Occupational Therapy and

Mental Health
Mary Rectenwald

Introduction
PIO question:
Does occupational therapists use of the
recovery model/approach throughout
interventions increase community
independence among individuals with
mental illness?

Significance of Applying EBP to Mental Health

and OT

Mental illness is the leading cause of disability in the world

(Castaneda, Olson, & Radley, 2013).
Prevalence of mental health issues: 1 in 4 people worldwide
will be affected at some point in their lives, 450 million
people have such conditions worldwide (Gibson, DAmico,
Jaffe, & Arbesman, 2011).
Occupational therapys origin is rooted in mental health
(Castaneda, Olson, & Radley, 2013).
Occupational therapy helps enable individuals to participate in
daily occupations. This is congruent with the recovery
approach, which promotes living alongside the challenges of
mental illness (Cone & Wilson, 2012).

What is the recovery model/approach?

The model views recovery as a life-long process with an end

focus on full community participation (Castaneda et al., 2013).
The recovery approach is based on recognizing need, and
assisting people to live a satisfying life despite the
challenges of mental illness (Cone & Wilson, 2012).
The vision of recovery calls for a change from symptomcenteredness to person-centeredness (Jacob et al., 2015).
Recovery is an individualized, strengths-based, and personcentered process that includes self-discovery; empowerment;
holistic, nonlinear peer support; respect; responsibility; and
hope (Gibson et al., 2011).

Description of Search Strategy

Search engines:
AJOT, CINAHL, Google Scholar
Search terms:
Mental health, mental illness, occupational therapy, mental
health recovery, recovery model, community, community
integration
Inclusion criteria:
Articles focused on recovery and mental health/illness, English
language, peer reviewed, after 2010
Exclusion criteria:
Articles that did not include recovery and mental health/illness,
non-peer reviewed, before 2010

The Evidence:
Article #1:
Focus Occupational Therapy Interventions for Recovery
Level I Systematic Review
Article #2:
Focus Mental Health Recovery: Lived Experiences
Level V Qualitative Phenomenological Method
Article #3:
Focus Occupational Therapists use of the Recovery Approach
Level V Qualitative Descriptive Study

Occupational therapy interventions for recovery in the areas of community integration

and normative life roles for adults with serious mental illness: A systematic review

Study Objectives: This systematic review focused on finding the evidence of the
effectiveness of occupational therapy interventions, in the context of the recovery
model, when working with individuals with serious mental illness.
Methods: An advisory board developed a search strategy highlighting key words
based on areas of occupation (IADLs, education, work, etc.). Having a serious
mental illness was defined as an individual having at least one 12 month disorder
other than a substance use disorder. Only studies with level I, II, or III evidence
were included. A database search was conducted yielding 1,964 abstracts with 52
articles meeting all inclusion criteria.
Outcomes: Social skills training shows moderate to strong evidence for
supported employment and support to result in competitive employment. Life
Skills, IADL training, and supported education to improve performance showed
moderate supportive evidence. Neurocognitive training paired with skills training
showed moderate support in areas of work, social participation, and IADLs.
Overall, there is limited evidence in regards to interventions improving recovery.
Although client-centered intervention evidence is limited, it showed to be positive.

Mental health recovery: Lived experiences of consumers, carers, and nurses

Study Objectives: To gain an in-depth meaning of recovery for individuals with

mental illness and identify the gaps in thinking between the consumers, carers, and
nurses.
Methods: Consumers had to be living in the community setting and receiving
voluntary treatment for an Axis 1 diagnosis. Carers were included if they were
actively involved in the care and treatment of the consumers. Mental health nurses
were required to have formal qualifications and two years experience or no formal
qualifications and five years experience. If inclusion criteria was met they were
interviewed for the study. Participants were interviewed following a semi-structured
format using core questions. The core questions were to describe their experience
with mental illness, the meaning of recovery from mental illness, the barriers and
enablers to mental health recovery and their recommendation towards a recoveryoriented reform (Jacob et al., 2015).
Outcomes: In recovery, there are internal and external factors. Internally there is a
need to gain strength by learning about ones self. While externally, the process
focuses on being at home or having a home, staying out of the hospital, and enjoying
life with family and friends. The most prominent theme of recovery involved
acquiring a sense of self. The ability to understand the self and possess selfacceptance, self-control, self-belief/confidence all contribute to the sense of self.

A study of New Zealand occupational therapists use of the

recovery approach

Study Objectives: Through exploring how occupational therapists incorporate the recovery
approach in practice, Cone & Wilson explain that this study aims to identify aspects of practice
that would enhance occupational therapists work within mental health settings (2012).

Methods: Inclusion criteria was that participants were registered occupational therapists that
identified incorporating the recovery approach in their practice, were employed in mental health
services (at a Non-Government Organization or the Southern District Health Board), and had two
years of experience as an occupational therapist. Ten participants were interviewed with a semistructured format in focus groups and/or individually. The questions were: how do you
incorporate the recovery approach into your practice, what facilitates and what challenges the
incorporation of this approach, how do you use occupations to facilitate recovery, to empower
people, and inspire hope, and how is the recovery approach useful and/or not useful in the New
Zealand context.

Outcomes: Participants primarily incorporate the recovery approach by engaging clients in

meaningful occupations on the ward, in the community, and on an ongoing basis in life.
Incorporating this approach into practice can be challenging, however it is seen as a crucial part
of occupational therapy in mental health. The occupational therapists that participated do
incorporate the recovery approach into practice. Therefore, this study shows that occupational
therapy and the use of the recovery approach are complimentary in day-to-day practice.

Summary
Occupational therapists can work on the following areas using the
recovery model when working with individuals with mental illness:
Social skills training to help with supported employment and to result in
competitive employment
Life Skills, IADL training, and supported education to improve
performance.
Neurocognitive training paired with skills training to support in areas of
work, social participation, and IADLs
It is important as occupational therapists to understand what the recovery
model is and what OTs role is when working with individuals that have a
mental health condition.

Reference List
Castaneda, R., Olson, L. M., & Radley, L. C. (2013). Fact sheet: Occupational therapys role in community mental health. The American
Occupational Therapy Association, Inc. Retrieved from
http://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/MH/Facts/Community-mental-health.pdf
Cone, E. & Wilson, L. (2012). A study of new zealand occupational therapists use of the recovery approach. New Zealand Journal of Occupational
Therapy, 59, 30-35.
Gibson, R.W., DAmico, M., Jaffe, L. & Arbesman, M. (2011). Occupational therapy interventions for recovery in the areas of community
integration and normative life roles for adults with serious mental illness: A systematic review. American Journal of Occupational Therapy,
65, 247-256.
Jacob, S., Munro, I., & Taylor, B. J. (2015). Mental health recovery: Lived experiences of consumers, carers and nurses. Contemporary
Nurse, 50, 1-13