Alison Blank

The Role of Work in Recovery

The vocational rehabilitation agenda is gaining prominence within United Kingdom health care policy, with occupational therapists poised to play a major role in the delivery of vocational services. The evidence base for supported employment has been widely accepted, although this is poorly implemented within the United Kingdom. This opinion piece considers some of the recent literature and social policy around work, occupation and recovery. It suggests that there is a need to consider supported employment interventions under the broader approach of recovery-oriented practice, alongside a process of enabling people with mental health problems to engage in personally meaningful occupations.

The lived experience of people with mental health and substance misuse problems: Dimensions of belonging:

Introduction People with co-occurring mental health and substance misuse problems are among the most excluded in society. A need to feel connected to others has been articulated in the occupational science literature although the concept of belonging itself has not been extensively explored within this paradigm. This paper reports findings from research that explored the meaning and experience of belonging for four people living with dual diagnosis in the United Kingdom. Method Researchers employed an interpretative phenomenological approach to the study. Four semistructured interviews were carried out. The interviews were guided by questions around the meaning of belonging, barriers to belonging and how belonging and not belonging impacted on participants’ lives. Data analysis facilitated the identification of themes across individual accounts and enabled comparisons. Findings Data analysis identified four themes – belonging in family, belonging in place, embodied understandings of belonging and barriers to belonging. Conclusion The findings add further insights into the mutable nature of belonging. A link between sense of belonging and attachment theory has been proposed, along with a way to understand the changeable and dependent nature of belonging through ‘dimensions of belonging’.

Facilitators and Barriers to Living with Psychosis: An Exploratory Collaborative Study of the Perspectives of Mental Health Service Users

Introduction: The purpose of this research was to deepen understanding of what is helpful to those who have experienced psychosis, in order to facilitate best practice within mental health services. Psychosis presents challenges for people on an everyday basis, yet strategies can be developed to facilitate living with psychosis. Investigating the service users perspective is crucial for informing recovery oriented occupational therapy practice. Method: Initiated and designed by a service user research group, this research was exploratory and, primarily, participatory. Data were gathered from two focus groups, involving 13 people with experience of psychosis, facilitated by service user researchers and an MSc student. Data analysis was systematic and based on grounded theory principles Findings: Participants shared experiences and thoughts about their everyday lives. Data analysis revealed six elements of the self: the social self; the occupational self; the integrated self; the unsupported self; the stigmatised self and the isolated self. The importance of balancing these six facets of the self is theorised as being essential to successfully managing the experience of living with psychosis. Conclusion: This emergent theory could underpin occupation-focused approaches to living with psychosis, with interventions aimed at enabling service users to balance the experience of psychosis with satisfying and contributing lives or recovery.

Patient Violence in Community Mental Health: A Review of the Literature

The past decade has seen an increasing focus on care in the community. During this period, the media has given a high profile to a number of incidents where members of the public and health service staff have been assaulted by patients of mental health services. Many occupational therapists work in community mental health teams and there is a nationally acknowledged need for risk assessment and management. Despite this, an electronic search of five major databases and eight occupational therapy journals revealed no literature within the occupational therapy profession examining risk assessment and management. The existing literature is from the nursing and medical professions. A systematic review of 10 studies, two conducted in the United Kingdom and eight in the United States of America, is presented. It is suggested that the occupational therapy profession urgently needs to address this gap in its literature and consider what can be learned from other professions.

Coping with the Problems of Minor Tranquilliser Use in South Wales

Whilst working as a member of the community mental health team, the author was part of an initiative looking at minor tranquilliser use in the locality. This article describes the way in which the adult psychiatric service, the local drugs advice project and the local branch of MIND set about meeting the needs of the community.

The Meaning and Experience of Work in the Context of Severe and Enduring Mental Health Problems: an Interpretative Phenomenological Analysis

Research into mental health and employment has indicated that work holds multiple meanings for people with mental health problems. This paper reports findings from a phenomenological study which aimed to understand the complexity of these meanings by exploration of the perspectives of one individual who was considering returning to work. Data were gathered through a series of three interviews carried out over a period of 18 months. Three themes were identified - Beliefs and Values about Work, Working with a Mental Health Problem, and Planning for the Future. Analysis and interpretation facilitated understandings of what work represented for the participant. What this study has contributed to the evidence base is a deeper understanding of the multiple meanings of work, and the varied roles that work may play in contributing to meaning and quality of life for people with mental health problems.

Enabling Occupational Therapy Students to take a Fresh Approach to Psychosis

This practice evaluation describes the implementation of a 2-day workshop on psychosis with third-year undergraduate occupational therapy students at Brunel University. The work was undertaken by the teaching team at Brunel University, a clinical psychologist working in assertive outreach and an occupational therapist working in community mental health. The background to the project and the way in which the 2-day workshop was adapted to accommodate the university timetable are outlined. An evaluation of the workshop, its place in the occupational therapy programme and the feedback from students are presented.