Over the past 15 years, the number of occupational therapists entering the practice area of mental health has greatly declined. To determine the possible reasons for this decline, a random sample of 450 occupational therapy students who graduated in 1986 was surveyed to identify those factors that influence practice choice. Participants were asked to indicate their practice preferences at five points in time: before admission to the academic program, after completion of the academic program, after completion of Level I fieldwork, after completion of Level II fieldwork, and at first employment. The results from 212 questionnaires (a 47% response rate) indicated that the distribution of practice choices remained relatively consistent over time. After completion of the academic program, the choice of mental health practice was seen as negative. Specific negative influences were topic content, teaching methods, and teacher effectiveness. Level I fieldwork was perceived as a negative experience in all five practice areas, but was perceived most negatively in mental health. Level II fieldwork most influenced practice preferences. Specific positive factors were the student supervisor and the patient caseload.