Special Issue: Effectiveness of Occupational Therapy Services in Mental Health Practice. Am J Occup Ther 2011;65(3):235-237. doi: 10.5014/ajot.2011.001339.
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© 2019 American Occupational Therapy Association
At the time of transition from large intuitional care to community integration, the profession was neither able to sufficiently advocate for its role in community service provision nor able to flexibly embrace these health care changes. Some have argued that it may have been easier for therapists to leave mental health practice and enter school-based therapy than to fight for the profession’s role as mental health service provision changed (Mosey, 2004).
The profession has not been able to sufficiently document the effectiveness of occupational therapy services in mental health practice—not because such services lack effectiveness but because the profession has lacked trained researchers able to carry out intervention outcome studies (Gutman, 2009a). In addition, most research to date has largely focused on the psychometric properties of assessments and basic research describing the experience of disability and the nature of occupation (Case-Smith & Powell, 2008; Gutman, 2008, 2009b).
A gap may exist between actual clinical practice and the writings that appeared in the profession’s literature over the past four decades. Although this gap appears to be narrowing as scholars focus more heavily on evidence-based practice and research, some researchers have argued that the types of topics discussed in our literature have been divorced from the realities of the clinical setting. The profession may not have adequately described and documented its role in mental health practice sufficiently for administrators, legislators, and insurers to understand how occupational therapists help people with chronic mental illness to learn daily life skills needed to function optimally in the community (Rebeiro, 1998).
The shortage of occupational therapy positions in mental health practice may be mirrored by the larger, national crisis in which mental health services do not share reimbursement parity with physical health services (Buchmueller, Cooper, Jacobson, & Zuvekas, 2007). Occupational therapy students may perceive that mental health practice is not economically feasible, particularly because college education costs have spiraled and students graduate with significantly greater student loan debt than at any other time in the profession’s history (Stancliff, 1996).
The national association and foundation must be involved in advocacy efforts at a federal and state level and must fund research examining the effect of occupational therapy services in mental health practice.
The national association should also advocate for government loan forgiveness programs for occupational therapy students who enter mental health practice on graduation.
Researchers must examine the effect and cost-efficiency of occupational therapy services used in mental health practice with actual clients.
Practitioners must be able to advocate for and clearly articulate to administrators how occupational therapy services help clients learn to use the community living skills needed to function as fully as possible in the larger society. Practitioners must also have access to and be able to rely on a body of research demonstrating the effectiveness of occupational therapy services in mental health practice.
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