Wendy Bryant

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.

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.

Sustaining a Focus on Occupation in Community Mental Health Practice

Occupational therapists working in community mental health teams (CMHTs) are often challenged to justify their unique approach to health through occupation, within an environment that tends to press for generic working. Such a challenge requires practitioners to identify and communicate evidence that supports their unique occupational contribution. In the absence of extensive robust and relevant research evidence, it is suggested that the contribution of theoretical evidence be considered. This paper, therefore, explores the potential of occupational justice and its related concepts to provide the profession with a theoretical justification for occupational therapists adopting an occupation-focused role in CMHTs. It begins with an overview of how CMHTs, generic working and occupational science have evolved. The concept of occupational justice and its related occupational risk factors are then analysed in relation to practice. The potential conflict between the professional commitment to client-centred practice and the generic worker model is also discussed. The paper concludes with recommendations for further exploration and consideration.

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.

Visualising a safe space: the perspective of people using mental health day services

Day services for people using mental health services have been required to refocus on social inclusion rather than building-based services. This research explored how this policy was perceived by people using such services, using photography to capture their experience of areas of a mental health resource centre. An action research group took the photographs and analysed them for themes. The second author created a model to summarise the findings. Having a safe space was essential for getting involved, forming social networks and moving on. Constant organisational and staff changes impacted on this process. The findings raise questions about social inclusion. A safe space has been identified as centrally important, giving people a refuge, social contact and meaningful occupation.

Creative Group Work with Confused Elderly People: A Development of Sensory Integration Therapy

This article discusses the problems experienced by an occupational therapist in working with elderly con fused residents on continuing care wards in a psychiatric hospital. An approach based on sensory Integration therapy and object relations theory, developed by the author, is described. Case examples from group work are used to illustrate this approach and evaluation shows the problem areas and successful features.

Voluntary Work for Adults with Mental Health Problems: A Route to Inclusion? A Review of the Literature

Voluntary work is seen as a key component of promoting mental health through social inclusion. For many years, occupational therapists have worked in partnership with voluntary organisations to facilitate access for service users to voluntary placements. Yet there is little published evidence to support this aspect of occupational therapy or to indicate specific successful strategies, especially in establishing successful placements beyond mental health services. This review examined the existing evidence, discussing the implications for occupational therapy. The findings indicate a need for further research to ascertain the benefits of volunteering, the barriers and the ways to improve access for people with mental health problems. Occupational therapists, with their unique synthesis of knowledge and skills concerning occupation, enabling and client-centred practice (Townsend and Wilcock 2004), should be well placed to be able to respond to these issues, yet the literature does not provide evidence that they have risen to the challenge.

The Social Contact Group: An Example of Long-Term Group Work in Community Mental Health Care

Social contact groups offer support and social activities to long-term users of community mental health services. In this study, seven groups in Surrey were compared with 10 groups elsewhere, using information supplied by group leaders. From this comparison, those features that characterise social contact groups have been identified. In addition, those individuals attending the groups in Surrey were invited to identify the benefits of membership. Their positive response indicated the success of these groups in meeting their need for social contact and suggests that this approach should be considered by those developing day services for people with long-term needs. Occupational therapists, with their expertise in analysing and coordinating activities, have a major role to play in organising these groups in conjunction with other mental health workers.

'It's like having a day of freedom, a day off from being ill': exploring the experiences of people living with mental health problems who attend a community-based arts project, using interpretative phenomenological analysis.

To explore the psychosocial benefits of participating in a 2-year community arts project, eight people living with long-term mental health problems were interviewed. The project involved participants in selecting items of professional artwork, creating personal responses and curating a public exhibition. Interviews were analysed using interpretative phenomenological analysis. Participants experienced the arts project as improving self-worth, emancipating self from illness labels, offering a sense of belonging, enabling acquisition of valued skills and offering meaningful occupation and routines. Some regarded their developing creative skills as improving their self-management of mental health. However, some anticipated the project’s ending with anxiety.

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.