Occupational therapy should be a standard resource for people with mental health needs | Mental Health Perspectives

The coronavirus pandemic brought to light how woefully inadequate the U.S. health care system is in providing mental health treatment to people of all ages. Many people dealt with anxiety, depression, grief, or trauma over the last three years. One profession that can help is occupational therapy.

You might already know that occupational therapy practitioners help patients through physical rehabilitation to adjust to their home or school setting. But you might not realize that these workers also serve a crucial role in the mental health field, by working with patients who have mental health challenges to help them understand their triggers and make adjustments in their everyday living.

As an occupational therapist for more than 25 years with experience in inpatient treatment, jails and communities in Washington and California, I have worked with people who struggle to get out of bed, who are withdrawn and have low self-esteem and who find it difficult to concentrate or follow directions. 

Throughout my career, I’ve come to see that while occupational therapists are licensed providers with a long history of serving people with mood, thought and personality disorders, they remain an underutilized resource in the mental health field.

Disease, disability and traumatic events like abuse or neglect can make it difficult for people to complete daily tasks such as bathing or brushing their teeth. My role is to identify the skills necessary to do an activity, including cognitive, physical, emotional and environmental factors. I then break down the components of a task, modify as needed, and make recommendations to improve the ease of doing it.

This work is distinct from physical therapy, which mostly focuses on getting a patient to walk or gain mobility. In my job, I’m examining how a broken bone or mental health disorder impacts the entirety of a person, from their ability to move their body to their mood and head space.

What I love about being an occupational therapist is the flexibility and creativity I have. At any given moment, I am a detective, a researcher, a collaborator, a teacher and a puzzle-solver. 

Treatment can be trial and error, but I’m working all the while to understand a patient’s goals and connect them to meaningful activities that build on their strengths to help them with routine tasks. It’s incredibly satisfying when something works.

For example, I worked with one woman who had been incarcerated and involuntarily hospitalized for many years. She needed to relearn everyday skills, such as ordering tea from a cashier and determining how to pay. In meetings together, we talked about her anxiety, and I validated her feelings and reminded her of her ability to problem-solve. When she got insecure, I reassured her and gave positive feedback on her progress. 

I worked with a boy who had so much anxiety that he did not attend high school and rarely left the house. I slowly helped him feel more comfortable going outside. We started with a short distance from home in a car. The first time he got out of the car and sat on a bench by the beach was a huge accomplishment. 

In my private practice, I’ve worked with a couple of clients who had a mental illness and wanted to begin dating. I discussed with each of them how to communicate with partners that they had a mental illness and needed to take medications. We also talked about how to discuss birth control and sexual health.

By analyzing the skills needed to function despite cognitive, mental and behavioral health challenges, I was able to help these clients achieve independence for the goals that were most meaningful to each of them.

The occupational therapy profession began in 1917 during World War I, after health care providers found that soldiers healed more quickly and functioned better when participating in hobbies or leisure activities, like playing checkers or knitting, compared to those who were only getting physical health recovery treatment. 

However, many health care and treatment facilities don’t fully understand the scope of our discipline and falsely perceive that occupational therapists are too expensive to hire. In reality, I’ve found occupational therapists in mental health fields are paid less than peers in other settings. 

Occupational therapy should be a standard resource for clients and patients with mental health needs because it is an evidence-based, holistic, person-centered and licensed profession that helps a person function better despite diagnoses, illness or disability.

Editor’s Note: SB 5228, which would provide Medicaid coverage of occupational therapy services for people with behavioral health disorders, has passed the Washington state Senate and has moved to the House as of Friday.

M. Terry Bowman OTR/L is an occupational therapist, manager and advocate in mental health in Pierce County and a member of the Washington Occupational Therapy Association.