OT in Mental Health

Hey readers! Today I want to talk about OT in mental health: what it looks like, where OTs can work, my experience in lab, etc. This semester I completed my first practice-based course, which was all about OT in the mental health setting. This was paired with mental health fieldwork placements as well as mental health labs where we all led our own mental health OT group. It is impossible to share all that I learned in one blog post (you have to go to OT school to learn that!), but I want to share some key takeaways with all of you!

My Definition of OT in Mental Health

The role of OT in mental health is to support individuals with mental health conditions to engage and participate in the roles and activities that they have to do and that they find meaningful. Our focus is on recovery, which can be worked on in group settings, by teaching coping strategies and social skills, and implementing sensory tools.

OT’s View of Mental Health

Mental health is a state of well-being in which individuals can realize their own abilities, cope with normal life stressors, work productively, and are able to contribute to their community. Society’s view of mental health has come a long way, but it still has very far to go. We discussed stigma and its impact on individuals receiving treatment throughout the course.

Recovery is at the center of OT in mental health. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), recovery has four main dimensions: health, home, purpose, and community. Mental health recovery is a journey of healing and transformation that enables individuals to live a meaningful life and strive to reach their full potential. Recovery is non-linear and up to the individual. The 10 guiding principles of recovery are: hope, person-driven, many pathways, holistic, peer support, relationships and social network, culturally-based and influenced, address trauma, individual/family/community strengths and responsibility, and respect.

Where OTs Can Work

No matter where you work, mental health will always be a factor. Even in settings that are not mental health-specific, mental health should always be addressed. This may be in schools, outpatient clinics, in the hospital…anywhere! Some specific mental health settings that OTs can work in are:

• Inpatient psychiatry units in a hospital
• Psychosocial Clubhouses
• Homeless shelters
• Support Groups
• Wrap-Around Settings (essentially any place the client needs OT services!)
• Forensic Settings (prisons, jails, forensic hospitals, community correctional settings)
• And more!

Populations OTs Serve

OTs serve individuals with a variety of mental health conditions. This may include individuals who experience:

• Homelessness
• Depression
• Anxiety
• Schizophrenia
• Bipolar Disorder
• Eating Disorders
• Borderline Personality Disorder
• Suicidal Ideation
• Dementia
• Alzheimer’s Disease
• Etc.

Example Interventions

OTs may intervene for a number of reasons in the mental health setting, always relating back to function and participation in desired occupations. Here are a few examples of what an OT might do in a mental health setting:

Coping Skills

Individuals may have trouble coping (or dealing) with stressors in their daily life or environment. Coping involves three components: information processing, emotion, and behavior processing. Individuals may use behavioral, cognitive, or avoidant strategies in order to cope with stressful situations. An OT may run a group that explores various coping strategies, and individuals may determine which works best for them and implement that strategy in to their daily life. For example, one of my biggest stressors is grad school (no surprise there!) and I use coping strategies to manage that stress. Some coping strategies that I found that work for me include exercise, face masks, lavender essential oils, reading, spending time with my loved ones, scheduling my time, and setting aside time to just do nothing (AKA watch The Office).

Sensory Processing

Individuals with or without mental illness may experience sensory processing difficulties. This may be seen as hyper- or hyporesponsiveness, sensory modulation disorder, or sensory-based motor disorder. A person may be sensory seeking, sensory sensitive, sensory avoidant, or have low registration. Our senses include taste, smell, vision, hearing, touch, proprioception, and the vestibular sense. (Yes, there are more than 5 senses!) An OT may work with someone who has sensory processing difficulties by implementing a sensory diet program in which specific sensory activities are scheduled throughout the day to support the individual in participating in important roles and occupations. An OT may also hold a sensory group where individuals can try out various sensory tools such as scented lotion, weights blankets/vests/lap pads, massagers, bean bags, sour or chewy candy, etc. in order to determine what works for them (may be calming or alerting).

Emotional Regulation

OTs may use cognitive therapy or dialectical behavior therapy (DBT) as emotion regulation interventions. For example, DBT uses acceptance skills, such as mindfulness and distress tolerance, and change skills, such as emotional regulation and interpersonal effectiveness, to support individuals in changing their emotion and behavior patterns that interfere with relationships and participation in occupations.

Cognitive Skills

OTs may work on cognitive skills such as attention, memory, and executive function. Some techniques an OT may use to treat cognitive skills or adapt the environment to support success include cognitive remediation, integrated psychological therapy, dynamic interactional approaches, cognitive adaptation, compensatory thinking techniques, reality orientation and validation, utilizing the Allen Model, and changing beliefs about abilities. OTs may also use cognitive behavioral therapy (CBT) to change distortions in cognition using strategies such as socratic questioning, guided discovery, recording dysfunctional thoughts, the TIC TOC technique (task interfering cognition vs. task oriented cognition), identifying ABCs (activating event, belief, and consequences), creating behavioral experiments, assigning homework, and scheduling activities.

Communication & Social Skills

OTs may use groups to implement strategies such as social skills training, problem solving training, responsive skills training, conflict management, assertiveness training, and more. This may use peer support, group intervention, and role modeling to learn social and interpersonal skills. Some of the skills that OTs may work on include social interaction skills such as places self, turns towards, speaks fluently, touches, regulates, transitions, times response, matches language, takes turns, empathizes, etc.

OT in Mental Health Lab

As you may be able to tell, groups are a huge part of mental health intervention. That’s why every student in my class had to design, plan and lead an OT group for the lab component of our OT in Mental Health course. The group that I led was called “Defeating Self-Doubt” and you can read more about it here! Here are the groups that some of my classmates led:

“Methods for Motivation” by Amanda G., OT/s

Amanda really utilized her art therapy background for this group! She brought in tons of art supplies and had each of us create a motivational poster to keep as a reminder for when we need a little motivation. She brought in motivational quotes and had us each choose a few that spoke to us. We each then added our personal spin on it to work for us. I chose to write a few quotes on mine as well as some goals that I have for my future to serve as reminders for why I am pursuing my OTD. Learn more about Amanda in her OT Feature!

“Importance of Self Care” through Planting by Kasey B., OT/s

This activity was really fun! We practiced one method of self care by planting flowers and herbs. Not only is planting a fun sensory activity, but it can also be calming and act as a de-stressor. We also discussed the occupational cascade that occurs from planting an herb (cooking with those herbs, socializing with friends or loved ones over a home-cooked meal, etc.)

“Visualizing Your Goal Bridge” by Amy L., OT/s

The purpose of this group was to visualize a goal and determine supports and barriers to achieving that goal. Does this remind anyone of the KAWA model?! I visualized myself in a place where I am more relaxed, have time for myself, and am able to put in the effort that my friendships deserve. I visualized supports and barriers to get to that point by drawing a bridge to get there.

“Group Communication” using a Helium Stick by Rachel R., OT/s

This was a fun activity! Rachel used to do this activity with kids at summer camp to build teamwork and social skills. We each held a “helium stick” by one finger and had to lower it to the ground under various conditions. We had to work together to modify our behavior in order to complete the task.

Check out this video to learn more about this activity!

Compassion Fatigue

At the end of the semester, my professor took some time to discuss practitioner wellness and compassion fatigue. When a healthcare provider cares for individuals who are suffering for an extended period of time, the healthcare provider may experience feelings of isolation, apathy, bottling up of emotions, and substance abuse. This is a secondary experience of traumatic stress. It is really important to be able to put your work and your patients behind you when you leave at the end of the day. Always make sure that you take care of your own mental health, because you cannot serve others if you are running on empty.

I believe that compassion fatigue is so important to talk about that I want to dedicate a whole blog post to it. Be on the look out for this in the coming weeks!

Disclaimer: I have shared a few things here that I learned over the last semester. I am not a professional and this is not a conclusive list. Please consult a licensed occupational therapist and use your own clinical judgement before implementing any of these ideas, strategies, and techniques.

Thanks for reading!