|Year : 2020 | Volume
| Issue : 4 | Page : 125-131
Perception of psychiatrists on occupational therapy practice in mental health: A qualitative study
Sadichha Paresh Kamat1, Pooja Vivek Vajaratkar2
1 Department of Neurology, Goa Medical College, Bambolim, Goa, India
2 Department of Orthopaedic Surgery, Allied Health Science Courses, Goa Medical College, Bambolim, Goa, India
|Date of Submission||04-Mar-2021|
|Date of Acceptance||18-Mar-2021|
|Date of Web Publication||22-Apr-2021|
Sadichha Paresh Kamat
Goa Medical College, Bambolim - 403 202, Goa
Source of Support: None, Conflict of Interest: None
Background: In India, there is a significant predominance of mental illnesses in varied age individuals that leaves them incapacitated in various domains of functioning (self-care, occupational and interpersonal functioning, and social participation). Moreover, with the current lifestyle and working conditions, a large majority of the population also face psychological issues hindering their emotional and psychosocial well-being. All of these individuals require a comprehensive interdisciplinary intervention. The psychiatrists serve as a primary source of referral for occupational therapy (OT). It becomes essential to understand the perceptions of the psychiatrists on the role of OT practice in mental health and its relative contribution in the psychosocial rehabilitation and promotion of mental wellness to provide holistic treatment. Objective: This study aimed to explore the perceptions and understanding of OT practice in mental health among psychiatrists based in Goa, India. Study Design: A qualitative descriptive design was used for this study. Methods: A qualitative study was conducted on psychiatrists (n = 10) currently practicing in Goa, having experience of 3 or more years in psychiatric practice. The snowball sampling method was used. A semi-structured questionnaire was used to conduct in-depth interviews to explore the psychiatrists' knowledge and understanding of OT practice in mental health. Results: The psychiatrists have a general understanding of the role of OT in mental health. They stated the importance of OT interventions in vocational rehabilitation and promotion of functioning. They also reported that occupational therapists (OTs) are important stakeholders in the multidisciplinary team. However, it was found that there was limited knowledge about the scope and OT practice in mental health among the psychiatrists. They also lacked clarity over the professional roles of OT and other mental health professionals in a mental health setting. Conclusion: There is a general understanding of OT practice in mental health among psychiatrists. However, there exists a lack of clarity about the roles of OT in mental health.
Keywords: Mental health, Occupational therapy, Perceptions, Psychiatrists
|How to cite this article:|
Kamat SP, Vajaratkar PV. Perception of psychiatrists on occupational therapy practice in mental health: A qualitative study. Indian J Occup Ther 2020;52:125-31
|How to cite this URL:|
Kamat SP, Vajaratkar PV. Perception of psychiatrists on occupational therapy practice in mental health: A qualitative study. Indian J Occup Ther [serial online] 2020 [cited 2021 May 18];52:125-31. Available from: http://www.ijotonweb.org/text.asp?2020/52/4/125/314220
| Introduction|| |
Occupational therapy (OT) is a health discipline concerned with helping people carry out everyday activities which are important and meaningful to them through engagement in their valued occupations, enabling function, and well-being., Well-being is a multidimensional concept in which multiple factors such as physical, mental, social, and environmental aspects of a person's life are involved. Mental health problems are associated with difficulty in controlling feelings, thoughts, and behavior and issues in performing out everyday activities. The treatment of these mental issues requires comprehensive multidisciplinary care delivered by a team of psychiatrist, nurses, occupational therapist, psychologist, and a social worker. However, it is often noted that there is limited knowledge present about OT among health professionals., Since psychiatrists are the primary referral source for OT, it becomes increasingly important to know how psychiatrists perceive OT in mental health. There is a dearth of research on perceptions of the psychiatrists about OT practice in mental health in the Indian as well as western context. Moreover, the existing studies have explored the understanding of OT among health professionals or psychiatrists' knowledge about general OT. The purpose of this study is to explore and understand psychiatrists' perceptions of OT practice in mental health.
| Methods|| |
The present study was conducted with psychiatric practitioners currently practicing in the private sector in Goa.
This study employed a qualitative study design.,
The study was approved by the institutional ethics committee. Ethical clearance was obtained from the Institutional Ethics Committee at Goa Medical College, Goa, on February 7, 2020. Participation was voluntary and informed consent was obtained from the participants. All results are presented in an anonymous fashion with the least possible identifying information and the information confidentiality is maintained.
Participants and Recruitment
Ten psychiatrists (n = 10) currently practicing in Goa (age mean 55.6 standard deviation [SD] ± 16.32, in years) with major inclusion criteria of qualification of MD (Psychiatry) degree from a recognized institution, currently practicing in Goa, having a work experience of 3 or more years in psychiatric practice, were recruited for this study using the snowball sampling technique.
In-depth interviews with psychiatrists were conducted on a one-to-one basis and the conversation was recorded. The interviews were taken in English and the questions were open ended. A semi-structured interview guide (Annexure 1) was developed based on the review of literature which includes demographic information, qualification and work experience, psychiatrists' views and understanding of the stakeholders in mental health, mental health work settings, and the beneficiaries of OT in mental health and their outlook on the role of OT in mental health.
The analytic process is shown in [Figure 1]. The interview recordings were transcribed from audio files to elaborate written documents by the author. Thematic analysis was used. The interview themes were developed iteratively, starting with a set of questions by the authors [Annexure 1]. Information in each interview and the entire collected data was organized. Codes from the data were identified and defined iteratively [Table 1]. The analysis was aimed at describing psychiatrists' views on significant stakeholders in the field of mental health, their understanding of mental health work settings and the beneficiaries of OT in mental health, and their understanding of OT practice. This resulted in a refinement of the coding framework. The remaining transcribed interviews were coded using this framework.,
| Results|| |
Ten psychiatrists (n = 10) currently practicing in Goa (age mean 55.6 SD ± 16.32, in years) were recruited in the study. [Table 2] summarizes the other characteristics of the participants. This paper describes the perceptions of psychiatrists of OT practice in mental health. The findings are described in the following themes:
Occupational Therapist as an Important Stakeholder in Mental Health Practice
This study found that the participants are aware that occupational therapists (OTs) are important stakeholders in a mental health multidisciplinary team and OT is needed to address the occupational needs of the patient.
All of the participants (n = 10) thought that OTs were significant stakeholders in the rehabilitation of the patients with mental health illnesses along with the psychiatrists and psychologists. One participant said,
“I feel along with the psychiatrists, there are psychologists who are the stakeholders…. and there are Occupational Therapists. They (OTs) play an important role in the Occupational rehabilitation which takes place after the patient has improved.”
Some of them (n = 6) expressed the view that having a multidisciplinary team allows multiple inputs regarding the patients' problems and allows for a treatment program which is customized to meet the needs of the patient and that OTs are required to address the occupational needs of the client. A participant said,
“In the place where I would work earlier, the patient was seen by me (psychiatrist) and then I would work with a team which had a nurse, an Occupational Therapist, a social worker… and the Occupational Therapist would be assigned to the patient for his vocational difficulties…. and what happens is with such teams you get multiple inputs and it is a more customized approach tailored for that patient.”
Potential Mental Health Settings and the Beneficiaries in the Mental Health Practice
The study found that the participants are aware that OTs can work and deliver rehabilitation to those individuals they thought would benefit from OT services. According to them, OTs can work in diverse settings such as tertiary hospitals, long-term care facilities, de-addiction centers, prisons, child correction homes, corporate offices, and industries. The participants said that they would refer cases of psychoses, schizophrenia, bipolar affective disorder, depression, neuroses, personality disorders, Parkinson's disease, dementia, etc., to OT. Moreover, the study participants also highlighted that there is a scarcity of OTs practicing in mental health and more OTs should work in the area of mental health.
All (n = 10) of the participants stated that they should be working in tertiary hospitals or health facilities dedicated to the treatment of psychiatric ailments having a team of mental health professionals to provide rehabilitation in the wards as well as have consultations for the outpatients. A participant stated,
“I think there are all sorts of places where an Occupational Therapist can work… but ideally it should be a group setting where all clinicians meet and work together with the patient and Occupational Therapist is one of the clinicians.”
Apart from this, they also believed that OTs were largely required in the daycare centers, sheltered homes, and other long-term facilities. A participant said,
“In daycare facilities and sheltered homes, I think an Occupational Therapist has a very important role in providing Occupational rehabilitation.”
All of the participants (n = 10) opined that OT can greatly benefit people diagnosed with long-standing psychoses, schizophrenia, bipolar affective disorders, and chronic depression. However, a few of them (n = 4) also highlighted that OT can also largely help patients dealing with milder forms of schizophrenia too. One participant said
“I strongly feel there can be some really refined places for people dealing with milder illnesses, where people can go and engage into something rather than sitting idle at home and going into a spiral of setbacks.”
Only a few of them (n = 4) mentioned that patients suffering from neuroses (anxiety disorders and obsessive-compulsive disorders) and personality disorders require psychosocial rehabilitation and would benefit from OT intervention. A participant said,
“It (OT) is very useful for any case having mental health issues and wants to bounce back to normal; not just patients with schizophrenia or bipolar affective disorder.“
De-addiction centers, prisons, and child correction homes are potential work settings for an occupational therapist according to some (n = 4) of the participants. They stated that OT can play a role in the rehabilitation of victims of crime or abuse as well as the prison inmates who often have difficulty in maintaining overall functioning and mental well-being and have decreased social participation and. One participant said,
“If an Occupational Therapist is posted in jails, it would actually help the criminals and keep them continuously functioning.”
Few participants (n = 6) stated that OTs can render services aimed at managing the stresses faced by the employees in various industries and corporate offices. One participant said,
“People working in industries are often angry with their superiors, with the amount and the quality of the work. OTs can occupy these people with activities or yoga or meditation as a part of therapy for Stress management.”
Some of them (n = 3) were also of the opinion that should be employed at nongovernmental organizations (NGO) and clinics concerned with the well-being of the geriatrics, patients suffering from mental illnesses, and alcohol and substance abusers. A participant said,
“It (OT) need not be restricted to just an in-patient setting in a big hospital…. I know a really nice NGO where they have a really good OT setup and they are all out-patient based.”
Some participants (n = 6) also stated the importance of OT in patients with Parkinson's disease and dementia to promoting mental well-being and functioning.
Interestingly, most of the participants (n = 7) also expressed that the number of OTs practicing fewer are practicing in mental health and mentioned that more OTs should be working in mental health settings. A participant said,
“The number of OTs practicing in India in mental health must be a few hundreds… Even fewer in Goa. This may affect the OT practice… Sometimes, we really want to refer a case to OT but we don't know where to send them. More OTs should start working in this (mental health) area.”
Occupational Therapy Intervention in Mental Health Practice
The study found that the participants were aware that OT interventions help in promoting functional independence, social skills, socialization, and mental well-being. OTs are involved in vocational and occupational rehabilitation, skill training, and leisure training. However, it was evident that the participants were not very clear about how the intervention is delivered and what the clinical reasoning behind the activities OTs give is.
All of the participants (n = 10) found that OT interventions can be provided to the clients experiencing psychosocial dysfunction to promote functional independence and mental well-being. A participant said,
“Most mentally ill patients feel that they are unwanted at home. You (OTs) teach them grooming, dressing… even brushing when they don't do it properly. This shows the patient that there is someone who takes interest in them and they are wanted. This sort of gives them the boost to do constructive activities.”
Most of the participants (n = 8) believed that OT intervention is required to help the patient to function in the home and social settings. One participant said,
“The treatment of the patient doesn't end with medicines and/or counseling. It is very much important how the person is rehabilitated once he/she goes home. I think OT can aid in this.”
All of them (n = 10) stated that OT is majorly concerned with occupational and vocational rehabilitation and helps patients with mental disorders in returning to work. One participant said,
“Whenever the patient goes back home, he gets encouraged that after going to the hospital I've not lost my days but instead I've regained activities which I was doing before and I can be rehabilitated to my original work.”
Some of the participants (n = 6) also highlighted that OTs can carry out skill training and skill generalization. A participant said,
“Patients learn certain skills in daycare facilities, and then they are placed in some job. But then they realize that the skill does not always get generalized to this new setting. An Occupational Therapist should be able to help here.”
Few participants (n = 5) believed that OT can promote social skills, socialization, and interpersonal skills. Few of them (n = 3) further stated that OT interventions such as skill development and leisure training can significantly improve their self-esteem, self-confidence, motivation, and self-worth. One participant said,
“Sometimes simple things like singing or dancing or instrument playing can make the patient feel good… like reciting simple rhymes can then lead to them singing better and better subsequently and they gain confidence.”
Referring to the token economy used by occupational therapist in a daycare center, one participant stated,
“Whenever they (family members) go for work, he (client) goes to the daycare center and returns back home with them…. and while coming back he comes with some kind of a reward and this boosts his self-esteem knowing that he is also an earning part of the family.”
Most participants (n = 9) opined that group therapy used by OTs can significantly benefit service users to improve social and interpersonal skills. One participant stated,
“Group settings and Group based activities which OT uses is great. The group dynamics and social dynamics help to promote a lot of things towards better functioning.”
Few participants (n = 4) further added that promoting interpersonal skills and engaging with other people aids in promoting psychosocial well-being in the clients.
“They had a separate section which prepared and sold food items. Some of the clients were involved in preparation of items and some of them were taken as staff to sell it. And with this their social skills, confidence, and compliance to treatment improved. Earlier they were dropped to the place by their caregiver but now they have been coming to the place on their own” said one participant referring to an OT Unit she had seen in an NGO.
Interestingly, although most of the participants displayed a fair understanding of the services and roles of OT in the field of mental health, a few seemed to have limited awareness on the scope of OT practice and certain misconceptions about the professional roles. A participant said,
“The ultimate aim of OT in acutely ill patients is distracting them from their hallucinations and delusions.”
Another participant said,
“Socialisation is an important skill but its training can be done by many professionals-psychologists, psychiatrists, and an Occupational Therapist can also do it. But it is important that they (OT) focus more on other aspects like environmental manipulation, functioning at workplace.”
Furthermore, most of the participants (n = 7) named various activities such as gardening, woodwork, painting, and tailoring but admitted that they did not quite understand the clinical reasoning behind these treatment activities.
A participant said,
“I had seen OTs work and I knew that the activities aren't given just like that but I did not know what exactly was happening… I'm not exactly aware of how you (OTs) frame it (activities) out.”
| Discussion|| |
The study aimed to explore the psychiatrists' perceptions of OT practice in mental health. The major findings of the study have been discussed below.
First, the psychiatrists from the current study identified OT as a significant stakeholder in the multidisciplinary team involved in mental health care and can deliver their services in various mental health facilities. The participants claimed that the OTs are necessary mental health-care professionals in an interdisciplinary team. This finding is in line with a previous study which stated that OTs typically work as team members, whether in clinical mental health or psychosocial rehabilitation services. The psychiatrists from this study also reported that OTs can work in a variety of settings with tertiary hospitals or mental health facilities, daycare centers, and sheltered homes being the most agreed upon settings. However, they believed that although mental health OTs can practice in a wide range of clinical settings, they would benefit the most in a multidisciplinary team setting. According to the American Occupational Therapy Association (AOTA) factsheet 2016, OTs can deliver mental health services in inpatient behavioral mental health setups, group homes, nursing homes, and community-based environments.
Second, the psychiatrists in the present study reported that they would refer patients who are chronically incapacitated by longstanding mental disorders such as schizophrenia, depression, bipolar affective disorders, dementia, and psychoses to OT and thought they would benefit from OT services. Pottebaum et al. study showed that most referrals from the psychiatrists to OT were patients diagnosed with cognitive disorders, schizophrenia, mood disorders, depression, and psychoses, etc. Only few participants reported the role of OT service for the patients with neuroses and personality disorders. This shows that not all psychiatrists are fully aware that OT can benefit patients suffering from neuroses, personality disorders, or individuals with minor setbacks. There is literature published by OTs reporting the role of OT in the aforementioned conditions, but limited literature is available for other stakeholders in the mental health-care delivery including psychiatrists stating the role of OT in the rehabilitation of these conditions.,
Third, OT was identified as a health-care profession concerned with the functional and psychosocial rehabilitation of people with mental health illnesses by the study participants. OT was thought to majorly deal with vocational and occupational rehabilitation by most of the participants in the current study. They stated that OTs work with individuals having mental health illnesses to reintegrate them back into their jobs. Lloyd and Williams study showed that OT is considered a key professional group in mental health. It also stated that OTs are involved in health promotion, have a leading role in decreasing the social exclusion for people living with mental illnesses, and in facilitating system change toward the routine delivery of employment services. Another study showed that OT in mental health helps people develop skills and obtain the support necessary for independent, productive living, and the interventions result in improved participation and better quality of life. The promotion of functional independence and mental well-being of the beneficiaries thus helping them reintegrate into their community was also identified as a role of OT by the participants from the current study. This finding is similar to the findings of a previous study which showed that OT interventions help people with mental health illnesses to engage in everyday activities, leisure, social participation, and healthy daily routines. Furthermore, socialization, social skill training, and interpersonal skills development were identified as areas addressed by OT but were not considered as primary goals of the profession and claimed that those areas could be addressed by other mental health professionals too. The AOTA factsheet 2016 aforementioned states that OT's focus of services includes engagement in occupations to improve levels of daily functioning, community participation, and quality of life, skills training, social skills, community reintegration, supported employment, stress reduction, etc. A position statement of the World Federation of Occupational Therapists 2019 stated that OT enables people to be productive through skill training, group work, community participation, and inclusion and enables life participation while influencing well-being and quality of life. The psychiatrists highlighted the use of yoga, meditation, and group therapy as some of the intervention methods. A study has shown that group therapy improved the patients' interpersonal relating. A study reported that yoga can be a viable therapeutic option and when used as an adjunct to OT, has the potential to address state anxiety. This shows that although the psychiatrists have a general idea of the role of OT in mental health and the professional goals, there seems to be a lack of clarity about the other stakeholders in the mental health practice. They also seemed to display limited knowledge about the treatment methods and approaches of OT in mental health. These findings are consistent with studies which showed that there was limited knowledge about OT among general medical practitioners as well as psychiatrists and they were not fully aware of the OT services. Less number of OTs practicing in the area of mental health could be one of the reasons behind the differing views about OT among psychiatrists. The Mental Health Atlas 2017 by the World Health Organization (WHO) states that the number of OTs working in mental health is very low.
Fourth, some of the participants in the current study interestingly reported that OT practice in mental health should not be restricted only to the hospitals but could be expanded to newer practice areas like managing stress in the industrial and office employees and prisons and correction homes. Various research articles and textbooks stated that the use of OT intervention can be beneficial in reducing work-related stress and symptoms (industrial rehabilitation), forensic settings, jails, and prisons.,
Research and Clinical Implications
This study helps to understand the psychiatrists' perceptions of OT practice in mental health. It helps to conceptualize awareness strategies that need to be developed for the psychiatrists to aid understanding of the role of OT in mental health rehabilitation.
According to the WHO Mental Health Atlas 2017, the number of OTs working in the area of mental health is very low. Therefore, it is of utmost importance to encourage more OTs to work in the mental health area. It is also important to take active efforts and formulate awareness strategies in order to expand the insights about OT interventions- frameworks used and the clinical reasoning behind these interventions among the psychiatrists. Efforts should also be made to expand OT practice in newer areas like mental wellness at workplaces and forensic psychiatry. Furthermore, developing clear guidelines for OT practice in mental health and defining the occupational therapist's role in psychiatric rehabilitation is the need of the hour. The importance of OT perceived by the psychiatrists may influence to bring out the changes in national policy and advocating OT.
There are limitations in this study as follows: (a) The study was based on a relatively small sample in a confined geographical area. Further study can be conducted across a larger geographical area. (b) The recruitment of the sample was done using purposeful snowball sampling and as a result of this, the participant group is not an exact representation of the psychiatric practitioners from Goa. Therefore, the generalization of the study findings should be considered with caution. (c) The study did not use any kind of member checking or data audits for the recruitment of the samples.
| Conclusion|| |
The psychiatrists in the current study stated the importance of OT interventions in improving functioning and promoting mental well-being in individuals incapacitated by mental health illnesses and psychological issues which hinders their adequate participation and engagement in life activities. The importance and relative contribution of the OTs in the multidisciplinary team is understood quite well, although some misconceptions about the services and lack of clarity about the roles and responsibilities of OTs and other mental health-care professionals such as psychologists and social workers in a mental health setting seem to exist among the psychiatrists. The study finding reveals that OT practice in mental health and psychosocial rehabilitation is understood by psychiatrists to some extent, but efforts can be made to expand their insight into OT services.
We wish to express our deep gratitude to Dr. Vivek Vajaratkar for his deep insights and meticulous scrutiny which provided a smooth basis for the study. The authors would like to extend their heartfelt gratitude to all the psychiatric practitioners who agreed to participate in the study for providing their time, cooperation, and invaluable insights over the study topic which was vital for the completion of this study. The authors also expresses gratitude to Dr. S. M. Bandekar, Dean of Goa Medical College, Medical Superintendent, and H.O.D Department of Orthopaedics.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| Annexure|| |
Annexure 1: Questionnaire
A semi-structured qualitative guide for exploring the psychiatrists' perceptions of occupational therapy practice in mental health
- Who according to you are the stakeholders in treating mental illness?
- Do you have knowledge of an occupational therapist practicing in specialized fields? If yes, which?
- Which are the settings according to you where an occupational therapist specializes in mental health practice?
- Which patients in your opinion can ideally be referred to an occupational therapist specialized in mental health?
- Which domains according to you do we focus on in mental health practice?
- What according to you are the various treatment approaches and methods an occupational therapist uses?
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[Table 1], [Table 2]