Case study | OT and Community Mental Health

Written by Abigail Matthews, Occupational Therapist (UK)

This article will explore a case study of a typical intervention for an Occupational Therapist within a community mental health team in the UK. I have chosen to explore Behavioural Activation, given that I regularly use this in practice to help clients improve low mood.

The client was experiencing anxiety and depression. He found it difficult to maintain his daily living skills, meaningful occupations and work towards longer term goals. His anxiety meant that he did not engage in occupations outside the home, finding it difficult to go even go to the shop to pay his bills. His low mood resulted in reduced activity; he lacked motivation to carry out washing and cleaning tasks within the home. Initially he struggled to set goals, so we focused on walking his dog regularly, as he wanted to meet her needs.

I used a Behavioural Activation approach to support the client to re-engage with essential daily living skills and restful activities within the home. As a service, we use the Model of Human Occupation (MOHO), to analyse occupational life according to a person’s motivation, roles, routine and performance skills (Kielhofner 2008). I used the interest checklist to help the client explore his goals, in relation to occupational performance. We used activity scheduling to plan a routine, with necessary and pleasurable activities to meet the client’s needs. It is through engaging in valued occupations that one develops a sense of mastery, in order to promote positive emotions (Reid, 2011).

I chose to use Behavioural Activation given its evidence base in treating depression. It teaches us that we are able to control our mood through planning pleasurable activities, based on what we are motivated to change (Lovell and Richards 2008; Ekers et al, 2014). Whilst any professional is able to use these cognitive behavioural techniques, as Occupational Therapists we can draw on our expertise in goal setting and activity analysis (Thomas, 2012).

Goal setting by planning activities is a core occupational therapy tool, which helps to enhance skill development, to promote improvements in health (Park, 2011).

The intervention aimed to help the client develop skills in activity planning, to maintain functioning post OT input. Initially, session plans were structured. However, as time progressed, we used goal setting instead, due to his ability to independently plan activities. This demonstrates evidence of improvement in occupational performance skills (e.g. activity pacing, sequencing and planning) post intervention.

We were also hoping to link the client in with community services, due to his social isolation. The interest checklist helped recognise community groups of interest; over time the client was able to access these services. Initially, sessions were supported by a support worker, however, over time the frequency of support was reduced, to enable independent access.

The outcomes of this intervention were demonstrated through the SMART goals (Specific, Measurable, Attainable, Relevant, Time-based) created with the interest checklist, which were added to the care plan. The client was able to recognise improvements in occupational performance and we worked towards reducing support gradually over time. The benefit to the service user was long term, in relation to occupational performance. His suicidal thoughts also reduced considerably and we were able to step down his level of support.

On reflection, it may have been beneficial to use an outcome measure, such as the PHQ or GAD to further evidence changes in anxiety or depression. Verbal feedback was provided; the client reported to be very grateful for the support received from the care team.