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Advancing Occupational Therapy in Mental Health Practice

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Dedication

This book is dedicated to the memory of the late Hester Monteath, MBE, D.Ed, FCOT a pioneering occupational therapist whose vision, courage and determina-tion benefited people with mental health problems. Furthermore, she inspired generations of occupational therapists to specialise in mental health practice – her spirit lives on.

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Advancing Occupational Therapy in Mental Health Practice

Edited by

Elizabeth Anne McKayChristine CraikKee Hean LimandGabrielle Richards

BlackwellPublishing

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© 2008 by Blackwell Publishing Ltd

Blackwell Publishing editorial offices:Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Tel: +44 (0)1865 776868Blackwell Publishing Inc., 350 Main Street, Malden, MA 02148-5020, USA Tel: +1 781 388 8250Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia Tel: +61 (0)3 8359 1011

The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

First published 2008 by Blackwell Publishing Ltd

ISBN: 978-1-4051-5852-7

Library of Congress Cataloging-in-Publication Data

Advancing occupational therapy in mental health practice / edited by Elizabeth Anne McKay ... [et al.]. p. ; cm.Includes bibliographical references and index. ISBN-13: 978-1-4051-5852-7 (pbk. : alk. paper) ISBN-10: 1-4051-5852-2 (pbk. : alk. paper) 1. Occupational therapy. 2. Mentally ill–Rehabilitation. I. McKay, Elizabeth Anne.[DNLM: 1. Mental Health Services–trends. 2. Occupational Therapy–trends. 3. Professional Role. WM 450.5.O2 A244 2008]

RC487.A38 2008616.89’165--dc22 2007019845

A catalogue record for this title is available from the British Library

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Contents

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Part I: Introducing the Mental Health Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1 What have we been ‘doing’?: A historical review of occupational therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Elizabeth Anne McKay

2 The changing face of occupational therapy in mental health . . . . . . . . . . . . . . 17Gabrielle Richards

3 Cultural sensitivity in context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Kee Hean Lim

Part II: Exploring Practice Contexts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

4 Engaging the disengaged: Practising in acute in-patient settings . . . . . . . . . . 51Samantha Dewis and Michelle Harrison

5 Broadening horizons: Beyond acute mental health . . . . . . . . . . . . . . . . . . . . . . 63Michelle Harrison and Samantha Dewis

6 ‘Doing’ in secure settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Elaine Hunter and Elizabeth Anne McKay

7 Occupational, social and intrapersonal alienation explored in the community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Wendy Bryant

8 Strengths and challenges to practice: Reconciling occupational justice issues as a prerequisite to mental health recovery . . . . . . . . . . . . . . . . 103Karen L. Rebeiro Gruhl

9 The art of occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118Jacqueline Ede

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10 Vocational rehabilitation in the UK: How occupational therapy can contribute . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132Carla van Heerden

11 Powerful stories and challenging messages . . . . . . . . . . . . . . . . . . . . . . . . . . 147Graeme Smith

Part III: Research and Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

12 Reviewing consumer-run mental health services . . . . . . . . . . . . . . . . . . . . . . 161Samson Tse and Carolyn Doughty

13 Twists and turns: The development of a clinical–academic career pathway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189Edward A. S. Duncan

14 Researching within mental health: Slow and steady – a Canadian tour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204Thelma Sumsion

15 Future prospects for occupational therapy in mental health . . . . . . . . . . . . 215Christine Craik

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

vi Contents

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Wendy Bryant MScSchool of Health Sciences and Social CareBrunel UniversityUxbridge, Middlesex UK

Christine Craik MPhilSchool of Health Sciences and Social CareBrunel UniversityUxbridge, MiddlesexUK

Samantha Dewis MScPenn HospitalWolverhamptonWest Midlands, UK

Dr Carolyn Doughty Balance NZ – Bipolar and Depression NetworkChristchurch New Zealand

Dr Edward A.S. Duncan Nursing, Midwifery and Allied Health Professions Research UnitUniversity of StirlingStirling, Scotland UK

Jacqueline Ede MScNorth East London Mental Health NHS TrustGoodmayes HospitalIlfordEssex, UK

Michelle Harrison MAHallam Street Hospital West BromwichWest Midlands UK

Elaine Hunter MScRoyal Edinburgh HospitalMorningsideEdinburgh, UK

Kee Hean Lim MScSchool of Health Sciences and Social CareBrunel UniversityUxbridge, MiddlesexUK

Dr Elizabeth Anne McKay Department of Occupational TherapyUniversity of Limerick Ireland

Contributors

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Karen L. Rebeiro Gruhl MScSudbury Regional HospitalSudbury, OntarioCanada

Gabrielle Richards MScSouth London & Maudsley NHS Foundation TrustLondonUK

Graeme Smith MANorthumberland Tyne and Wear NHS TrustCherry Knowle HospitalSunderland, UK

Dr Thelma Sumsion School of Occupational TherapyElborn CollegeUniversity of Western OntarioLondon, Ontario, Canada

Dr Samson Tse Faculty of Medical and Health SciencesUniversity of AucklandAuckland, New Zealand

Carla van Heerden Employment and Vocational Opportunities Mascalls Park HospitalBrentwood, UK

viii Contributors

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Progress lies not in enhancing what is but in advancing towards what will be (Kahill Gibran)

Occupational therapy evolved as a health and social care profession from the roots of psychiatry. Occupational therapists have worked with people with mental ill-ness for over a century. It is accepted that psychiatry has changed and has been redefined since that time and that the emphasis for intervention has moved beyond the asylum of old to the multi-cultural community of today. Occupational thera-py’s contribution to mental health services internationally is significant, if under-recognised. That said, recent research from around the world demonstrates the importance of meaningful occupation to improve clients’ health, their functioning and participation in their local neighbourhood.

The editors represent both practice and education, and all believe that occupa-tional therapy has made, and should continue to make, that significant contri-bution to mental health practice. The editors include British, Australian and Singaporean therapists; the idea for this book grew from the belief that mental health continues to be a practice area within ever-changing contexts and dynamics and with particular challenges, and that expert narratives, whether from practitio-ners or researchers, are not well represented in the professional literature. Their stories of delivering or researching services in complex systems can offer real-world perspectives and useful insights to others.

Whiteford and Wright-St Clair (2005) highlight that complexity both challenges and explains our modern society, existing as it does at many levels. They define complexity as ‘the richness and variety of structure and behaviour that arises from the interactions between the components of a system’ (p. 5). It is the array of inter-actions and interconnections that make the health care and social systems in which we work complex environs. Rarely are occupational therapists required to find a simple solution to a client’s problem – most often clients’ problems are situated in contexts that demand intricate responses from practitioners.

Cowan (2006) discusses complexity in relation to higher education; here his per-spective is related to occupational therapy. If we consider therapy as an outcome of an interaction between individuals and environments, and if we further con-sider that both therapist and client are interactions of their history, culture, think-ing and emotions, then it follows that the result will be unpredictable, with interventions having unexpected outcomes. Given this, nothing in practice is

Preface

Advancing practice in complex environs: mental health

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certain and there is no correct answer; then, therapists must act well, in light of their understanding, experiences and research. This is advanced practice in action.

Professional practice knowledge refers to the knowledge base used by an indi-vidual or a profession including knowledge derived from theory, research and professional experience. Advanced practitioners develop practice wisdom. That is to say, practice wisdom generated from their practice experience, cognitive and meta-cognitive processes are linked in clinical reasoning, with professional judgements and the affective processes that together produce cultural competence (Higgs & Jones, 2000). These aspects form the basis of applying advanced professional knowledge in practice. To summarise, to become advanced practitioners, thera-pists must move beyond competent practice. They are required to be reflective, curious and creative: developing expertness in their own specific domain as well as being able to conduct and contribute to research and to educate others.

The need for advanced practitioners to deal with the ever-changing, complex, health and social care contexts worldwide is gaining in recognition. Fraser and Greenhaugh suggested that ‘successful health services in the 21st century must aim not merely for change, improvement and response but for change-ability, improvability and responsiveness’ (2001, p. 799). Advanced practitioners are seen as crucial elements to develop the health workforce and to modernise services. Esdaile and Ryan (2003).

outlined key elements of advanced practice. These included; breadth and depth of individual knowledge, appreciation of the wider context, critical thinking, continual striving to further develop knowledge and skills, often leading to additional qualifications and a commitment to quality. Typically such individuals also make a contribution to one or more areas of practice. (p. 32)

The advanced practitioner is defined as being specialised or having highly devel-oped knowledge and skills beyond those, which are required for registration, encompassing the breadth and depth of current and future professional practice (DOH, 2000).

This book captures and reflects current advanced occupational therapy practice, nationally and internationally. It showcases the innovative practice and research taking place in occupational therapy within mental health contexts. Throughout the text there is on emphasis on occupational therapists being specialists in occu-pation and for them to be specialists rather than generalists in the mental health arena. The authors articulate their expert knowledge and skills in their practice or research.

Finally, we hope that you are stimulated by the text that it speaks to you on many levels allowing you to reflect on your own practice and to consider how you can contribute to advancing occupational therapy in mental health in the future.

Elizabeth Anne McKayChristine Craik

Kee Hean LimGabrielle Richards

x Preface

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References

Brown G, Esdaile SA, Ryan SE (2003) Becoming an Advanced Healthcare Practitioner. Edinburgh: Butterworth Heinemann.

Cowan J (2006) On Becoming an Innovative University Teacher: Refl ection in Action. Berkshire: Society for research into higher education and Open University Press.

Department of Health (DOH) (2000) The NHS Plan. London: HMSO.

Fraser SW, Greenhaugh T (2001) Coping with complexity: educating for capability. British Medical Journal, 323(6 October), 799–803.

Higgs J, Jones M (2000) Clinical Reasoning in the Health Professions. Oxford: Butterworth Heinemann.

Whiteford G, Wright-St Clair, V (2005) Occupation and Practice in Context. Sydney: Elsevier Churchill Livingstone.

Preface xi

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Part I Introducing the Mental Health Context

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