Funder by the Department of Human Services Auspiced by Our Community

A CONSUMER'S GUIDE TO OCCUPATIONAL THERAPISTS

Occupational Therapy (OT) is perhaps the least understood of all of the clinical groups working in mental health. People find it easier to understand occupational therapy in the context of physical health, where providing people with occupations that rehabilitate limbs, for example, makes sense. But what does an OT do in mental health and why?

OTs work on the basis that everyone needs meaningful occupation (in this context we are talking about activity, not paid work necessarily) to optimise wellbeing.

Traditionally OTs have often been teased as contributing no more to mental health services than a diversion ("basket weaving"). This is unfair. Many people with experiences of acute psychiatric hospitals speak highly of the input of respectful OTs.

Over the past decade many OTs have also formed successful and promising working partnerships with consumer consultants.

OTs are interested in the social and environmental factors that exclude us (people who have been diagnosed with 'mental illness') from some of the vital parts of community life.

Within a hospital setting, OTs are often found running 'The Program'. This means that, within the constraints of their resources - including time resources - they design 'activities' for us to be involved in. Sometimes these are thought of as 'therapy' and sometimes not. Sometimes they are made compulsory and sometimes not. Sometimes these can be run really well and provide a great learning opportunity, but if poorly run by someone with an unfortunate attitude, it can feel like a kindergarten art class. This is definitely not OK and we shouldn't have to put up with it.

Like social workers, the new community provision of mental health has cast OTs into different roles. Many are now working as 'case managers' in clinical settings and key workers in the non-government sector.

Although consumers often heap praise on the contribution of an OT to their healing it is, to some extent, the forgotten profession in mental health.


Qualifications & registration

Most of the occupational therapists we will come across in the system will have trained for four years to achieve a Bachelor of Occupational Therapy. A smaller number will have done extra study and may have a Masters in Occupational Therapy or a Doctorate in Occupational Therapy.

Registration of all occupational therapists in Australia is undertaken by the Australian Association of Occupational Therapists (AAOT). You can check that an OT's registration is correct and up to date through the AAOT.

For more information on registration and professional bodies see the help sheet titled Accreditation & Registration.


The role of occupational therapists

The role of OTs is defined by the Australian Association of Occupational Therapists (www.ausot.com.au/) as:

As mentioned above, many people rather dismissively equate occupational therapy with basket weaving. There are probably as many jokes about OTs and basket weaving as there are about social workers and Rottweilers!

The way that we experience OT activities in hospital settings depends heavily on who we are as people, with all the individuality this implies, and who the OT is, with all the individuality that implies as well.

Many consumers say that OTs are their favourite clinicians. Often they find they are able to have conversations with an OT that they could not possibly have with some of the other clinicians. (Note, though, that OTs still work as part of 'The Team', and thus may report what you say to others.)

Many consumers say that they find the 'occupations' OTs bring to the ward pleasurable, and that they also fill in long hours of boredom.

Other consumers hate 'community ward meetings', or anything that's compulsory, or anything that poses as 'therapy', or anything that seems childish or amateurish or patronising.

Regardless of whether we are in hospital or not, we have a right to be in our bedroom during the day if we want to, without being "told off". After all, we are supposedly sick!

We also (in theory, at least) have a right to withdraw with honour from an activity that feels unsafe or stupid.

Some consumers in the private system get back-up letters from their psychiatrists designed to excuse them from programs. We can all ask for this but not all of us will have such obliging psychiatrists.

Some of us use the term, 'therapised' to describe the awfulness of being programmed into oblivion. This is more common in private hospitals where the arrangements with health insurance funds and the bodies that register and carry out inspections dictate the amount of programming needed for accreditation. Here, OTs (along with clinical psychologists), often against their instincts, are required to provide 'activities' which are, at best, banal, at the behest of agencies who know nothing about us.

Of course, none of these things represents every consumer's relationship with occupational therapy, and many of the objections can in any case be overcome by a highly capable OT. In addition, consumers who use private hospitals seem to have a very different reaction to well-equipped art rooms supervised by OTs. Where there is freedom of movement, mutual respect in relationship and choice of activity, great strides can be made towards our emotional health.


Status and hierarchy

Many OTs are keen to point out that they are different from, and have been trained differently to, other clinicians working in mental health.

To some extent this is true. Some consumer consultants working in clinical services in Victoria have reported that the person who is most supportive of their work is the OT. There are also reports that OTs and consumer consultants have set up programs in acute and other settings which they run together. This is a good model and should encourage attendance.

On the other hand, OTs are often not as different from the other clinical groups as they would like us to believe. Pragmatism is often the rule of thumb for these clinicians and sometimes this can come at the cost of developing a real understanding of the political parameters in which all psychiatric services operate.

The word 'political' refers here to power. In acute hospital settings, for example, OTs might not see themselves as having that much power in the scheme of things (not helped by the fact that it is a strongly female gendered workforce with limited political sensibilities) but compared to patients they have a lot.

If they are fair dinkum about their claim that they are different from other clinicians and their consumer orientation is central to their practice, we need to be able to rely on OTs to cease crying institutional impotence and try to join us politically. It's great to have a listening clinician but it's even better to have a listening-action one.


Complaints

If we wish to make a complaint about unethical or unprofessional behaviour by an OT, generally we will be advised that our first point of contact should be the director of clinical services within the organisation where the behaviour took place.

Some of us feel that that is bound to be biased as the organisation closes ranks, although it can be a useful place to start.

Complaints can also be addressed to the Australian Association of Occupational Therapists - see the help sheet titled Accreditation & Registration).


Rebates

Some Medicare-funded counselling under the Better Outcomes in Health Initiative can be provided by OTs who are registered counsellors, though only a very restricted range of therapies are allowed.

OTs are funded to provide Focussed Psychological Strategies - whatever this is. No one, including many OTs, seems to have any idea.

See the help sheet titled How money (or lack of it) affects a consumer's choices for more on this topic.