Occupational Therapy Practice in Mental Health: Models, Conditions, Interventions, and Recovery

In this chapter, the Model of Human Occupation (MOHO) and its concepts are introduced to the reader. More specifically, each of the four components of the MOHO is defined and described, and examples from everyday practise are provided.

This chapter describes the key aspects of the CMOP-E model and how occupational performance and engagement are understood through the lens of the CMOP-E model. The chapter ends with a case study illustrating the application of the model in practice.

This chapter overviews the Kawa Model as developed by Michael Iwama and colleagues. It starts off with some insights into a conversation with Dr Iwama following a chance meeting with the author in 2006. This chapter then explores model concepts and ends with an exploration of how the Kawa Model may be utilized in practice.

This chapter will provide an overview of the Person-Environmen- -Occupation (PEO) and the Person-Environment Occupation Performance (PEOP) Models. The PEO model emphasises the importance of congruence between person, environment, and occupation (PEO fit) and the subsequent occupational performance within an event. Another ecological model, PEOP, focuses on the client and relevant intrinsic (person) and extrinsic (environment) influences on the performance of everyday occupations. The chapter discusses how these models can be applied to individuals, groups (or organizations), and populations. 

Psychosis is a debilitating group of symptoms that affects an individual at the same time and occurs over a period of time. These symptoms often include disturbances in behaviour, the thinking process, thought content, perception, affect, and mood. This chapter with briefly explore what psychosis is and then focus on one of the most debilitating psychotic disorders known to mankind, schizophrenia.

Note

This chapter is meant to be introductory, and the reader is encouraged to seek further information from comprehensive psychiatric texts. This chapter can also be used as a quick revision chapter for students and clinicians.

This chapter gives an overview of anxiety and mood disorders. Anxiety and mood disorders are arguably the most common mental illness worldwide. The purpose of this chapter is to introduce the reader to the pathophysiology, aetiology, and epidemiology of these conditions so the reader can develop an in-depth understanding of how to work with people with anxiety and mood disorders. The occupational therapy perspective is woven in throughout this chapter.

Currently, one in five Australian children suffer from an eating disorder (ED). Eating Disorder (ED) is a severe mental health condition characterised by severe disturbances in eating behaviours, related thoughts, and emotions (American Psychiatric Association [APA], (2013)). Occupational therapists have a unique skill set to assist with the recovery of an ED. As occupational therapists, we analyse the person, occupation, and environment to provide a variety of interventions to reduce/minimize occupational performance issues (OPI). This chapter will review the diagnostic criteria for the different EDs, the occupational therapy process using the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Canadian Practice Process Framework (CPPF), and apply the learnings to a case study.

This chapter focuses on the unique role of occupational therapy in the assessment and treatment of personality disorders. Integrating occupational therapy assessments and interventions within existing assessment and treatment approaches can improve functional outcomes for people with personality disorders. Occupational therapy plays a pivotal role in multidisciplinary areas and across generic therapeutic approaches, for example, Dialectical Behaviour Therapy (DBT). Occupational therapists are experts in assessing the performance of daily activities and functioning across the lifespan. Therefore, occupational therapist makes a valuable contribution to the recovery journey of people with personality disorders. This review introduces the role of occupational therapy in the management of personality disorders as defined by the Alternative Model of Personality Disorders (AMPD) in the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5). Assessment and treatment options unique to the profession are also described.

This chapter provides an overview of occupational therapy practice in mental health. Occupational therapists often find themselves working in a multidisciplinary team. The occupational therapist (OT) enables and promotes consumers to obtain the skills needed to enhance their ability to participate in or modify the environment to support their participation in everyday occupations. This chapter introduces the occupational therapy process and discusses some common interventions used in mental health, such as supported employment. The chapter concludes by discussing emerging and future mental health occupational therapy practice opportunities.

This chapter offers a thorough examination of psychosocial therapies used in occupational therapy, with an emphasis on cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), and family therapy. Giving readers a thorough grasp of these strategies and how to use them in occupational therapy practice is the main goal. This chapter explores the theoretical underpinnings, guiding principles, and practical applications of each intervention through the lens of evidencebased practice, emphasising the intervention’s applicability in resolving a range of psychosocial issues that people encounter in their lives. The chapter emphasizes the holistic approach to client care by clarifying the integration of psychosocial therapies with the scope of occupational therapy, drawing on recent research and clinical experiences.

Drawing on current research and clinical insights, the chapter elucidates the integration of psychosocial interventions within the scope of occupational therapy, emphasizing the holistic approach to client care. Special attention is given to the role of occupational therapists in facilitating meaningful engagement and participation in daily activities through the implementation of tailored interventions.

Practical case examples and vignettes are employed throughout the chapter to illustrate the application of psychosocial interventions in real-world occupational therapy contexts. By the conclusion of this chapter, readers will not only gain a nuanced understanding of key psychosocial interventions but also develop the necessary skills to critically evaluate and select evidence-based approaches in their clinical practice.

Leisure is a powerful therapeutic modality that can build meaning and purpose for consumers, particularly those who have mental health issues. When acutely unwell, it can be challenging to engage in productive activities or understand cognitive-based interventions; therefore, leisure is an opportunity to build graded engagement. This chapter explores leisure as an evidence-based therapeutic modality in occupational therapy.

A brief history of leisure and how this has been incorporated in leisure or recreation settings is explored to provide context for Australia’s current mental health system. A number of leisure theories are explored and applied to a mental health context, including the flourishing model, salutogenesis, serious leisure, and resilience. Furthermore, prominent leisure theory is then applied to occupational therapy theory to provide an occupational therapy focussed lens to the broader scope of leisure that could be utilised by multiple disciplines.

With the consideration of theory and occupational therapy, a number of informal and formal assessment strategies are explored with a specific spotlight on participation, satisfaction, and boredom in leisure. Utilisation of leisure as a therapeutic intervention is explored based on mental health contexts such as inpatient, rehabilitation, and community settings.

Finally, evidence-based recommendations are suggested to implement leisure in therapeutic services, such as inpatient and community settings. Occupational therapists can improve occupational engagement and performance by using occupation as an opportunity to explore, assess, and build meaningful engagement. 

This chapter provides an in-depth exploration of the concepts and characteristics of group therapy and theories that highlight the need for using group therapy in practice. It equips occupational therapists with the tools to substantiate the incorporation of group therapy into their interventions. It also brings into foreground the various stages of conducting development and how it is used in the realm of occupational therapy. Different types of groups that are used in occupational therapy are discussed, supplemented with evidence-based examples. This aids occupational therapists in making informed decisions regarding the selection and timing of group interventions. The advantages of utilizing group therapy in occupational therapy, in contrast to individual therapy, are discussed. The chapter also addresses pertinent challenges and issues faced by therapists when employing group therapy. Lastly, steps in developing group protocols are explained using examples. This comprehensive content aims to assist practitioners in effectively conducting group sessions.

Everyone experiences the world in unique ways based on their individual neurological systems, which have developed over time in an intricate and complex interplay between our genetic endowment, our sensory systems, and our past experiences of the world and the people in it. Convincing evidence has shown that people with mental illness and trauma histories have differences in their sensory processing patterns and also that they are more likely to be insecurely attached. In recognition of this, occupational therapists have shown a rapid increase in interest in the implementation of sensory approaches in mental health over the last 20 years. The relevance of attachment theory and the interrelationship between sensory and attachment systems have more recently been recognised in occupational therapy, with the recognition that these two systems develop at the same time within the same environmental conditions. In this chapter, an overview is provided of our sensory system, our attachment system, the interplay between these two systems, and the relevance of these systems in the fields of mental illness, trauma, and substance use. Understanding the sensory and attachment systems and the interrelationships between these can inform person-centred and trauma-informed occupational therapy for people with mental illness, ultimately improving occupational performance for clients with mental health conditions. 

Mental health affects a large number of children and young people worldwide. The role of child and youth mental health services is to provide timely assessment and interventions to improve the well-being and standard of life of children and youth with mental health conditions, foster child development, and ultimately save lives. This chapter explores the role of occupational therapists when providing services to children, families, and carers. The chapter summarises common models of practice used by occupational therapists and provides a synopsis of common conditions seen in child and youth mental health settings. The chapter then introduces common recovery-oriented interventions used when working with children and young people experiencing mental health problems and their carers and families.

The COVID-19 pandemic has significantly impacted global health, prompting widespread public health measures that inadvertently disrupted occupational engagement and mental health. This chapter highlights the specific challenges presented by COVID-19 with a focus on mental health. This chapter focuses on mental health, a key strategy in responding to the pandemic, as identified by the World Health Organisation (WHO). Key mental health-related impacts of the COVID-19 pandemic on the world’s population included occupational disruption, increased mental health issues, and a marked impact on vulnerable populations such as children and those with pre-existing mental conditions. Telehealth emerged as a crucial adaptation in occupational therapy, facilitating continuity of care. However, disparities in access to these services persist, necessitating further attention to health equity. Lessons learned are ongoing and point to the use of virtual/ teletherapy technologies, the need for integrated health services, and ongoing support for mental health care in future pandemics. 

Living a healthy lifestyle is influenced by personal agency and societal structures, which contribute to a continuum of physical and mental health. The social determinants of mental health offer a perspective on how structural factors may influence a person's lifestyle. These determinants include the conditions in which people are born, live, grow up, and age, shaped by policy decisions and resource distribution within their communities and societies. These social, political, cultural, and economic conditions, along with spiritually problematic situations, may disrupt optimal mental health, increase the risk of mental disorders, and worsen outcomes among those affected. The concept of social inclusion holds great potential in the rights-based examination and redress of challenging social determinants of mental health. Further to this, the chapter proposes drawing on a critical occupational perspective as a paradigm shift from an individualistic medicalised view to a more collective and justice-oriented approach, challenging the taken-for-granted ways of participation and centering participation in meaningful occupations for all.

This chapter views recovery through multiple perspectives, focusing on the lens of personal recovery in the mental health context. The process of personal recovery may be as unique as the individuals experiencing it. However, some common themes are discussed, including the presence of connection, hope, optimism, identity, meaning, and empowerment. This chapter draws on the lived experience of mental health consumers to highlight the role of occupational therapists in recovery and breathe life into the theoretical concepts discussed throughout. Examples of how occupational therapists may use strengths-based and person-centred approaches to facilitate recovery and engage consumers in the occupational therapy process are provided. In addition, this chapter emphasises the importance of shared decision-making and describes the unique considerations when working with diverse populations including culturally and linguistically diverse individuals, individuals who identify as LGBTQIA+, and individuals who are neurodivergent.

This chapter was co-authored by a peer researcher with lived experience. People with mental health challenges are often pushed to the margins of society, and experience powerlessness, which prevents them from being able to access their full rights as citizens. The chapter explores the concept of citizenship within the context of mental health and occupational therapy. Limitations of the recovery approach are discussed and opportunities for enacting participatory citizenship to address the limitations are explored. The intersection between participatory citizenship and occupational justice is examined.

The chapter also delves into the impact of technology on citizenship, discussing the opportunities and challenges it presents for individuals with mental health conditions. It highlights the importance of considering technology's role in shaping social norms, facilitating participation, and promoting inclusion. In an increasingly technological society, occupational therapists could play a key role in public health and through ‘occupation’ support people with their identity and finding meaning. It is essential that occupational therapists engage in promoting digital citizenship, people’s interaction with AI, and participation in the virtual world.

The chapter suggests reflective exercises for readers to consider; these can be undertaken individually or collaboratively as part of group activities. These reflections are designed to support a shift in thinking towards a more participatory approach to promote citizenship, address occupational injustice, and create inclusive societies for individuals with mental health challenges.