Helen Gatley discusses the relationship between occupational therapy and mental health and wellness with the Moulding Health Team.
How does an Occupational Therapist find themself in the mental health and wellness setting.
Essentially, as occupational therapists, our big concern is, how are people managing to function in the day to day lives. And I don’t think there’s anyone in the world who would deny that mental health has an impact on our ability to function, to do our jobs, learn if we’re at school, manage our household, enjoy our hobbies, all these things. And so it is something that a lot of people don’t necessarily realize.
But once you understand the connection to function, which is really the home of occupational therapy. Then it makes perfect sense that mental health and OT would have a crossover and a big crossover. Yeah, so we work in many, many settings, and hospital-based, community-based, private practice, obviously. And, yeah, we, work with other people, we work within the team. So it’s not, that we work individually necessarily, but we often work with psychologists with the psychiatrists and bring our little perspective into helping people really re-engage with the sort of self-selected activities, the things that they want to do with their lives. That’s our focus, largely.
Are there certain mental health and wellness issues that you treat as an occupational therapist.
So it’s a deceptively complex question that you have asked. But there isn’t a specific set of disorders that we say these are the domain of OT and anything else isn’t. Because at the end of the day function is the name of the game. We will work in the perfect world, we would always work with psychologists and psychiatrists to make sure that we get as holistic care as possible for the clients.
I’ve worked with people with many disorders, from mood disorders to psychotic disorders to substance use disorders. But then we also might work with people who maybe don’t have as, as clearly defined mental health concerns, but are looking for, for building up of greater health-promoting practices within their lives. Or just struggling with conflict resolution, maybe within particular situations. We might even work with people who, within the mental health space don’t have a clear diagnosis.
There’s also a huge crossover because humans are not made up of a mind in a jar and a body in a jar. Our minds and bodies are integrated. And so even working with a person, that was in a car accident and has some sort of broken bone or a tendon injury that needs to be rehabbed. But they’re also probably dealing with some sort of traumatic response to the injury. As well as dealing with the changes to their body and the changes to what they can and can’t do. And so there are elements of mental health, that affect every person, we see. I don’t think there’s an occupational therapist on the planet, that can avoid mental health.
But on the other hand, how, does someone know they need to come to us? It is tricky, because, a lot of people don’t know, don’t necessarily know what an occupational therapist can do to help them. So self-referral is relatively rare. Most referrals will come from other therapists or doctors. As well as psychologists and psychiatrists, who understand where we can add to what they’re already doing. So that is largely, what happens.
There are a lot of elements to what constitutes a good therapeutic relationship. And so it’s like with a psychologist, obviously. It’s not just about the skill set as I’m an OT, therefore I can help this person. Because we work with very personal, difficult and deep parts of their lives. They need to feel safe with the individual who’s their therapist as well. So there’s complexity in that referral system. We have to be quiet, sensitive to the people who come into our space and make sure that we’re looking for the people who can best serve them.
It’s possible for someone to be referred to me and I have the skill set to help them. But I might not be the best individual because we don’t relate to each other well. And it’s not that I’m saying, I can’t work with people who, are different to me, that’s not it at all. But you do need to feel comfortable and safe in that space with your therapist. So, that is similar to how psychologists also have to look at how they work with people. Because we’re often dealing with very deeply personal things.
What would you do as an Occupational therapist to help a person improve their function.
As OTs, we look at function from multiple different levels. One of the things we would do is assess some of the core components of functions. Perhaps, there’s an issue in concentration, or there’s an issue in mood specifically. So specifically depressed mood, and then we would add elements into our therapeutic package that address those individual client factors. Which may include the specific activities we choose as part of our sessions or may include home program elements.
We know that exercise has a massive beneficial effect on mood. But a depressed person is probably really struggling with motivation to get up and go for a run. Part of what we will do is try and find ways to facilitate the movement from the theory of this is quite good for you. Which most doctors who deal with mental health will say to their patients, you should really try and exercise and preferably outdoors, because the natural light helps better. But the OT will try and help transition them from the recommendation to the action.
And, and that’s sort of the little space that we interact with. So perhaps we’ll use strategies, like habit-building strategies, goal setting strategies, planning strategies. Perhaps we will add in other elements that we know can elevate mood to try and get that motivation up. We also do a lot of patient education, a lot of working with family groups.
Support systems for mental health and wellness
If there’s one individual in the family who is struggling, the support system is a hugely important part of their function and their well being. So having, having connection and helping them build that connection, but also working with their support system. So that because we can’t be there all the time, they have to have more than us. And so that might be part of what we help with. And we could also then look instead of like these tiny little individual factors, like specific mood or specific concentration, we might zoom out of it and look at slightly bigger parts to the whole functional complexity, which could be overall activity schedules.
So maybe we look at if a person has a pattern in thier engagement that’s potentially problematic. How do we try and shift that? One of the challenges of OT, but also the thing that I love is that it really works best when the client is the leader of the change. So we are there as a facilitator and a helper and a therapeutic presence. But everything has to come from a person-centred perspective. Because what works for me will not work for you or someone else necessarily. And so it’s very difficult. I think this is one of the reasons why OT is often misunderstood and hard to explain. Because it’s so individualized, there’s a lot that doesn’t necessarily explain here is the protocol we would follow. Even though there are elements of that there’s a lot that individually.
As an OT do you find giving the patient accountability for their mental health and wellness works with people.
So sometimes just the act of coming to therapy is part of that, because there’s an external person who’s in the process with you. And so, you’ve got to go and see the therapist in a week’s time, and they’re gonna ask how did it go? And you’re going to have to say. Now, that’s not enough for everyone. But for some people, that in itself is enough. There’s some people who work brilliantly with a checklist or if I can tick it off at the end of the day and say, Yes, and sort of almost like reward systems and people that really works for them. But other people, it really doesn’t just feels like admin.
So there are a number of different strategies like that. One of the big things I find is really important is to actually reexamine the goal-setting process itself. And just because often we set goals, and I can’t claim credit for this because I learned it from a very wise person who’s actually not an OT, but a coach. But she often talks about goal setting and how we often and I think this is true for New Year’s resolutions, too, we often set these lofty goals. Which are great goals and, things that we should be working for and beneficial and all these things. But we don’t have the first step yet. Thus we just never get going. So that’s one thing.
And another huge factor that I definitely do use in my practice, is pacing. W all have the capacity for change. But it’s not unlimited. I can’t change everything today. When I try to, I’ll probably fail and become demotivated. So I do find that I often end up with patients who are just those very driven, motivated people. And so they get very frustrated when they can’t fix the problem that they have. Therfore teaching them to slow down and do one step at a time is really important. Because, there’s often I work with people who just, they’re used to succeeding, and when it doesn’t work, they get extremely frustrated, which is frustrating, to be honest.
How as an Occupational Therapist do you find the mental health or wellness barrier to help a client.
One of the things that occupational therapist’s are taught is to examine things, from multiple angles and on multiple layers. So when we look at function, we’re taught to find the barrier. And it takes years of practice to get really skilled at this. I often say to students, that it will feel natural and logical to you, but you’ve trained to do it. So it isn’t necessarily common sense to your client. So I think it’s it’s something that we often think but isn’t it obvious?
And it’s not necessarily because that’s what we trained ourselves to learn to do. So when you have a goal and you’re working for it, and you’re not succeeding, part of as an OT that I would want to do is to go and sit with the client and help them examine where the barrier is, and maybe there’s something that we missed there. Originally, that we need to go back and look at that, okay, this thing is still in the way.
And I think another big part of that is, is sort of finding effective measurements for your success. Because when it takes a long time to get where you’re aiming at, you can become demotivated, but, and I’ve had this with clients before, we sort of feel like they’re getting nowhere. And then I can go back to my files there. But now look at these measurements we did on your first session. Now, can you see how far you’ve come? And that’s incredibly useful.
Can occupational therapy help with burnout and stress management
Yes, absolutely. So I mean, burnout and, and just general stress is just so prolific. And it has been, but even more, so now. I just this weekend was running a workshop on this and talking about how, we’re all just exhausted, our systems are exhausted, our nervous systems are tired because we’ve had to maintain this level of alertness constantly.
And besides all the other problems that existed before COVID, you know, we’ve, we’ve now maintained an added layer of alertness and, you know, probably there were other life things happening in everyone’s lives as well as well. So managing that is enormous. And as OTS we do have a few unique tools, particularly looking at the nervous system, and the process of stress and one of those is our understanding of sensory systems and the nervous system, and how that affects mental health.
There’s a lot of body-brain Confluence around stress, we all know, you’re nervous for a meeting, and so your tummy starts googling. I mean, we know that our body carries stress. So, we ignore it often. As OTs, I think we’ve got a huge role in helping work some of those really practical solutions around somatic or body-based approaches to some of the stresses as well. And we obviously also trained in some of the cognitive strategies, but psychologists also do that, in that area. So we have a slightly more crossover, not okay, I have to qualify myself, psychologists also do somatic therapy, but we just approach it slightly differently. And I think as OTS we have, we have a bit of a unique space there.
To listen to the Podcast with Helen Gatley please click here