Academic journal article British Journal of Occupational Therapy

Promoting Physical Activity in Acute Mental Health

Academic journal article British Journal of Occupational Therapy

Promoting Physical Activity in Acute Mental Health

Article excerpt

Government initiatives, such as mental health promotion and social inclusion, have influenced the provision of physical activity to clients on an inpatient acute mental health unit in north Manchester. The use of physical activity as an intervention fits well with the Model of Human Occupation and is particularly relevant to the concepts of volition and personal causation. This practice analysis discusses the current interventions taking place in north Manchester and expands on some of the theory and policy initiatives that influence practice. Suggestions for improvements in the service are then made based on a critical reflection of existing practice.

Key words: Mental health, physical activity, social inclusion.


The relationship between physical activity and mental health has been well documented (Taylor et al 1985, Fox 2000, Jones and O'Beney 2004, Saxena et al 2005), not least because physical occupation based interventions 'can facilitate the development of self identity' (Frances 2006, p183). Lloyd et al (2003, p19) stated that occupational therapists are well placed in mental health, with their focus on occupations to improve health, to play 'a pivotal role in promoting fitness-oriented physical activity'. Despite these factors, Reynolds (2001, p331) reported a 'rather limited inclusion of physical activity in mental health interventions'. This article discusses the practice of an occupational therapy service on an adult acute mental health inpatient unit in north Manchester, and reflects on the theory and policies that have influenced the increase in provision of physical activity interventions within the service.

The age-range of clients is between 18 and 65 years. The primary diagnoses are the severe and enduring mental health problems, such as schizophrenia and bipolar disorder, alongside a number of clients with a dual diagnosis, that is, a mental health problem coexisting with a substance misuse problem. There are three mixed gender wards, with 20 beds in each. Manchester has one of the highest rates of mental health problems in the United Kingdom as well as high levels of social and economic deprivation (Manchester Public Health Development Service 2004).

The role of the occupational therapist on this acute unit is to assess the level of function in self-care, productivity and leisure activities. Treatment plans are devised to address areas of occupational need and commenced during the inpatient stay. A 6-week follow-up period post-discharge is also used, before referring on to other agencies if intervention is incomplete. After an initial non-standardised interview to get to know the client, a number of functional assessments are performed; for example, observing self-care, shopping, cooking and general routine. These are non-standardised owing to difficulties in engaging the client group in structured activities or interviews. Occupational therapists on the unit use the Model of Human Occupation Screening Tool (MOHOST), an observational assessment covering motivation for occupation, pattern of occupation, motor, process and interaction skills and the environment. This provides a baseline assessment and highlights potential areas for intervention.

Clients who identify physical activities as an interest area, have difficulty in structuring their time, or have problems in maintaining a routine or accessing community facilities are likely to be appropriate for the provision of physical activities as interventions. In the experience of the occupational therapists working on the unit described above, this tends to be the case for the majority of clients taken onto their caseload.

Description of practice

The occupational therapy service in north Manchester offers a range of physical activities as standard interventions for clients with acute mental health problems. Badminton, walking, swimming, football, pool, table tennis, yoga and gym sessions are offered to clients on a regular basis, using community facilities such as leisure centres and local parks. …

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