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OT in Mental Health Examples
Some examples of what Occupational Therapists might (and do) do in the case of the following mental health conditions:
· Prescribe a specific regime of emotionally energising activities for a client who is so severely depressed that thoughts of suicide are creeping in. For each client the specific activities are varied. However, we would start by educating them on emotional depletion and then start exploring very subtle responses to activities until we hit upon the right combination to get that person out of that acutely unwell state. At this severity, the activities typically all focus on simple pleasures such as showers, ‘people-watching’, eating, curling up in bed with music (all guilt free – a critical factor for success of this regime) until they start to feel a small glimmer of ‘wanting’ to ‘do’ something. Then we would get them to make themselves a scrummy meal and do one very small ‘have to’ task. Then gradually through a uniquely designed combination of ‘want to’ and ‘have to’ activities, we get them to the point that they can face the world again. Then we start on the big-picture aspects of restructuring their lives eg. Transitioning from a job that is totally wrong for who they are, to one that matches them.
· Take a person with severe anxiety of being in public through a graded activity program so they can do their shopping. The intervention program would consist of education about the neurological structures underlying the ‘emergency mechanism’ that is firing off unnecessarily, the principles for successfully breaking down the established pattern and the relaxation skills required to do it. A graded plan of exposure would be developed. The OT and the person would, over coming weeks, gradually work through that program until the person could independently access the shops without terror being their constant partner.
· Working with teachers of a child with Asperger’s Syndrome to educate them on the unique behavioural and education requirements of the child so that the child (1) can successfully participate in a classroom environment without violence, (2) can build a successful vocational opportunity so that by the time they finish school, they are employable, and (3) can successfully navigate the social environment in which they will live and work through participation in a specialised social skills program.
· Restructure household task delineation between a mother/wife and her family to address burn-out and relationship breakdown. At the same time as building a new family routine, coaching the client with strategies to manage the draining and unacceptable behaviours of her children so that the household runs successfully and relationship effectiveness is the result.
· Support a family carer of someone with Schizophrenia in the manner with which they approach re-engaging their loved one in ‘life’ after an acute psychotic episode. This is done so that the carer doesn’t overcare thereby exacerbating disability, but is able to create the right environment to stimulate their loved-one’s recovery, while still looking after themselves.
· Restructure the life of a client with Bipolar Mood Disorder by setting up protective systems for when they are manic, developing a range of destimulating activities to use to head a manic episode ‘off at the pass’, and to help them find employment that uses their immense abilities without triggering off the acceleration that will precipitate an acute episode. Education on emotional energy is critical to this process.
· Teach a client with a chronic and debilitating psychiatric disability to cook a nutritional meal for themselves. Then to develop an achievable meal plan for their budget, skill and energy levels. This is done in the person’s home, in their context.
· Take a client with Obsessive Compulsive Disorder through the challenge of breaking down the compulsive behaviour of hoarding through education about the condition and the tricks their mind is playing on them. Then structuring a graded activity program of throwing things out which initially would be supported in person by the OT, and then gradually toward them doing it themselves. Organising replacement healthy activities would also be a critical part of the success of the program – which usually the OT would accompany them to the first few times until the client was fully integrated in the activity.
Occupational Therapy (OT) is a health profession that has been around for over 100 years and actually began in mental health first before expanding into other areas of health care.
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