Profile, Practice and Perspectives of Occupational Therapists in Community Mental Health Teams in Ireland
O'Connell, Jane E., McKay, Elizabeth Anne, British Journal of Occupational Therapy
Mental health services in Ireland are undergoing major reform, structurally, strategically and operationally. This can be seen since the publication of the Mental Health Act 2001, which outlined rights for service users and the protection of people within mental health services in Ireland (Government of Ireland 2001).
A more recent Government document, A Vision for Change: Report of the Expert Group on Mental Health Policy (Department of Health and Children [DHC] 2006), outlined a framework for future mental health services in Ireland. This made many recommendations to improve mental health services, focusing specifically on the need to move towards community-based treatment, which is identified as a core element of a quality mental health service (Mental Health Commission 2006a). As a result, community mental health teams (CMHTs) should be emerging as a central component in the provision of care to those with mental health problems.
Furthermore, a recent Mental Health Commission Report found that mental health service planners and professionals were unsure of the contribution made by allied health professionals, such as occupational therapists, and found that the occupational therapy programmes that were in place were of poor quality and unbalanced in availability (Mental Health Commission 2006b). In addition, the Vision for Change report found that little is known about what happens in mental health services regarding the type and effectiveness of interventions or treatments being conducted (DHC 2006).
This research, therefore, aimed to address these uncertainties by establishing the profile, the work practices and the perspectives of occupational therapists working in CMHTs in Ireland.
Literature from 1998 to 2009 was included in the literature review and the databases searched were the Cochrane Library, OTseeker, and the bibliographic databases MEDLINE, PubMed, Embase and CINAHL. Relevant internet sites were accessed and Government publications were searched. Examples of general search terms used were 'Occupational therap*', Community*, 'Community Mental Health Team', Intervention, 'Mental Health', Outpatient, Chronic, 'Mental Disorder' and examples of key words used were 'Occupational therap*' AND ('mental health' OR psych*) AND outpatient AND community.
The most recent evidence relating to CMHTs was a Cochrane systematic review (Malone et al 2007). This examined the available evidence in relation to CMHTs working with people with severe mental illness compared with non-team community care. This systematic review acknowledged the presence of occupational therapists in CMHTs, but a breakdown of the professionals in the trials was not provided. The CMHTs in each study were involved in multidisciplinary assessments of each person, followed by regular team reviews. This systematic review found only three trials indicating some benefit in terms of acceptability of treatment, and noted the overall evidence for CMHTs to be inadequate; it stated the need for further research to determine their effectiveness. The Sainsbury Centre (1995, 1997, 2000) suggested that CMHTs were having difficulty in functioning effectively as units due to communication difficulties, conflicts about leadership and role identification.
There is also a noticeable gap in the literature of in-depth qualitative research exploring the views of occupational therapists working in CMHTs (Lloyd et al 2002) as well as a scarcity of research on occupational therapists working in CMHTs within an Irish context. Since 1998, two surveys have been completed, by Craik et al (1998) in the United Kingdom (UK) and by Lloyd et al (2002) in Australia, regarding the profile and practices of occupational therapists working in CMHTs. The methodologies informing both were appropriate in their purpose because of the lack of evidence available on all aspects of service provision. …