Introduction

Occupational therapy (OT) aims to improve physical and mental health and general well-being. OT can be used in mental health treatments to help people with mental health conditions live and work more independently and participate more fully in activities meaningful to them.¹ Let’s take a closer look.

What is occupational therapy?

As noted by the National Health Service (NHS), OT “aims to improve your ability to do everyday tasks if you’re having difficulties”.² OT can help those with any of the following:

• Those with a physical disability
• Those recovering from an operation or an illness
• Those who have learning disabilities
• Those who are getting older
• Those with a mental health condition

OT takes a holistic view of the individual, taking account of their age, daily life, home, school or workplace, and activities they would normally do but find difficult. Occupational therapists typically perform an initial assessment to determine what the individual is struggling with, what they need help with, and what equipment they may need. It could be for everyday tasks at home, such as cooking and cleaning, or work experience and education support. 

OT can be delivered at home, within the community, or in the hospital wards. In the community, OT may, for example, help prevent an individual from entering a hospital or care setting. In the hospital, occupational therapists may support patients in the kitchen with tasks like making tea or in the bathroom to determine what support or equipment may be needed. OTs help individuals to continue to live in this environment. 

In a work setting, OTs can support by suggesting and implementing the appropriate reasonable adjustment needed for the individual to work effectively in that environment. These may be physical adjustments to the workplace (for example, making the office more accessible), or social to understand how the employer could best accommodate and support that person in the workplace. 

OTs help individuals set goals to make, personal, realistic support to achieve these goals. They can also provide psychosocial support.

How can occupational therapy support mental health?

Occupational therapists support people with a variety of mental health conditions to participate in activities that are purposeful to them, supporting their recovery.³

OT helps those with mental health problems:

• Improve their self-care by setting a morning routine, cooking healthy meals
• Manage their finances by budget-setting
• Build confidence and self-esteem by participating in local groups or interacting with neighbours
• Develop professional skills by connecting them to work experience to build their careers

In the United Kingdom, occupational therapists are core members of the teams that sit in community services and inpatient mental health services. These multi-disciplinary teams (or MDTs) support mental health services. Occupational therapists can also operate in GP practices, universities, secure settings, and prisons.¹

What are the benefits of occupational therapy for mental health?

OT can be beneficial for mental health for several reasons. Evidence shows that OT for supporting people with mental health disorders is holistic and cost-effective. 

OT can improve well-being, help people feel more socially included, promote recovery, support employment, and prevent hospitalisation.¹

The research supports these benefits,¹ which we will take a deeper look at here:

Promoting health and well-being

Occupational therapists can help promote a healthy lifestyle within the community setting. For example, evidence suggests that occupational therapists can improve physical activity levels in those with severe mental illness through interventions that focus on motivation and positive self-worth (for example, through social networks and hobbies).⁴

In addition, occupational therapists can help provide advice and guidance on healthy eating habits to those with severe mental illness.¹ Health promotion is a must as people with severe mental illness tend to suffer from higher rates of obesity from poor eating habits.⁴

Preventing deterioration 

Occupational therapists are pivotal in preventing mental health conditions from getting worse. They might otherwise require escalation to a hospital environment that is more challenging, intensive, and costly.⁵ Interventions provided by OT practitioners are vital to reduce the demand on primary care and other community services; and to prevent the worsening of mental health symptoms that may impact a person’s everyday life (for example, by reducing their ability to work, socialise or carry out previously purposeful activities).⁵

Improving patient experience

OT can improve patient experience of the ward in acute inpatient mental health hospitals by helping them make choices about their recovery and providing structured activity programmes.¹

Achieving parity of esteem

Parity of esteem refers to prioritising and valuing physical and mental health equally; OT mental health interventions can support parity of esteem. Occupational therapists could, for instance, act as disability champions in mental health services to support physical and psychological disabilities.¹

Promoting recovery

OT positively affects recovery and it may be highly beneficial to embed OT within mental health services.⁶ A key theme that has emerged is the benefit of occupation in improving a sense of meaning, purpose, productivity, ability, and social cohesion.

Many factors have been found to influence recovery through occupation, for instance, the individual’s knowledge of the recovery model and knowledge about the potential barriers to occupation. Occupational health in a recovery context has been associated with improved self-concept (one’s beliefs about oneself) and improved mental health.⁶

Occupational therapists working in mental health services were interviewed in one study in Australia, to understand their experiences of recovery-orientated practice in mental health. Recovery-orientated practice means promoting hope for the future, tailoring support to the individual, and advocating for independence, choice, and opportunity. Active development of recovery-oriented practices in mental health (and ensuring they are sustained) were cited by occupational therapists as important to support recovery.⁷

Enabling social inclusion

Occupational therapists can support those with mental health conditions to participate in meaningful occupations and activities in the community that promote social inclusion.⁵ Occupations promote mental health by offering social interaction, providing meaning, promoting self-esteem, and supporting an individual financially. Occupational therapists can support job seeking and links to work experience and activities that encourage employment and support social inclusion.

Providing employment support

As noted above, engaging in meaningful occupation is key to mental health and well-being.¹ The Royal College of Occupational Therapists (RCOT) outlines the need for “good work for good health” in their 2019 report.⁸ This outlines the need for access to occupational therapy through primary care practices. It also discusses the need for supported employment, particularly Individual Placement and Support (IPS) which supports those with severe mental health problems to gain paid work, through a system of “place then train”.

Occupational therapists support IPS in community mental health teams. Evidence suggests that those who gain employment through IPS are less likely to experience relapses in their mental health, spend fewer days in the hospital, and have sustained employment for longer and at a higher salary.⁹ This contributes to significantly positive outcomes overall.¹⁰

Creative and activity-based occupations (such as art, cooking, crafts, horticulture, etc) are beneficial for those with mental illness, though further research is needed.¹⁰

OT mental health interventions help examine their time use, occupational activities, and goals. They help to achieve these goals by redistributing their daily actions. This has been shown to have a positive effect on self-esteem and stress-related mental illness.¹⁰ But again, further research is needed.

OT interventions can support skills development, positively modify habits and lifestyle, and enable better occupational engagement and connection which confers positive benefits on mental health.¹⁰ OT interventions that modify lifestyle can reduce symptoms; OT interventions incorporated into the community and near home can improve goal attainment; and better occupational engagement and performance at work.

Providing education support

OT can also help support educational development and attainment for those with mental illness. OT interventions are delivered in the environment in which people learn and work. It when integrated with other mental health treatments and interventions, can support recovery.¹⁰

Learning about mental health and well-being and better understanding it (referred to as psychoeducation) can be beneficial to adults living with mental ill health. Incorporating psychoeducation into OT interventions can augment the effectiveness of the OT intervention, although further research is needed in this area.¹⁰

Supporting specific areas

• Younger people and families: OT interventions in groups or as a family are beneficial for mental health. For example, an occupational therapist educating parents on mental health illness (including key features, signs of relapse, and coping strategies), with helping the individual set goals, have a positive impact on the younger person¹⁰
• Addiction and substance misuse: OT can be beneficial for those with addiction and substance misuse problems.^1,11 For substance misuse, for instance, occupational therapists can evaluate the individual’s readiness for change and use motivational strategies to support them (such as motivational interviewing). They can help them find substance use recovery programmes, offer brief interventions (such as screening, evaluation, feedback, and referral), and signpost to cognitive behavioural therapy¹¹
• Homelessness: Occupational therapists can play a key role in working with the homeless, effectively offering practical, and improving their overall quality of life.^1,12 They can help them develop skills, find meaningful occupations, access training, education, and work experience, find employment, and locate suitable accommodation. They can also support those transitioning to being housed
• Depression and anxiety: Occupational therapists can support those with depression and anxiety, helping people to feel more confident and motivated to carry out an occupation that is meaningful.^13,14 OT can help with goal development, coping strategies, and management of daily tasks to help the person gain independence. OT can support people to improve their self-care (from preparing meals to getting dressed), productivity (going to work, sustaining employment, studying, or volunteering), and leisure activities (carrying out hobbies)
• Psychosis: Occupational therapists can be helpful in the community by participating in early intervention for psychosis services, and offering support for daily living.¹⁵ However, more research is needed, to overcome barriers to access and implementation of OT for this purpose

Summary

Occupational therapy helps people regain independence and offers holistic physical, social, and mental health support. OT interventions are widely studied and used to support mental health and confer many benefits. One of the most effective interventions is employment support, particularly individual placement and support (IPS) which provides those with mental illness the vocational skills that prepare them for employment.

Many other OT interventions are beneficial to mental health. Supporting education, enhancing social inclusion, advancing service access, integrating OT into the community and primary care, and assisting with daily activities all promote better mental well-being. However, further research is needed to determine the effectiveness of OT interventions in mental health.