The surging mental health crisis in our country often overlooks a vital method of support — the power of occupational therapy. Each year about 1 in 4 adults are diagnosed with a mental health disorder, yet many are unaware of the transformational potential that support from occupational therapists provides when it comes to mental health.
With anxiety disorders being the most common mental health condition, affecting over 40 million adults in the U.S. alone, understanding the scope of this issue is crucial.
Occupational therapy supports the resiliency and dignity inherent to every client, especially those with serious mental illnesses, and helps clients draw on and enlarge their capacity for self-reliance to create meaningful lives for themselves. With more than 57 million Americans living with a mental illness today, occupational therapy must be utilized through occupational therapy programs, supported, and celebrated — not overlooked.
Walking the walk of therapy
Focused on personalized and holistic care, occupational therapy differs from other types of mental health support. Rather than meeting mental health clients with medicalized treatments, occupational therapy utilizes the recovery model to meet clients where they are to help them navigate their circumstances and achieve a meaningful life that is unique to them. It can help improve clients’ function in every area of life, including work, play, social relationships, self-care and community contributions. Whereas other mental health treatments tend to focus on addressing symptoms, occupational therapy works with clients as they are and focuses on finding solutions for them in their daily routines.
This approach aligns with recent evidence that indicates the acceptance of negative emotions and thoughts can lead to more positive outcomes — not just in the mental health sphere but in the wider field of medicine. For clients who have often been stigmatized by mental illness, occupational therapy can help them discover solutions that they find meaningful and identify ways to pursue that meaning.
Occupational therapists take the “talking cure” approach of other mental health specialists, such as therapists, psychologists, and psychiatrists, and put it into action. Think of it as “walking the walk” of therapy. For example, if a client is anxious about completing a banking errand, an occupational therapist can accompany them to provide functional support. Similarly, an occupational therapist might join a client at the grocery store to teach coping strategies and lend support on their journey to regain independence. Instead of operating from the mindset that they are “fixing” clients, occupational therapists help people labeled with serious mental illness accomplish the tasks they want or need to do despite the barriers they face.
By ensuring clients feel they have the power to make their own decisions, occupational therapy helps people live the meaningful lives that they want to live.
Mental illness has been persistently under-resourced
To fully understand the state of mental health treatment today, we must understand how we got here. The deinstitutionalization policy of releasing people labeled with mental illnesses into mainstream society began in the mid-1950s. The change stemmed from a desire to end inhumane treatment, from optimism about emerging medications, and from the expectation of saving money. On all three counts, the policy proved misguided, leaving a massive gap between the former institutions, inadequate though they were in many ways, and federally funded support for mental health resources. Without proper support, people with significant symptoms were released into the streets. Hospital ERs and jails became the default backstop for people with serious mental illnesses, delivering little care for those in need and creating tremendous strain on these facilities.
Having been previously underfunded and inadequate, certified community behavioral health clinics didn’t emerge until 2014. The severe lack of resources for such a significant amount of time has contributed to the spread and persistence of serious mental illness today and impacted treatment efforts.
The fragility of conventional mental health treatment
While conventional mental health treatment has come a long way, it still has many weaknesses. The most pressing is the severe barrier to mental healthcare access, including lack of affordability, social stigmas, and scarcity of services.
Those who are able to access care face a medicalized mental health landscape. Many psychiatric drugs today can come with serious adverse effects, including headaches, weight gain, dizziness, sleepiness, or problems sleeping, and long-term impacts, such as depression, paranoia, personality changes, and memory damage. These side effects may contribute to a high rate of treatment noncompliance. In fact, poor adherence to maintenance treatments for chronic illnesses such as schizophrenia and affective disorders can exceed 50%.
For some time, drug development in psychiatry has stagnated relative to other medical specialties, although this trend may be reversing. Meanwhile, outcome reporting systems are not as robust in mental health specialties as elsewhere, leaving more room for doubt that conventional treatment outcomes are improving over time. Together, these factors point to spaces where novel mental health interventions and approaches might flourish.
Combination therapy with OT may provide greater effectiveness
There is reason for optimism with the emerging use of integrated treatments for mental illness. We already have seen that combining pharmacotherapy with psychotherapy can be more effective than either approach alone in treating major depression, panic disorder, and obsessive-compulsive disorder. And occupational therapy has shown promise on its own as a tool for helping people with serious mental illness remain connected to their sense of purpose through school and work. More research is needed to establish the place of occupational therapy alongside other treatment options in the greater mental health arena, ideally to pinpoint which models and methods should be applied under specific circumstances and maximize the benefits of OT in mental health treatment.
As more people begin to recognize the growing mental health crisis and its spectrum of challenges, we must also promote occupational therapy’s vast recovery potential and encourage its accessibility. A powerful resource in the healthcare provider’s arsenal, occupational therapy has the potential to transform mental health treatment efforts by helping empower more people to lead the lives they want alongside their mental illnesses.
Dr. Jessica De Brun
Dr. Jessica De Brun is an Assistant Professor of Occupational Therapy at the University of St. Augustine for Health Sciences San Marcos, CA campus. Dr. De Brun has a wide variety of experience as a mental health occupational therapist working in emerging practice, community-based pediatric, and adult mental health services. Her clinical practice experience includes pediatric trauma intervention centers, domestic violence shelters, substance use, recovery services, local school districts, and regional centers. Dr. De Brun’s research and scholarly interests have focused on emerging practice, program development, trauma-informed education, secondary trauma and burnout, early childhood trauma, the maternal-child co-occupational experience, and occupational justice. She has served as a fieldwork educator in various emerging practice and community-based settings, including mental health programming for children, survivors of domestic violence, and for individuals with co-occurring mental health and substance use disorders. She also serves as chair of the Occupational Therapy Association of California’s (OTAC) nominations committee, where she advocates for OT leadership in California and for the occupational therapy profession.
Dr. Lacey Spark
Dr. Lacey Spark is an Assistant Professor of Occupational Therapy at the University of St. Augustine for Health Sciences Austin, TX campus. She's worked in community mental health practice and presented at the annual American Occupational Therapy Association conference on occupational therapy groups for early intervention and treatment of psychosis. Dr. Spark has also served the older adult population in home health, skilled nursing, assisted living, and independent living settings. She is also serving as chair of the Capital Centex region of the Texas Occupational Therapy Association.
