Occupational Therapy in mental health treatment

Recently someone suggested I write a blog about Occupational Therapy and how it has helped me. Life is difficult at the moment so I am using this blog as a way of distraction from what is going on in my mind.

I’ve spent time on acute psychiatric wards and an eating disorder unit as an inpatient. What has often made me sad is patients talking about how lonely they are in the community. I am very lucky that I have family, many don’t. Many are isolated. I remember one patient who really appreciated the company in hospital, the activities and conversation on the ward helped their depression. They were discharged without warning into the community, without any plan around their loneliness or difficulties. The common line given ‘The Community Team are responsible for organising and planning support in the community, they can pick this up on discharge’ Unfortunately as we all know the Community Teams can’t just pick things up quickly and even if they do they don’t always have the resources or time to address someone’s needs. When someone is an inpatient on a physical health ward they often see an OT before discharge, to make sure they have what they need to function in the community, I’ve often wondered why this isn’t used more in a mental health context.

My experiences of OT – The Good

I am Autistic and hospitals can be scary and overwhelming places. When I feel frightened and overwhelmed by an environment I behave differently to how I normally behave in the community. This can be seen as ‘bad behaviour’ to an outsider that doesn’t understand. It’s particularly pronounced in a hospital environment as there is no escaping from the triggers. I experienced much less distress when in a physical health hospital as things run to more of a schedule, you are given what you need, it is quieter and you aren’t overwhelmed by other patients. In the acute psychiatric ward I have been admitted to they have two Occupational Therapists allocated to each ward and they also have general OTs who run some of the groups. The OT’s have the power to make an admission more bearable for a patient, they can explore what might be difficult in the ward environment and offer solutions. Here are the types of things which were helpful to me:

  • The OT understood that I liked structure, so they helped me to plan a timetable for my time on the ward. This included which appropriate groups I could access, but also included ways I could structure my time, such as sitting in the garden, taking my drawing out onto the ward or doing craft that she had put in a folder for me to do. She knew the routines of the ward so was able to fill in some of the things I wasn’t aware of, which then meant I wouldn’t struggle with unexpected things happening. We talked about how I could find some types of groups difficult, so she planned in a one to one session and we also talked about what barriers there would be in me attending groups. The groups took place at times in a different part of the hospital and you needed to be taken there by a member of staff, I would become distressed if someone couldn’t take me as promised or if they were really late in leaving. The OT agreed to come and get myself & any other patients from the ward 10 minutes before the group start time.
  • I often found that I didn’t get any time with staff to talk through my difficulties or my worries whilst in hospital. The OT staff were happy for patients to talk with them about these difficulties and it was often easier to talk when engaged in an activity.
  • Taking part in the OT groups helped lift my mood. I’d lost all hope when I was admitted and by attending groups such as gardening or creative writing I felt I was able to contribute to something in a meaningful way. As they had specific OT’s to run activities they were well planned and run, rather than just something to pass the time. They ran some groups on the ward, such as smoothie making or creating banners for a festival they held in the ward grounds. The atmosphere on the ward was often intense and volatile, it did improve when patients had something to do together and helped people to build relationships with each other.
  • The things that I made with OT helped me to connect with my family, particularly my daughter at home. I learnt how to do things that I could do with her when home and I also made things that I could give to her, so that she knew I was thinking of her. Within the folder of things to do that the OT gave me was card making materials. I made cards for other patients and for my family. I now no longer buy cards and will often use card making as a distraction tool when I am depressed.

My experiences of OT – the bad

  • Largely my experiences of OT have been good. Where they have been bad is in situations where non qualified staff have been asked to conduct groups which would usually be run by an OT. One particular group was creative writing. The group consisted of a printed sheet of suggested writing tasks which looked like it had been obtained from Google. It had been used in previous groups, so was repetition for a lot of the group. The tasks were too long and weren’t particularly relevant or help for people’s difficulties. Sitting in silence when your mind is blank for a long period of time is not helpful and can be frightening or overwhelming. The group of patients eventually rebelled and suggested some better, more inclusive, shorter activities. We had fun and left the room smiling. I think it is possible for non qualified members of staff to run OT based groups, but they need to be given the time to properly prepare. Listening to patients and getting feedback is especially important in these type of situations. Enabling patients to help plan groups is also another way of helping people to see their qualities and to feel like they have something to contribute to the world, something I often struggle to see myself.
  • OT groups where patients were expected to take part in a task which was too complex were hard. I have an eating disorder and my concentration and thinking are often poor. I am also very self critical. If presented with a task that is too difficult for me to do I will withdraw or become distressed. A good OT will have graded levels for an activity so they can offer different levels of difficulty for all patients. I recall attending a pottery group, I explained to the OT that I couldn’t think what to make. She found me a mould that I could use to make a bowl and provided stamps for me to use to decorate it. Without her support I would have just sat there staring blankly at my ball of clay.
  • OT’s often aren’t included in ward rounds, where the patient meets once a week with the consultant and other staff to discuss their treatment. They often have more knowledge of patients than other members of staff and may be more qualified to suggest adaptions to the ward environment or support with discharge planning. Even if an OT doesn’t have the availability to attend ward rounds their feedback could be sought in advance particularly for patients with additional needs or difficulties.

I’ll end this blog with a story of kindness, which in part I covered in a previous blog. During my last admission I made some pottery. I didn’t stay long enough to paint it. The OT on the ward offered to paint it for me and to have it fired. This meant a lot to me as I had made them for my daughter. The OT took the time to help me select the colours to paint it. They remembered to phone me when it was ready to collect. I’d taken a series of photos whilst I was an inpatient and I’d had them printed for the ward, thinking they might be able to use them to help promote their nature walk to the patients. The OT took the time to look through the photos and make nice comments. I was still in a really dark place and their comments stuck with me for sometime. A few weeks later, still feeling very low a Thank You card arrived in the post from the OT team.

As far as I am aware our local Community Mental Health Team don’t have an Occupational Therapist they can refer to (unless it’s just not been offered to me) this is a great shame, as you can see from above Occupational Therapists are skilled individuals who have a great deal to offer to helping mental health patients improve their quality of life, including helping to support a hospital admission not being a distressing experience, but something to aid recovery.

 

12 thoughts on “Occupational Therapy in mental health treatment

  1. Julia Reid

    As an occupational therapist working on an acute inpatient ward your comments are both moving and motivating.
    Thank you for making the time to share you experiences and recommendations which are so helpful.
    I wondered if you would be happy for me to quote and reference you or add a link to your blog when teaching people about occupational therapy.
    If you have time to get back to me I can be contacted at Julia.reid1@nhs.net.
    All best wishes for your ongoing recovery
    Julia

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  2. Kaylee

    As someone who currently has 1 year left until becoming a Occupational Therapy Assistant; I admire this whole heatedly. The courage, strength, and motivation you shared and it gave me – absolutely inspiring. I wish nothing but the best on your continued journey, because everyday is a new stepping stone! Best wishes, friend!
    Kaylee

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  3. Karen Henderson

    What a wonderful blog! I am an Occupational Therapist who started her career on an acute ward and reading this reminded me of the smiles i was able to make happen just by being supportive and listening to what my clients really wanted. We did a creative writing session which was a bit dry so we livened it up by doing some charades, and ending with swear word scrabble! may not have fitted the evidence out there but what the heck, the noises of laughter were heard by the consultant and he actually commented that it was bound to be one of my groups! The cheek (grin). We used to offer 6 post discharge sessions too, to help the transition from ward to home and then onto the community team, but i suspect that funds no longer allow this. I hope you continue in this wellness phase, you are inspirational, as were all my clients, the ability to pick yourself up and start again is to be admired, and to take time to write about your experience humbled me. I wish the very best for you and please consider giving talks to OT educators about your experience as this would inspire students too.

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    1. Hi Karen,

      Thanks for your reply, it means a lot. There aren’t any post discharge sessions or OT groups. I wish our local eating disorder service ran a weekly OT group, I think this would be more effective(and cost saving!) than seeing people individually. They used to run a breakfast club once a week, but this fell by the wayside due to lack of resources and promotion of the group to service users. There are a lot of groups in my community that service users can be signposted to – eg walking groups (for people with mental health difficulties) art groups, employability groups or just general wellbeing activities, but there is a total lack of knowledge in CMHTS and inpatient wards of what is going on in communities. Unless someone has access to a social prescriber it can be hard for them to get started in a group or to even find out what is going on. I found on my last hospital admission the creative writing group was still dry and boring, at one point all the patients rebelled and said they’d rather do art. The issue was the exercises were just too long. I think inpatient services need to be much better about seeking feedback on their groups and improving them, it doesn’t cost money to improve a group.

      I’d love to contribute by giving talks, but would have no idea where to get started. In my local area getting involved in service user involvement is virtually impossible 😦

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      1. Karen Henderson

        Gosh that is really disappointing to hear – you sound as if you would be a great advocate for service users. Does your hospital have PALS – the reason why I mention this is because one of my service user (once discharged into the community) put herself forward for patient liaison service, and then became an occupational therapy technician! so from small acorns ….. what area do you live in?

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    1. Karen Henderson

      Oh that is not good news at all! ours in Surrey was really supportive and a brilliant stepping stone to help others who had been in a similar position as yourself.
      I network a lot, so let me see if I can see if anyone would benefit from a chat, i.e. OT students or the like

      Liked by 1 person

      1. bobcorrick

        just seen that @outdoorprescription is not on Twitter – have you had recent contact? I mean I just saw a tweet from them a few minutes ago, and went to their blog, but when I went back to twitter, their account was not there. Bit concerned.

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