Visions Journal

Inpatient Occupational Therapy

A tool for overcoming relapse and continuing the recovery journey

Shu-Ping Chen, PhD, OT Reg (Alberta)

Reprinted from the "Blips and Dips in the Recovery Journey" issue of Visions Journal, 2019, 15 (2), pp. 34-36

When people stay in inpatient settings (that is, stay a period of time in hospital and receive hospital mental health services), they experience particularly tough times when symptoms return because they have lost contact with their everyday lives and familiar routines. The primary role of an occupational therapist (OT) is to help people resume their lives in the community quickly following short-term hospitalization and to ensure the continuity of their recovery journey.

Occupational therapists care about what people want to do, what people need to do, the skills people need and the environment that impacts a person’s ability to do the things they want and need to do. When a person cannot concentrate on a task due to psychiatric symptoms, the occupational therapist works with the person to find their preferred way to manage or cope with symptoms, and changes the environment to help the person accomplish the task.

For example, occupational therapists teach people how to drown out voices in their heads (by listening to music on headphones, for instance), to actively distrust the voices (by questioning them) or to change their environment (by finding a relaxing, safe place, for example) so that the individual can undertake a meaningful activity. We understand that an episode or relapse of psychotic symptoms can be a traumatic life crisis that results in feelings of loss and shame. Occupational therapy helps people find meaning for what happened (making the psychotic experience meaningful and acceptable in people’s recovery journey) so people can integrate the understanding into a new sense of self and retrieve a sense of control.

In the words of one patient, occupational therapy “gave me something else to … focus on. I had my mind off of my problems basically and my feeling of being a nobody and I could focus on doing this and it was something that I’m learning to do and that I can do it… it was a step I took to self-confidence.”¹

Occupational therapists collaborate with people to develop their goals and to create action plans to achieve those goals. During this process, an OT supports the person to discover and identify their strengths and to promote a positive sense of self, with a focus on assisting the person to engage in meaningful activities—often by participating in those activities themselves. Yes, actually doing the activities that are meaningful and important to the client is the primary strategy of occupational therapy.

The underlying purpose of the meaningful activities varies widely. For example, an activity can offer the opportunity to practise daily-living skills (such as banking, grocery shopping and laundry), establish social relationships, build self-confidence, or develop positive thoughts and hope. Activities can be completed alone or within groups. Even in a restricted inpatient setting, occupational therapists can provide a range of opportunities for activity participation. For example, they can use the activity of cooking to focus on a person’s past role as a cook, they can use exercise to promote physical well-being, they can use tabletop games to have fun and to encourage social interaction, or they can help plan and host a bake sale to incorporate the skills of event planning, baking, selling and money management.

Families’ assistance in meaningful activity participation can promote the progress of a personal recovery journey. Occupational therapists always work closely with families to facilitate the families’ participation in supporting their loved ones’ recovery. Occupational therapists help families learn how to provide appropriate supports and build on family strengths to encourage positive joint activities, such as eating meals together, going for walks, or even just sitting and talking about things in a supportive family context.

There are four core elements of occupational therapy in an inpatient setting:²

1. Assessment. The occupational therapist carefully assesses what the person used to do in the past, what the person wants to do currently and what the person hopes to do in the future. This includes assessing the person’s ability and strength to perform those activities and the barriers that the person faces in doing so. To make their assessment, the OT uses a range of assessment tools (such as the “Personal Recovery Outcome Measure”³) as well as close observation.
2. Individual therapy. When individual therapy begins, the OT can help a person to set recovery goals and then to work towards these goals. If a person is involuntarily admitted to the hospital or admitted in a crisis state, the occupational therapist recognizes and addresses the person’s unique barriers and needs in this state, such as lack of motivation, anxiety or disturbed cognitive and behavioural function.
   Solution-focused, brief therapy is one of the interventions used to affirm a person’s feeling of anxiety and encourage them to refocus on the self and on possible solutions. The OT helps people clarify what they want to happen in their lives (e.g., “I want my own place”), design strategies to bring them about (e.g., finding resources for independent housing), and co-construct solutions (e.g., practising independent living skills). The OT encourages the person to stop doing what doesn’t work and do more of what does, and helps them change their thinking and actions to be more positive and solution-oriented. On a practical level, the OT will identify all the things that could potentially go wrong, discuss the possible positive and negative consequences of each risk, and then work together with the person to identify actions that reduce negative consequences.   
3. Group therapy. Occupational therapists also use a wide range of therapeutic groups, depending on the facilities and resources available. These groups can be activity-based or support-based. Inpatient group settings provide opportunities for social interaction, sharing of experiences, learning from each other and practising skills. A typical group might focus on education to understand the illness, stress and anxiety management, lifestyle management, arts and crafts, leisure, gardening or activities of daily living (e.g., doing laundry or grocery shopping).
4. Discharge planning. Part of the recovery process in an inpatient setting is putting in place plans to help the person solve problems they may encounter once they leave the hospital. These problems can include issues involving finances, housing, relationships, employment, education and finding resources such as community rehabilitation programs. People and their families and support networks need ongoing support after the client has left the hospital. The occupational therapist ensures that the transition process from hospital to community is smooth and that the client receives the mental health services they need without interruption. Occupational therapists integrate community resources (for example, the community agencies that provide employment services) and connect them to people and their families.

The ultimate goal of occupational therapy in the inpatient setting is to foster a positive cycle of hope, empowerment, life meaning and personal growth—and to make that process as seamless as possible in the transition from inpatient setting to community. Occupational therapists actively convey their belief in people to be an agent in their recovery, envisioning a future life for the client even when they are hospitalized. Occupational therapy encourages people to make decisions to empower themselves and increase their sense of self-worth and helps people to find and use their strengths to achieve their goals.

By encouraging and ensuring a client’s activity participation, occupational therapists show the acutely ill individual how to take the first steps in the recovery process on the way towards returning to health and re-entering the community. As one patient summarized, occupational therapy “[makes] you feel good. I thought, Oh boy, I can do this … then maybe I can do the banking or make myself a decent meal … it grows from there.”¹

For more information on finding an OT in BC and using occupational therapy as a tool in the recovery process, try the following:⁴

• contact a local hospital or community health care centre to determine if occupational therapy services can be accessed as an outpatient or in your home
• ask your family doctor or other health care professional (e.g., a psychiatrist or nurse) for a referral to occupational therapy
• if you have extended health coverage (e.g., Blue Cross, The Cooperators, SunLife), contact your coverage provider and find out if occupational therapy is covered under your plan
• use the “Find an Occupational Therapist in BC” tool to access OTs in your area.