OT in mental health wards

It can be rather interesting listening to the things that OTs supposedly do in mental health wards/hospitals when I attend lectures. It’s a bit like, “Woah really, they actually DO STUFF??!” I should probably have a more positive attitude towards occupational therapy, especially as I’m studying to become an OT… I am only referring solely to OTs who work in psych wards though, as I do know that those in outpatient settings and rehab wards do a lot with their clients.Let’s face it, those of us who have been in psych wards possibly haven’t found occupational therapy to be all that helpful.

In the lecture yesterday, the OT used a person she had worked with previously as a case study, a young man who had been involuntarily admitted to hospital. According to her, an OT would do assessments with him, would do an interview and a Mental State Examination, establish a therapeutic relationship, set goals with the client, carry out interventions… Obviously I can’t claim to be aware of all the happenings within the ward, but I have very rarely seen OTs work one on one in such depth with inpatients. I thought all they did was conduct beading, painting, bored board games or cooking activities! Oh, and possibly a few groups in between.

So me being the cynical and pedantic person I am when it comes to provision of mental health care, I had to go up and ask the lecturers about whether this actually happens. I gave examples of three of the wards I’ve been on, saying that I haven’t really seen that happen. “Is this from personal experience, family members or….” asked one of the lecturers. “Umm, personal experience,” I answered. I can’t quite remember all of what they said, but they agree that in acute inpatient wards it can be more group work as well patronising, primary school level activities such as the art and sports ones. One of the lecturers explained that it also depends on how well the client is, as those who are on acute inpatient wards may not be ready to participate in the one to one actual occupational therapy intervention. Oh, and now all three lecturers who teach this unit recognise me. Heh, awkward.

I’m curious though, has anyone actually experienced proper occupational therapy in mental health, whether as an inpatient of outpatient, that was helpful?

15 thoughts on “OT in mental health wards

  1. The “occupational therapy” that we got while I was in the hospital consisted of games of Bingo (holiday themed!), and coloring cutout Christmas ornaments. I’ll list all the ways that this helped me become less suicidal:

    *crickets*

    • If you want we can go back to the old asylum days where we locked people in padded cells or just let them wander around a fenced area. but nah a group program is useless to have.

  2. I’ve had some really helpful OTs in previous admissions! 2 in particular who went out of their way to sit with me while distressed, teach me what I now know to be distraction techniques, try & teach me how to cook & reduce ED behaviours while cooking. Even simple things like when I was struggling, taking time to sit with me & encourage me to drink a cup of water because the nurses didn’t have time. These particular OTs worked really well with the rest of the treatment team, came to case reviews, etc. & I found their engagement to be invaluable. However I’ve had other admissions where OTs have been like “let’s play nintendo” & I’ve been like “nah” & they’ve been like…ok. I shan’t interact with you again! I think it really depends on the OT & how hard they’re willing to work with the patient & if what they’re willing to do fits in with the rest of the team. x

  3. Yeah I’ve had some OTs do actual stuff with me. Sometimes they have done similar work as the social workers and tried to plan how I would go home, how to make home environment better etc. Others have taken a group of us young people on community outings such as taking some of the ones with anxiety to shopping centres and on buses. I’ve also had OTs take people with EDs out for snacks and coffee at a cafe. Then I’ve had ones that do craft etc with me. I actually really appreciated the craft and planned activities. I was extrememly ill when I was on a psych ward and just couldn’t plan anthing for myself or even really muster up any energy to do anything but sit in a chair all day. I actually owe so much of getting better to the planned OT activites, which maybe some of the well-er people found moind numbing… but were almost challenging for me. So I guess I’d say, don’t knock the massive benefits these activites can have for people just because you didn’t find them helpful. Everyone is different and you’d be amazed how some of the very sick people found a bit of relief from their illness during these sessions.
    Also I had an OT work with me onceto help me start off the day each morning, eat breakfast, wash hair, change, clean room.
    SSo yeah, hope that helped and showed you a few of the things OTs do!!

  4. I’ve had some great help from OTs in an acute psychiatric ward here (UK). Had a couple of one to one cooking sessions, where the OT helped me with adapting stuff so things were less dangerous (I managed to frighten her a bit the first time :P), and she took me to the new area I was moving to (was homeless when I arrived on the ward) to find the supermarket and other places so I would feel better there. I think she also went shopping with me once for some toiletries as I didn’t have any when I went in. That was really good (and helped her get an idea of what problems I had with travelling and shopping, so was part of her job).

    The other activities also helped, the group cooking (which also involved a trip to the supermarket to get the ingredients for those allowed to leave the ward) and stuff. Some of them were run by OTs, some by activities coordinators, some by both. I found them really helpful, even the simple ones like colouring in. I discovered I was really really good at pictionary in one of them 🙂 One of the pieces of art I helped with is now in the front waiting area of the unit, which is cool.

    I know a lot of the patients thought the activities were boring and pointless, but I got a lot out of them. Okay, it didn’t stop me being suicidal, but it was a slight distraction for a bit with people who weren’t there to interrogate me on how I was feeling.

  5. In the (adult) inpatient units I was in, the OTs ran 1 of 3 groups daily – an art (coloring, glue) group and a hygiene group (nail care – I kid you not. nail polish was the only thing provided.) and a wellness group that consisted of handing out worksheets printed from the internet about holistic wellness (that one could find googling on his own). They were also present during meals but did not interact with patients at that time. It was mind-boggling to me that they received a salary for this. They did nothing that a babysitter would not be able to do.

    I work with OTs professionally in a related field and have nothing but respect for them. After my hospitalizations my view of the profession, at least in the USA, did shift quite a bit. It has not been my impression that OTs who work in mental health do much, apart, perhaps from individuals with severe illness such as schizophrenia who may need help learning to do day to day basic tasks — again, something which most caregivers could easily provide without an OT background. This impression was further solidified by post-hospital discussion with OTs who do not work in mental health, who shared my impression that hospital based MH work was a serious easy out.

    • An easy out, that’s laughable!
      Adult mental health inpatient units have one of the most unwell client demographics out of all health care settings. I encourage the OT who shared your impression to try working in one for 3 months and see if her perspective changes. Like any skilled OT knows, our role is to increase participation in meaningful occupations, when we do our job well our clients are doing “normal things” and our hard work isn’t seen as easily.

  6. After my first admission, I started seeing an OT as an outpatient. She helped me to build up the courage and resources to find a job so that I could keep my house, and in the interim when I was not well enough to work, she did things like got some food donations from a charity for me and stuff. She didn’t seem amazingly adept at knowledge of mental health issues, nor was she completely comfortable dealing with a young person who had a vague idea of how the world worked, but she definitely helped me by breaking things down into small steps and encouraging me.
    Then, of course, there is the crappy activities that come along with IP admissions, but tbh I have found comfort in them at times. (Well, the art stuff anyway, not really anything else.)

  7. I’ve had good OT as inpatient and outpatient – in fact partly influenced me studying it myself. Yeh there were lots of group stuff – art, craft stuff, but found that helped me distract from negative thoughts, and also very slowly encouraged me to interact with others rather than isolate myself. went out off the ward to local community – was good to have the support to gradually increase my confidence. Before I did any of this I remember having a long one on one sort of chat (although I wasn’t really talking much) to see what were my interests. I think it needed an OT to realise what was meaningful to me, and how to grade it appropriately, and that that’s not something that any support worker could necessarily do (nursing assistants on the ward would think taking me for a walk around the block was enough).
    Some of the stuff seems so obvious, esp when I’m well, but when I’ve been ill, obvious stuff goes out the window!!!

    REally sorry to hear that you haven’t had a good positive experience of mh OT. You need to go out there and show them all how it should be done!

    btw well done on at least asking the lecturers – and hey, if they know who you are, they know you know that things aren’t always as theory wants it to be!

    tag

  8. I am currently working as an inpatient MH OT. I found this thread very interesting as I don’t often get to hear what people think I do.
    When I first started we had an activity programme that placed more emphasis on arts and crafts. Although we have now had a review and have freed up our time for one to one’s.
    I have more autonomy in my role to decide what someone finds useful for them.
    1. Some of what I do is assessment based for the purpose of informing discharging planning, so whether if someone needs Rehab, Independent living, Community support or some form of Supported Accommodation. A Home visit normally happens in this case.
    2. Some people are high functioning with some deficits in coping mechanisms or lack the skills to maintain wellness in their mental state due to external stress. So I provide Recovery model based support in one on one or group basis. Looking at Relapse triggers, and putting together a plan to stay well. This can lead to a Community referral.
    3. Some people have a good grasp on their functioning, they know why they are in hospital, they want to be there to get better, they know what to do in the future to stay well. They are just bored. I provide activities that they are personally interested in to make their stay in hospital better.
    4. Available for everyone: Some people need help with Dental appointments, Opticians, or have no clothes. This all comes under Self care.
    5. I also help people find accommodation or help with benefits.
    6. I support the Psychologist with talking groups.
    7. I attend professional meetings, CPA meetings, and ward rounds.
    8. I also advise the consultant on the appropriate amount of Leave people should have and ensure everyone uses their Leave daily.
    9. I have also supported the HCA’s in setting up weekend and evening groups when there is no OT.
    10. I support the art therapist with groups.
    11. I run community link groups to take people to town, zoo’s, beach, supermarket, garden centre, golf etc…this assess’ s a persons ability to cope in the public domain, particularly useful for anxiety or mania.

  9. I’m currently an OT graduate student doing a internship at an inpatient mental health facility. I have to admit, I’m frustrated and cynical about what OTs do here as well-running craft groups and assorted other groups. Simple, mind numbing, childish beads and markers and shit. But we have patients across a wide spectrum of functioning due to their illness. Daily, I ask myself: how the hell can I provide a group that is meaningful for people with schizophrenia who are completely “disorganized and psychotic” as well as high functioning people who are depressed and suicidal but essentially in touch with reality? Not to mention there are so many supplies that are forbidden due to the safety risks. Coloring pencils? Nope, they are sharp and pointy.

    I feel lost and worried that I spent two years on a graduate degree that is nothing more than a glorified camp counselor role. I would love to get more insight about what good OT might look like for patients in inpatient MH facilities-from the the patient’s perspective.

  10. Hi everyone, I have just started working as an ot in an inpatient setting and have been directed to set up a weekly inpatient group…any ideas about what would be useful?

  11. Hi,
    So i have just started my role as an OT on our mental health inpatient ward.
    Starting here only 5 weeks ago has been one of the most frustrating and mind blowing experiences i have ever been faced with. I am faced with being called an “activities coordinator” every day it really doesnt sit well. I feel my skills as an OT from the past 5 years have been left at the door. I would really love some support or even guidance to what groups i could run that would see the OT vibe change from activities coordinator to meaniful groups and education.

  12. Im currently working as an OT in a medium security forensic mental health setting and yes we do do a lot of groups such as cooking and sport and art etc but due to the restricted nature of the setting this is the only oppurtunity these consumers get to engage in something meaningful. No one gets forced to do any of the activities, so they only participate if they want to and they get to choose what they would like to cook or play or whatever. We also do a number of skills building activities which aim to prepare them for when they go back into the community. Some have been institutionalised for a long time and have said they have really struggled entering back into the community on previous occasions and remark how helpful this skill building will be for the future. The skill building typically revolves around social skills but includes other things as well! Also we do alot of mental health education programs, drug and alchohol sessions/ phases of change sessions, sensory sessions and sessions with therapy dogs.
    Hope this helps in some way! 🙂

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