Occupational therapy literature has noted that the recovery approach for mental health is highly congruent with occupational therapy beliefs and values. Occupational therapists are concerned with enabling people to participate in the daily occupations that are important to them while the recovery approach is based on living life alongside the challenges of mental illness. Despite there being considerable literature about occupational therapy, the recovery approach, and the similarities between it and occupational therapy, there are few descriptions of practice that enable us to know whether occupational therapists do practice in accordance with recovery principles. Therefore we undertook a qualitative study in which occupational therapists who saw themselves as practicing in a recovery framework discussed in focus groups and individual interviews how they do this, how they know they are doing this, and aspects of the context that influence their practice. We hoped to identify aspects of practice that would enhance occupational therapists' work within mental health settings.
The recovery approach is based on recognising need, and assisting people to live a satisfying life despite the challenges of mental illness. Recovery is an individual journey in which people develop their sense of self, whether experiencing symptoms or not (Anthony, 1993; Deegan, 1996; Lloyd, Waghorn, & Williams, 2008).
Aotearoa New Zealand has national policy, strategies, and workplace competencies that specify ways in which service providers can integrate the recovery approach into practice (Mental Health Commission, 1998; Minister of Health, 2000, 2005; O'Hagan, 2001). These publications support the development of a recovery focused culture within the mental health workforce. Practitioners whose work is guided by the principles of recovery use a recovery approach (O'Hagan, 2001) in their service. This may be done either explicitly, implicitly, alone, or alongside other models and approaches specific to the service or practice. Recovery principles and values include acknowledging the right of people, despite serious mental illness to be actively involved in their own life decisions, to not delay involvement in relationships, activities and opportunities until they are well, and to develop a personal sense of purpose and meaning in life (Lloyd, Waghorn, & Williams, 2008). Despite these principles the use of the recovery approach may be more aspirational than reported; there are few exemplars of its successful utilisation in the literature (Davidson, O'Connell, Tondora, Styron, & Kangas, 2006; Farkas, Gagne, Anthony, & Chamberlin, 2005).
Literature documents how the ideas of recovery may affect occupational therapy, and concludes that the profession is in a good position to integrate the approach into practice because of philosophical similarities (Lloyd, Tse & Bassett, 2004; Rebeiro Gruhl, 2005). Occupational therapy and the recovery approach have similar values about what contributes to wellbeing. For example, the belief that engagement in occupations can increase quality of life is common to both (Rebeiro Gruhl, 2005).
The restorative and sustaining power of occupational engagement reaches further than the notion of simply doing by acknowledging the importance of the process and the action of participation. Bejerholm and Eklund (2007) describe occupational engagement as "the extent to which a person has a balanced rhythm of activity and rest, a variety and range of meaningful occupations and routines, and the ability to move around in society and interact socially" (p. 31). Similarly, Wilcock (2001) argued that being engaged in meaningful and purposeful occupations can generate feelings of wellbeing. This is reflected in reports from people who are in recovery and who claim that occupation is intimately linked to wellness (Hammel, Magasi, Heinemann, Whiteneck, Bogner, & Rodriguez, 2008; Kelly, Lamont, Brunero, 2010; Mee, Sumison & Craik, 2004). …