area with specific beautiful: During an art group meeting at Spectrum, a
applications to occupational therapy practice.Each box uses community meeting place of consumers, Cherie Bledsoe
a standard format in which the evidence is cited,followed by did a finger painting. She was about to throw it in the
a bulleted list of implications for practice,and then the full trash, but Jan Kobe, the art teacher, saw its potential and
reference.The research is drawn from the occupational ther- the images emerging from it. Jan claimed it for the Art
apy literature as well as the larger interdisciplinary mental Coalition to salvage and complete, using a Monet-like
health literature. impressionist theme.The Art Coalition finished the paint-
ing,adding a pond,flowers,and swans.Due to the quality
of the work, it was chosen for the “Sunshine from Dark-
Active Learning Strategies and Reflective
ness” exhibit in 2008. The painting reflects reclaiming
Journal Prompts
quality of life after the losses of mental illness and the re-
birth of regained skills and recovery.Contributors:Cherie
When using this textbook within a course, students are
Bledsoe,Ella Devosha,Jan Kobe,and the Art Coalition of
encouraged to start a Reflective Journal.The Reflective Jour-
Painters.
nal is a separate notebook used to record individual
impressions,reactions,and insights gained from the learning
experience. Each chapter includes one or more experiential
activities that promote active learning ofconcepts within the Closing Thoughts
chapter.In many cases,the activity involves developing an ap-
preciation for the lived experiences ofpeople with mental ill- Many experts in the field,both occupational therapists and
ness.In others,the reader has the opportunity to engage in an people with mental illness,have come together to create this
assessment or intervention experience. Many activities are work. In doing so, these individuals have created the most
followed by a set of reflective questions,which is where the comprehensive occupational therapy in mental health text-
Reflective Journal comes in.The student can use these ques- book available.It is our desire that the reader finds the infor-
tions or others developed by the instructor to help personal- mation accessible and useful for occupational therapy prac-
ize and process the experience.The questions are intended to tice,but perhaps more important,that the vision ofthe book
enhance the reader’s understanding ofthe chapter and facili- is realized.Our hope is that this text contributes to the revi-
tate the synthesis ofapplicable person,environment,and oc- talization of occupational therapy practice in mental health
cupation concepts. The journals also provide a means of and that the profession plays a significant role in supporting
preparation by which the students can more meaningfully participation in everyday life for those people with psychi-
engage in a discussion around the content ofthe chapter. atric disabilities.
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Contributors
Katie C. Alexander, MS, OTR Mona Eklund, PhD, Reg OT
Program Development Consultant Professor
The Model Asperger Program Department ofHealth Sciences
The Ivymount School,Inc. Division ofOccupational Therapy and Gerontology
Rockville,Maryland Lund University
Lund,Sweden
Cherie Bledsoe
Executive Director Joyce M. Engel, PhD, OTR, FAOTA
S.I.D.E.Inc. Professor and Program Director
Kansas City,KS University ofWisconsin–Milwaukee
College ofHealth Sciences
Charles Christiansen, EdD, OTR, OT(C), FAOTA Department ofOccupational Therapy
Executive Director Milwaukee,Wisconsin
American Occupational Therapy Foundation
Bethesda,Maryland Pamela Erdman, MS, OTR
Quality Assurance Director
Patricia Crist, PhD, OTR, FAOTA Wraparound Milwaukee Program
Chairperson and Professor Milwaukee,Wisconsin
Department ofOccupational Therapy
John G.Rangos Sr.School ofHealth Sciences S. Megan Exley, MOT, OTR/L
Duquesne University Occupational Therapist
Pittsburgh,Pennsylvania Landmark Home Health Care
Pittsburgh,Pennsylvania
Jeanenne Dallas, MA, OTR/L, CPRP
Instructor and Academic Fieldwork Coordinator Judith Gonyea, OTD, MSEd, OTR/L
Program in Occupational Therapy Assistant Professor
Washington University Occupational Therapy Department
St.Louis,Missouri Ithaca College
Ithaca,New York
Noralyn Davel Pickens, PhD, OT
Assistant Professor Sharon A. Gutman, PhD, OTR, FAOTA
School ofOccupational Therapy Associate Professor
Texas Woman’s University Programs in Occupational Therapy
Dallas,Texas Columbia University
New York,New York
Janis Davis, PhD, OTR/L
Associate Professor Kristine Haertl, PhD, OTR/L
Department ofOccupational Therapy Associate Professor
Dominican University ofCalifornia Department ofOccupational Science and Occupational
San Rafael,California Therapy
St.Catherine University
Frank P. Deane, PhD, BS., MSc, Clinical St.Paul,Minnesota
Psychology Diploma
School ofPsychology and Illawarra Institute for Mental Carol Haertlein Sells, PhD, OTR, FAOTA
Health Professor,Occupational Therapy
University ofWollongong University ofWisconsin–Milwaukee
Australia College ofHealth Sciences
Department ofOccupational Therapy
Mary Egan, PhD, OT Reg. (Ont.), FCAOT Milwaukee,Wisconsin
Associate Professor
School ofRehabilitation Sciences Carole Hays, MA, OTR/L, FAOTA
University ofOttawa Director ofRehabilitation Services
Ottawa,Ontario,Canada Springfield Hospital Center
Sykesville,Maryland
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