Academic journal article British Journal of Occupational Therapy

Implementing the Model of Human Occupation across a Mental Health Occupational Therapy Service: Communities of Practice and a Participatory Change Process

Academic journal article British Journal of Occupational Therapy

Implementing the Model of Human Occupation across a Mental Health Occupational Therapy Service: Communities of Practice and a Participatory Change Process

Article excerpt


Government policy over the past 10 years has focused on specifying the capabilities required of all mental health workers (Sainsbury Centre for Mental Health 2001, Department of Health [DH] 2004), rather than the specific contributions of individual professions. The Mental Capacity Act (DH 2005a) and Mental Health Act (DH 2007a) have created more permeable boundaries between psychiatry and the allied health professions (DH 2005b, 2007b). Although such policy and legislation provides new opportunities for occupational therapy, it also requires greater competence and confidence of practitioners. Contemporary practice is fluid and challenging, requiring practitioners to work with heavy caseloads, in complex and indeterminate situations (Higgs et al 2004). On top of these demands, practitioners must articulate their specific contribution and make explicit their professional knowledge (Higgs et al 2004, Richardson et al 2004, Pettican and Bryant 2007).

A 10-year strategy developed for mental health, Recovering Ordinary Lives (ROL) (College of Occupational Therapists [COT] 2006), seeks to keep occupational therapy abreast of new policy and situated at the heart of modern mental health services. This document calls for development in several areas, including a focus on occupation and adding value to occupational therapy (COT 2006).

Literature review

Occupational therapy literature acknowledges that the profession has some way to go in achieving the vision outlined in ROL. For example, some occupational therapists have abandoned the delivery of profession-specific services, adopting evidence-based techniques from outside the profession in order to receive funding and status (Layard 2004). Elsewhere, practitioners have been viewed as 'gap fillers', accepting an identity imposed upon them by their workplace (Fortune 2000, p229). Furthermore, significant tension revolves around the appropriate balance of generic skills and profession-specific practice, especially within community mental health teams where consensus regarding the optimal type of casework for occupational therapists has not been reached (see Craik et al 1998, Brown et al 2000, Hughes 2001, Parker 2001, Dunrose and Leeson 2002, Harries and Gilhooly 2003, Pettican and Bryant 2007, Lloyd and Williams 2009, O'Connell and McKay 2010).

Since the 1980s, conceptual models have been developed to define more clearly and support occupational therapy practice and to generate evidence concerning its value. It is recognised that these models can strengthen practice (Hagedorn 1997, McColl 2003, Forsyth et al 2005), yet practitioners often struggle with, or fail to see, their relevance (Duncan 2006). The demands and constraints of the practice setting, along with therapists' attitudes, are consistently identified in research as major barriers to implementing theory (see, for example, Storch et al 1995, Oxman et al 1995, Dunning et al 1998, Haglund et al 2000, Wye and McClenahan 2000, Walker et al 2000, Metcalf et al 2001, Elliott et al 2002, McCluskey 2003, Brown et al 2005, Lee et al 2008). However, these studies have not investigated in depth or over time what actually happens when therapists are involved in a supported process of incorporating a practice model.

The literature suggests that certain approaches might be more effective. For instance, Chard (2000, 2004, 2006) identified the importance of a team or whole systems approach to the implementation and adoption of new knowledge. Descriptions of efforts to support occupational therapy practitioners (Reeves and Summerfield Mann 2004, Forsyth et al 2005, Wimpenny et al 2006, Boniface et al 2008, Parkinson et al 2010) acknowledge that such team approaches can be effective. Nonetheless, an in-depth study of the processes involved in supporting mental health occupational therapists to adopt a conceptual model has yet to be reported.

The present study is situated in a journey that began in June 2003. …

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