Occupational Therapy in Local Psychosocial Practice
by Catherine Galea
Head of Occupational Therapy Department
Mount Carmel Hospital
Man is an active being whose development is influenced by the use of purposeful activity.1 Life is a process of continuous adaptation which brings about a change in function, and which promotes social and self-actualisation. Occupational Therapy is based on the belief that purposeful activity, including its interpersonal and environmental components, may be used to prevent and mitigate dysfunction.
Mental illness is unfortunately highly stigmatised, however with a combined effort to ease the suffering and empower maximal potential, modern day society may gradually become more tolerant and willing to support and appreciate efforts made by the individual who is experiencing psychiatric problems.
Occupational therapy (OT) is defined as the art and science of using selected theories as a guide for collaborating with a client. Occupational therapists (OTs) assess the individuals’ abilities to engage in the performance of life tasks and if necessary assist them in acquiring the knowledge, skills and necessary attitudes.2 OT is concerned with an individual’s potential to be involved in activities which one has to perform in order to meet one’s own needs and to be a contributing member of a community.
The brief phrase, ‘GIVING SENSE TO LIFE’ with its very expressive message is the chosen motto for OT in Malta. Working with persons with mental health problems, we often encounter individuals leading a poor quality of life. Mental health disorders have a wide range of manifestations. The psychosocial professional encounters many relatively young persons who may spend the peak hours of the day in bed or roaming around and smoking, feeling a sense of apathy with no objectives and guidance. These are usually heavy smokers. On the other hand, people with mental health problems could be very stressed with obsessions and indecisions, or highly agitated and fearful. In both scenarios, in part because of the limited support, the patients experience difficulties to honour commitments, manage money and plan time. How meaningful can such a person’s life be? A mentally ill person often finds it difficult to appreciate the positive aspects of a situation or take control of challenging circumstances.
The role of the OTs is to recognize these functional problems and plan a holistic treatment programme. This usually consists of carefully chosen activities that are purposeful to the client and address skills of self-care, productivity and leisure. The main OT focus is to promote development, improve function, enhance independence and empower the person to lead a fulfilling life. Hence, OTs are involved in helping clients to engage in appropriate familial roles, to care for their personal needs such as grooming, shopping and housekeeping, to maintain satisfactory interpersonal relationships, to participate in gainful employment and to engage in satisfying recreational and vocational pursuits.
The OTs and their assistants who work in the mental health field, provide these services at Mount Carmel Hospital (within the wards, OT department and the Social Centre) and the Day Community Services of Qormi and Cospicua. They are also involved in sessions at the Psychiatric Unit, Psychiatric Out-Patients and Child Guidance Clinic at St. Luke’s Hospital.
Catering for children, adolescents, adults and elderly, OT looks at a person as a whole, so the three main functions of the individual – self care, productivity and leisure – are assessed for dysfunction and incorporated in the treatment programme. Various activities are utilized to simulate working environments to which a client would be returning. These include industrial work, information technology responsibilities, clerical duties, woodwork, sewing and household tasks.
OTs are also involved in helping the client to deal with the nonhuman environment which may for example, include animals, plants and books, and this is done through the versatility of self-expressive and creative activities. Creative activities enhance self-expression and involve various types of arts such as drawing, pottery and music. These experiences assist the individual in discovering meaning and existence. The physical environment of the premises from where the OT service is delivered plays an important role. Our department has been recently refurbished to make the environment welcoming and supplied with all amenities. The services now include a multipurpose activity hall, computers’ room, kitchen, laundry room, pottery room, carpentry workshop, a big yard with gardening areas, a gymnasium which is very popular, and offices.
Versatility of OT activities
Our service users participate in a variety of therapeutic individual and group sessions. These help the individual to increase self-esteem and motivation, maintain present skills, build on developing ones, learn coping strategies and experience a sense of satisfaction and pleasure. Types of activities include personal hygiene, domestic chores, nutrition classes, physical fitness, stress management, compliance to treatment education, social skills training, self-expression, time management, health promotion and budgeting skills. Activities take place both in a sheltered environment within the hospital as well as in the community. OT staff assist clients to reintegrate into the community by practicing the use of public transport, bank facilities, shopping skills and neighbourhood services. These are complemented by sessions with the carers and regular home, school or work visits, as necessary.
Undoubtedly, financial independence is the fulcrum of self-sufficiency. Hence OT is also greatly involved in the assessment, training and job coaching of our clients to form part of a rehabilitation work scheme. Computer literacy is an asset for some individuals in the employment field nowadays. The OT department has thus made biannual arrangements for such training at Valletta through other agencies.
Apart from the physical wellbeing, a healthy life is complimented with a range of activities and
responsibilities. Therefore, one should strive to find a reasonable balance between work and leisure. Psychosocial OT services also organize various group activities in the community. Seasonal events like Carnival ball, Easter events, beach activities in summer and Christmas functions are highlights in the OT recreational calendar. Other activities include visits to historical sites, village feasts, sports events, libraries, cultural evenings, artistic exhibitions, and organizing talent shows and day trips to Gozo or Comino.
With the aim of involving the outside community into the hospital environment, the OT department has taken the initiative to make requests for sponsors to help, by example, involving clients in an annual Christmas Fairs, in the running of snack bars and in the promotion of craftworks prepared throughout the year. It is comforting to note that public awareness of the significance of the OT in the psychosocial field is on the increase. This is evidenced by the increasing requests for our interventions in a vast range of mental health difficulties which hinder an individual’s personal fulfilment in an independent and meaningful life, possibly within the community.
While OT has its own core skills to offer in the mental health field, the multidisciplinary nature of this work cannot be stressed enough. Working in close liaison with other professions and agencies, both inside the hospital as well as in the community, ensures an integrated treatment approach to the benefit of the client.
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Polatajko HJ. Naming and Framing Occupational Therapy. Canadian Journal of Occupational Therapy 1992; 59(4).
Code of Practice – Occupational Therapy. Council for the Professions Complimentary to Medicine, 2006, Malta.,
Yerxa EJ. Audacious Values. In: Keilhofner G. Health through Occupation: Theory and Practice in Occupational Therapy. Philadelphia: FA Davis; 1983. p149-62.