Christine Craik

Living in a Glasshouse: Exploring Occupational Alienation

Background. Community mental health care has shifted focus from resettlement to empowerment, reflecting a wider agenda for social inclusion. Purpose. This study evaluated mental health day services from the perspectives of thirty-nine clients. Method. Data analysis of the four focus groups explored the implications for occupational therapy. The data collected were subjected to constant comparative analysis and theoretical sampling. Results. Participants described how mental health day services structured their day and enabled access to support networks. However, many perceived aspects of the services as fostering their dependence and threatening sessions they valued. This dependency led to them feeling alienated and wishing to seek greater influence over decisions about their current and future life. The concept of occupational alienation was used to further interpret their situation. Practice Implications. Occupational therapy could overcome occupational alienation experienced by mental health day service clients, through the development of services within and beyond day services which promote a sense of belonging and offers meaningful occupation.

Some factors influencing occupational engagement for people with schizophrenia living in the community

With the emergence of occupational science, there has been renewed interest in the health benefits of occupational engagement and a call for more research into the occupational nature of humans. Engaging in occupations is known to have a positive effect on an individuals health and sense of wellbeing. A common feature of people with schizophrenia, however, is a decrease in volition and a reduction in the occupations performed. This study explored some of the influences on occupational engagement for people with schizophrenia living in the community. A qualitative approach was chosen, using semi-structured interviews. Four male and four female participants, aged 23 to 49 years, described the influences on their occupational engagement. Content analysis, primarily using coding and memoing, was employed to categorise the data. Four main themes emerged: health, routine, external factors and internal factors. Some specific factors identified within these themes were medication, daily schedules, staff, family, work, self-concept and challenges. The implications of the results are discussed, with particular reference to assisting occupational therapists to enable clients with schizophrenia to engage more successfully in occupations.

Perspectives of day and accommodation services for people with enduring mental illness

Background: This qualitative study analysed user, carer and staff perspectives on day and accommodation services for people with enduring mental illness in the London Borough of Hillingdon. Method: Twelve focus groups, attended by 95 participants, were conducted by the independent research team and the data collected were subject to constant comparative analysis. Findings: Practical and strategic recommendations were generated for the funding agency. Day services were valued highly for preventing relapse and promoting independence. Users sought a more active role in developing opportunities in day and accommodation services and staff were believed to hold a pivotal role in offering ongoing support. Conclusions: In the area studied, facilitating discharge, managing risk and meeting shelter needs had been emphasized at the expense of user empowerment and access to meaningful occupation. Day and accommodation services enable users with enduring mental illness to achieve stability and increase independence, but are currently under-resourced and undermined by wider service pressures.

College of Occupational Therapists: Position Paper on the Way Ahead for Research, Education and Practice in Mental Health

The future of occupational therapy in mental health has been a topic of reflection and debate. The Education and Research Board (now the Education and Practice Board) of the College of Occupational Therapists created a Working Group to develop a position paper on the way ahead for research, education and practice in mental health. Following consultation, the Working Group reviewed literature, examined current research and surveyed practitioners, managers and educators. From these findings, recommendations have been made which will create a firmer evidence base for the practice of occupational therapy in mental health, leading to a more effective use of the expertise of occupational therapists and an improved service for users.

Mental Health Clients Confirm the Value of Occupation in Building Competence and Self-Identity

Engagement in occupation is proposed to enhance health and wellbeing. To date, few studies have demonstrated this in relation to people with mental health problems. This study aimed to evaluate occupational therapys beliefs in the restorative powers of occupation from the perspective of people with enduring mental health problems living in the community. Qualitative research methods were used in two mental health day service settings: a workshop, where woodwork was provided as a medium for creative therapy, and a drop-in facility. Participant observation was undertaken over 10 sessions and, during six in-depth interviews, the clients were asked about their occupational experiences and whether they had perceived any benefits from engagement in occupation. Content and inductive analysis as well as concept mapping of the data resulted in emergent themes and subthemes. Occupation was identified both as a means for building competence through the acquisition of skills, coping with challenges and achieving success and as a medium for developing self-identity through the drive to create, feelings of usefulness and engendering a sense of self. These themes help to support the need for an increase in the provision of meaningful occupation for people with enduring mental health problems. However, further research is required to develop and corroborate the findings.

Occupational Therapy in Mental Health: A Review of the Literature:

This review of the literature was conducted as part of the development of a position paper on the way ahead for research, education and practice in occupational therapy in mental health. It included publications over the past decade and concentrated on the British Journal of Occupational Therapy. Recognising that experience from other countries would be beneficial, aspects of the literature from the national journals in the USA, Canada and Australia which were most relevant to practice in the United Kingdom were included. The shortage of articles on mental health was conspicuous and their diverse topics and descriptive nature were notable. In the United Kingdom literature, the clinical subjects featured most often were dementia, work rehabilitation, community mental health and forensic psychiatry, with other subjects either appearing infrequently or not included. The literature from the other countries also explored new roles for occupational therapy, reflecting the changes in the delivery of mental health services. In the American Journal of Occupational Therapy, there was concern about the declining number of occupational therapists working in mental health. The review identified major themes in the literature, posed questions for research, education and practice in occupational therapy and formed the foundation for the position paper.

Without Leisure … 'It wouldn't be Much of a Life': the Meaning of Leisure for People with Mental Health Problems

Previous research has explored the occupational engagement of people with mental health problems. This study set out to establish the meaning and value of leisure for people with enduring mental health problems living in the community. Using a mainly qualitative design, semi-structured interviews were conducted with 10 participants randomly selected from clients referred to a local assertive outreach service in South-East England. Initially, the data were analysed for content, phrases, language and words used; subsequently, emerging themes were identified which were confirmed by a second occupational therapist. Three themes are reported here: why certain occupations were considered to be leisure, the feelings expressed during leisure and the value of leisure. Although the participants had some difficulty in articulating their views, leisure was differentiated from other occupations, with the time available to complete a task in the absence of pressure being the distinguishing feature. Overall, the participants had positive views about leisure, which was valued in terms of meeting their individual and unique needs. The implications for occupational therapy are explored. In determining the meaning and value of leisure for people with mental health problems, more emphasis should be given to their actions and less to their skill in verbalising emotion.

A qualitative study of service user experiences of occupation in forensic mental health

BACKGROUND/AIM  This qualitative study explored occupational engagement of those detained in forensic units. Legal and institutional restrictions on occupation have implications for their health and wellbeing. METHOD  Twenty-six current forensic mental health service users participated in five focus groups, which were audio-recorded, transcribed verbatim and subjected to constant comparative analysis. FINDINGS The participants highlighted previous occupations, current occupations and hopes. Key aspects were control over decision-making, motivation and support, generating suggestions alongside positive experiences of occupational therapy. CONCLUSIONS  Institutional barriers could be overcome with a dynamic balance between risk management and mental health promotion through occupation. This demands a sustained focus on occupation for everyone involved in providing care and treatment in these settings.

Factors Enabling and Hindering Participation in Leisure for People with Mental Health Problems

Although leisure is recognised as a key aspect of occupational therapy, few studies have explored it in relation to people with enduring mental health problems. Using a qualitative design, semi-structured interviews were conducted with 10 participants with mental health problems living in the community, randomly selected from clients referred to a local assertive outreach service in South-East England. Initially, the data were analysed for content and the phrases, language and words used; subsequently, emerging themes were identified, which were confirmed by a second occupational therapist. The three themes arising from the data reported here were the number and range of occupations engaged in, the factors enabling participation in leisure and the factors hindering participation in leisure. The range of leisure occupations was similar to that noted in the literature. The main enabling factor was having an adequate network of people to provide support, while the main hindering factors were physical limitations, lack of finances and lack of transport. In the absence of paid employment, leisure was important to the clients. Occupational therapists need to recognise that enhancing the factors enabling participation in leisure and assisting clients to overcome the factors hindering participation in leisure will lead to the increased wellbeing of people with enduring mental health problems.

Occupation, Mental Illness and Medium Security: Exploring Time-Use in Forensic Regional Secure Units

Research investigating occupational experience among people with mental illness has highlighted their difficulties in selecting, organising, valuing, enjoying and competently performing occupations. Although occupational therapy literature consistently identifies environmental factors as key in facilitating successful and valued engagement, few authors have studied the implications of detention in secure mental health settings for this population. This study investigated the occupational experiences of five people with schizophrenia in two forensic regional secure units. Quantitative and qualitative methodologies were used, with semi-structured interviews adding depth and subjectivity to Occupational Questionnaire (Smith et al 1986) responses. The quantitative data were analysed using non-parametric analysis, with content analysis applied to the qualitative data. Time-use was characterised predominantly by engagement in passive leisure and rest occupations. This reflects the findings of both inpatient and community-based studies elsewhere and suggests that mental illness is a common factor influencing time-use. The participants chose occupations based on expectations of enjoyment and success, and associations with independence and normality. Significant correlations were found between perceived competence, value and enjoyment (p<0.01), and the participants were more likely to enjoy self-chosen occupations (p<0.05). Forensic occupational therapists must use evidence to optimise resources and deliver interventions that facilitate choice and autonomy and reflect individual needs. Further research with larger samples and longitudinal methodologies will facilitate generalisation and establish temporal perspectives.