The OT Journal Club

Background:

Inpatient settings are important in mental health care, with occupational therapy maximising independence, promoting recovery and transitioning people back into their community. The unique contribution of occupational therapy interventions relates to meaningful activities, offering choice and enabling sense of normality and belonging in patients lives.

Link to article: The role of occupational therapists in acute mental health inpatient settings: A systematic scoping review - PMC

Method:

A scoping review was used to explore the evidence (21 studies) for occupational therapy interventions within acute mental health inpatient settings.

Implications:

Five main themes:

1. How patients feel about occupational therapy

2. Helping patients do daily activities and make choices

3. Helping patients improve daily living skills

4. Reducing the use of strict rules and locked areas

5. Using sensory tools to manage stress

These themes link to inpatient spaces and how occupational therapists work to support recovery through developing skills and building confidence in abilities. Therapist’s support with developing routine, stress management, relapse prevention and social inclusion.

In conclusion, findings highlight the vital role of occupational therapists in acute inpatient mental health settings in addressing occupational deprivation and functional decline; reducing the need for restrictive practices and enabling self‐management strategies to reduce distress.

Key Points for Occupational Therapy:

Occupational therapy interventions offer a positive experience for consumers in acute mental health inpatient settings.

Occupational therapists enable consumers' activity engagement, choice, and functioning in acute mental health inpatient settings.

Use of sensory modalities can reduce the need for restrictive practices.

Future studies should look at:

How well occupational therapy works in acute mental health wards

What gets in the way of using occupational therapy in this setting

How patients feel it helps their recovery

Limitations:

Being a scoping review, the search included three databases which may have limited findings of studies. This review also focussed on interventions designed or delivered by occupational therapists and missed the wider role of discharge planning, assessments and multidisciplinary intervention in recovery. It is difficult to separate the benefit occupational therapy from multidisciplinary interventions, given team working in acute mental health inpatient services.

Furthermore, despite the values of choice and least restrictive practice in occupational therapy, inpatient mental health settings can be restrictive and offer limited choice and meaningful occupation, prioritising activity.

Host’s rational for choice of article:

I work in an inpatient acute mental health setting, working with people to support with rehabilitation. I found the scoping review was to understand multiple interventions in one piece of research. I was interested in reviewing evidence and interventions used by other occupational therapist’s, and felt reassured by the summary of findings.

In recent time I have felt more confidence in challenging restrictive practices in order to support patients independence and choice available. I resonate with the focus in the article on meaningful occupation, not just activity which my colleagues assume is the same.

I was reminded of the importance of sensory strategies and how they can support individuals who often present with complex emotional and neurodiverse needs in acute inpatient settings.

It reaffirmed my role as an Occupational Therapist in offering sensory assessment to support with stress management, despite the additional time it takes to complete assessments. This can promote independence and help patients reduce distress in restrictive and sensory overwhelming inpatient environments.