Elizabeth Anne McKay

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.

Clinical Reasoning through Story Telling: Examining a Student's Case Story on a Fieldwork Placement

This article considers narrative (story telling) as the way In which human experience Is made meaningful. Narrative reasoning has been Identified as a means of enabling occupational therapists to explain their practice. A review of the literature Includes the concepts of the professional artist, narrative reasoning, expert and novice practitioners, and experiential learning and reflection. A single case study looked at the use of narrative reasoning by a second year occupational therapy student (novice) on a fieldwork placement and an experienced therapist (expert) who was supervising her. During the routine fieldwork visit of the academic staff member to the student, both novice and expert were asked to tell their story about one particular client with whom they were working. The findings highlighted the fact that the expert and the novice told different narrative stories but that, by asking probing and reflective questions, the students story could be enhanced to Include more narrative. This study has Implications for the education of students in both university and the fieldwork setting.

' Baking Gives You Confidence' : Users' Views of Engaging in the Occupation of Baking

The quality of care in acute inpatient areas has been identified as unacceptable and, in some areas, as counter-therapeutic (Sainsbury Centre for Mental Health 1998). Occupational therapy continues to make a significant contribution within this practice area. However, specific research that has addressed the acute service users perspective of engagement in occupation is limited. This qualitative study explored 12 mental health service users perspectives of engagement in the occupation of baking through a semi-structured interview. The findings identified that the opportunity to acquire new skills and, importantly, confidence while producing an end product stimulated the participants to attend the treatment session. The engagement in baking was also influenced by the participants desire to add structure to their daily routine. The study concludes that the physical and social environment in which the therapy takes place is a powerful motivating factor in facilitating individuals to participate in an occupation. The findings emphasise the importance of engagement in occupations, in conducive settings that meet the individuals needs. The study highlights that baking has many recognisable benefits for service users, offering a flexible and valued occupation.

Occupational Therapists' Perspectives of the Needs of Women in Medium Secure Units

The Department of Health and Home Office (1992) formally acknowledged women in forensic provision as being a vulnerable group, with neglected needs in terms of care and treatment. It also clearly identified a role for occupational therapy in meeting these needs through involvement in multi-agency cooperation. The aim of this investigation was to ascertain if, from an occupational therapy perspective, the needs of women in medium secure care were being met. A postal questionnaire was administered to 62 therapists working in medium secure provision in England, with a response rate of 73%. The data generated identified occupational therapists perceptions of female client needs and the intervention available to women in medium secure care and provided a snapshot of therapists views in relation to current issues in secure care. The findings demonstrated that occupational therapists working in medium secure care had a good understanding of female client needs and tailored their intervention to be as gender-sensitive as possible within the limitations imposed by the environment. The study also highlighted the requirement for further research to investigate the needs of women in forensic environments from their own perspectives.

‘Rip That Book up, I've Changed’: Unveiling the Experiences of Women Living with and Surviving Enduring Mental Illness

The lives of women with an enduring mental illness have been little researched within occupational therapy. This study explored the experiences of five women living with enduring mental illness in their communities. The women were interviewed over a 2-year period using the life history method. Data were recorded and transcribed verbatim. The data set was analysed in two ways. First, from the narrative analysis, an individual unique narrative of each womans life was created. Secondly, the data were analysed using the constant comparative method. This paper presents the findings from the constant comparative analysis. Six themes were identified, which lifted the veil on the experience of living with and surviving enduring mental illness. Each theme represented a section of the womens lived experiences: a specific frame of the bigger picture of their lives. The themes were present life, life roles, relationships, illness transitions, help and cultural context. The findings highlighted the complex life roles and needs of the women over time. They unveiled how the women became agents in creating a better life for themselves and others. Practitioners have a role to play in creating meaningful and safe environments that encourage social inclusion and recovery.

Consultant Therapists: Recognising and Developing Expertise

The introduction of consultant therapists provides an unprecedented opportunity for the occupational therapy profession and for individual therapists. The literature on clinical reasoning suggests the characteristics of experts, which may be a useful guide both for those who wish to create consultant therapists posts and for those who aspire to fill them.

What's Cooking? Theory and Practice in the Kitchen

Occupational therapists are challenged to demonstrate how their practice is informed by evidence of effectiveness. In the absence of evidence from scientific investigation, theories are used to frame judgements about clinical situations. This paper explores how the process of adapting a kitchen can be informed by occupational theories, based on the first authors experiences as a social services occupational therapist. The kitchen is a familiar space in occupational therapy and forms a key environment for meeting nutritional and social needs in the domestic setting. The process of altering a kitchen is used to illustrate concepts associated with occupation in everyday life. Issues arising from two kitchen adaptations are investigated using categories from the Canadian Model of Occupational Performance and the definition of therapeutic occupation (Nelson 1996). The limitations of applying theory to practice are explored, alongside analysis of how theory enhances practice. Finally, a synthesis, of knowledge based on science and creative practice based on art, is proposed.

Occupation: Reaffirming its place in our practice

s. London: College of Occupational Therapists. Molineux M, McKay E (1999) Occupation: reaffirming its place in our practice (Workshop). Inaugural United Kingdom Occupational Science Symposium: Abstracts. York: College of Ripon and York St John. Wilcock A (1993) A theory of the human need for occupation. Journal of Occupational Science: Australia, 1(1), 17-24.

Profile, Practice and Perspectives of Occupational Therapists in Community Mental Health Teams in Ireland:

The Mental Health Commission (2006a) and the Department of Health and Children (2006) have identified a gap in the knowledge relating to the interventions carried out by mental health workers in community mental health teams (CMHTs) in Ireland. The purpose of this research was to address this gap by exploring the profile, the work practices and the perspectives of occupational therapists working in CMHTs in Ireland. A mixed methodological approach was chosen: survey questionnaires (quantitative) were sent to 40 occupational therapists working in CMHTs, with 21 responding (52.5% response rate), and semi-structured interviews (qualitative) were carried out with six occupational therapists. The results suggest that occupational therapists working in CMHTs are experienced and are generally satisfied in their positions. Occupational therapists in this setting offer a wide variety of interventions, guided by models of practice, frames of reference and outcome measures. The issues facing occupational therapists include a lack of resources, role blurring and the need for access to supervision and postgraduate education specifically tailored to mental health. Finally, the findings suggest the need for occupational therapists to establish a channel in which to inform wider mental health practice of their contribution to clients recovery journeys.