Occupational Therapy and Independent Prescribing

Keir Harding
3 hours ago
6 min read

By Keir Harding

Occupational Therapy and Independent Prescribing - Keir Harding (Therapy Articles on The Occupational Therapy Hub)

Occupational Therapists (OTs) within mental health services support people to improve their function, which often involves both working with multidisciplinary teams (MDTs) and the use of medication. However, there are limitations in prescribing opportunities for OTs, compared to other Allied Healthcare Professionals (AHPs, e.g. Physiotherapists). Occupational Therapists are barred from training to be independent prescribers in the UK, despite support from their professional body, the Royal College of Occupational Therapists (RCOT).

RCOT argue that granting independent prescribing rights to occupational therapists is essential for improving care quality, efficiency and professional development.

Currently, OTs can only enable access to medicines through Patient Group Directions, which limits their ability to deliver timely, holistic support. Through the #PrescribingNow campaign - run jointly with other Allied Health profession bodies - RCOT is calling on the UK government to amend legislation under the Medicines and Medical Devices Act (2021), to extend prescribing rights.

While there is broad support, the change requires a formal consultation, regulatory review and political commitment, meaning progress will take time. RCOT continues to gather evidence, engage members and lobby policymakers, to make independent prescribing a reality for the profession.

Open to physiotherapists, podiatrists, nurses, etc, the independent prescriber role is closed to occupational therapists.

I gathered some mixed feedback from sharing my ideas about this and I'm going to try and address some of that. But first, this is why it would have been useful to me, in my 27 years working within mental health.

I work with a group of patients who are highly stigmatised. They are literally the patients psychiatrists dislike (2), so medication - too much or too little - is often a problem for them (3). There are many times in my career where I've thought "If I was able to do something here I would do it." As I couldn't, my patients suffered as a result. Here are some examples…

-When I wanted to prescribe-

Occupational Therapy and Independent Prescribing (Therapy Articles on The Occupational Therapy Hub)

1) Acute pain

We all experience pain in life. Most of the time we will toddle off to our GP and get some help. Some people I work with do not trust their GP to listen, or cannot bear to go through the morning lottery of getting an appointment. When they are in acute pain, I'd like to be able to help them. If I could've helped, they would have avoided days of intense pain (which they would have thought they deserved), before others responded and systems brought relief. I'm not arguing for managing chronic pain (although I would love to be able to refer to pain clinics); I'm arguing for helping the new problem in the moment.

2) Psychosis that decimates functioning

I was working with someone who didn’t want to be injected and asked for oral medication instead. We convinced a consultant to do this and they changed them from a high dose depot injection to a sub-therapeutic dose of oral antipsychotics. When the oral, tactile, olfactory and visual hallucinations increased, the response was that "the next outpatient appointment is in six weeks." The prevailing argument from the consultant and the team was that, despite the high dose antipsychotic the patient had been on, antipsychotics do not work for people with their diagnosis...

Being alongside her for the weeks until the next appointment was one of the most hellish in my career, as my patient was neglected.

I would have wanted the competence - and the authority - to act, in collaboration with medical colleagues, rather than being unable to respond at all. I’d have done it differently.

3) Withdrawal

Whenever people I work with get admitted, PRN benzodiazepines are given out fairly liberally. They take the edge off strong emotion and agitation and, as Tom Maine might say, make patients a bit quieter (4). At discharge time, the Benzo prescribing tends to stop dead. I have people coming into the community with a sudden cliff edge of strong emotion to manage, as well as withdrawal from recurrent Benzo use. I would do that differently.

4) Sleep

I do not want to medicate sleep long-term, but... sometimes I sit with people to do a session and they cannot function. They cannot focus, concentrate or learn anything. They cannot rest and haven’t slept for days. I would like to occasionally medicate them, to get their sleep pattern back on-track.

5) Withdrawal (Part 2)

It doesn't happen often, but a few times in my career, the consultant/MDT have stopped all medications for those I work with. It tends to happen at the point where the team is incredibly fed up with them - and if you argued there was a cruelty in suddenly exposing people to withdrawal, I think there would be evidence to support that. I might well help people reduce medication. I would ensure people were never suddenly stopped without titration.

6) Polypharmacy

There is no medication with an evidence base for people living with a diagnosis of Personality Disorder (5) (regardless of what the locked rehab bins tell you), but sleepy people are definitely easier to manage. For those told they have Personality Disorder, polypharmacy is a huge issue, with everyone on multiple medications.

Every tribunal I do I meet people taking enough sedation to floor a rhinoceros while their notes are full of comments about laziness and lack of motivation (6).

Gently, sensitively and slowly I would like to help people live with fewer chemicals and side effects. Often, the side effect is the desired effect; I want people to be more able to function, not just be tired.

-Independent prescribing: A case example-

I was talking to someone in the community who described how they had been on antidepressants for over five years and didn't like taking them. Everyone in the family was terrified and the healthcare environment had given the message "KEEP TAKING YOUR MEDS."

We looked at what the medication did, the side effects they experienced and how one of her medications was specifically contraindicated for her. While I told her that she could stop them whenever she liked (because it was true), it was best to meet and plan with their doctor.

So she did. And, at a snail's pace - while every appropriate reaction to life's adversity was described as relapse, while every pang of withdrawal was described as meds not working - she came off the medication she had taken needlessly for years.

She took those pills for others, not for herself.

Some people will not get the chance to negotiate lowering meds, so will carry on with a sense of defeat, or stop completely without telling people. I'd do something different to that.

-Promoting functioning-

So, six examples above of when I would've wanted to prescribe... All in order to help someone function; some about responding to an environment that impacts the functioning of staff and patients. Now, because I would like to be able to do these things, should I be able to? In one way it's a pointless question; as an occupational therapist, I am excluded from being able to do this in a way that a nurse is not.

1) "But you don't have the training!"

It doesn't matter, because I can't do the training. My competence has been found wanting before any assessment has been done. Mary E. Brunkow won the 2025 Nobel Prize for Physiology and Medicine (7) and, if she were an occupational therapist, she would be deemed too incompetent to start an independent prescriber course.

We are not excluded because of our skills or experience.

We are excluded because of our profession.

2) "But this isn't occupational therapy!"

Maybe. But occupational therapists are no longer unqualified workers 'helping out' in hospitals. We are professionals with a professional body, who have expanded far beyond the role we had when we first donned those green trousers.

We can be 'Approved Mental Health Professionals'. We can be 'Responsible Clinicians'. We can be safeguarding leads. We can be chief executives of huge healthcare organisations.

None of these roles are pure occupational therapy.

Not every OT will want to do this. Not every OT should do this. But, for the ones who desperately want to do it, who should stop them?

Should other OTs hold them back? Should the Department of Health hold them back? Or, should no one hold them back - and we let, even encourage, occupational therapists to get on their wagons and pioneer new roads for the profession?

We can always fail a prescribing course, but if we can pass the same course as our peers, should we still be deemed to 'lack the competence'?...

3) "But all those other professions are better than you, in some way that we can't quite articulate"

Different. Not better. If other professionals can step out of their core roles and learn new things, why are we uniquely incapable?

If you are an occupational therapist, almost every NICE committee will take place without you. You will struggle to get on some therapy training. Like it or not, there are many doors that are closed to us.

A closing thought: