OT assessment in mental health

Person-centred assessment of a service user’s occupations is a key part of understanding what activities may have contributed the service user’s mental health problems

Person-centred assessment also helps identify what activities will enable the person to gain empowerment in their lives, feel socially included and promote recovery. For example, having a highly stressful job may be detrimental to a person’s mental health while engaging in enjoyable leisure activities with good friends will ensure mental resilience. Occupational therapy assessment aims to gather information about a service user’s level of function in their everyday lives. This will include consideration of three main areas (Creek 2003):

• self maintenance activities which include the ways that a person attends to their immediate health needs and those of their environment including washing, dressing, cooking, cleaning, eating, managing money and paying bills, looking after the home, dealing with mail, using public transport, sleep and sex
• productivity activities which include the main way that a person feels they contribute to society including voluntary work, child rearing, caring for relatives, paid employment and attending college
• leisure activities which include everything a person does for enjoyment and relaxation including exercise, hobbies and socialising

The occupational therapy assessment will also consider the service user’s physical, cultural and social environment and how this impacts on a person’s occupations

For example if a service user lives in an isolated, deprived area with poor public transport and low levels of income, this will probably restrict their range of options to engage in social and leisure occupations. In addition, the stigmatising sociocultural environment reduces a service user’s chances to gain work or meet a partner (Hean Lim 2005).
 

Assessment of service user’s values and interests can lead to an understanding of their motivation for occupation, their everyday habits and patterns of occupation (Kielhofner 2002)

The occupational therapy assessment will also need to include present levels of functioning related to past patterns of occupation and the expectation of future patterns of occupation (Creek 2003). Information about a service user’s occupations may also be discussed with the consent of the individual, with significant others and carers to gain additional insight into the presenting situation.
 

In addition to talking with the service user, an assessment activity will be carried out where the service user carries out an everyday activity which is observed by the occupational therapist

This enables the therapist to carry out an analysis of the service user’s occupational performance, including skill and deficit areas.  Any activity is a complex interaction of a person’s physical, cognitive, intrapersonal and interpersonal skills. Occupational therapists are skilled at using activity analysis to further assess exactly how illness and disability have impacted on the service user’s ability to do (Creek 2003).
 
Occupational therapists use a range of evidence-based, standardised assessment tools which produce data to assist the service user and team members to understand how a person is managing their occupations and how this changes through occupational therapy interventions. Three commonly used assessment tools which can be used singularly or in combination:

• The Model of Human Occupation (MOHO) assessment tools e.g. Model of Human
• Occupation Screening Tool (MOHOST)The Canadian Occupational Performance Measure (COPM)
• The Assessment of Motor and Process Skills (AMPS)

Following the assessment, formulation requires that the therapist, service user, and where appropriate carers or family mutually explore and interpret what the challenges are, where they are located and what might be achieved (Creek 2003).
 

Complex challenges require analysis from a variety of perspectives and theoretical frameworks and in some cases more than one way of formulating a problem is applicable (Creek 2003)

Working with the service user and the rest of the team allows for each person’s expertise to contribute to a meaningful, multifaceted understanding. As roles for team members expand, occupational therapists in addition to offering their unique occupational assessments are also developing expertise at wider assessments that include for example general mental health and physical health (DH 2007). The therapist may formulate problems at different levels such as occupational imbalance, occupational performance deficits, activity limitations, task problems, skill deficits and environmental problems (Creek 2003).
 

Occupational therapists utilise a phenomenological, person- centred approach which recognises and validates the unique life world that each service user experiences

The assessment process should allow the service user to describe and interpret the meaning of their own unique, occupational narrative (Finlay 1999). Much occupational therapy research reflects this desire to give service users a chance to voice their experiences of mental distress  (Bryant et al 2004, Inman et al 2007, Lloyd et al 2007, Mee and Sumsion 2001, Nagle et al 2002, Nayar et al 2007).
 

References

• Bryant W, Craik C, Mckay EA (2004) Living in a glasshouse: Exploring occupational alienation. Canadian Journal of Occupational Therapy, 71(5), 282-289.
• Creek J (2003) Occupational therapy defined a s a complex intervention. London:COT
• Finlay L (1999) Applying phenomenology in research: Problems, principles and practice. British Journal of Occupational Therapy, 62(7), 299-306.
• Inman J, McGurk E, Chadwick J (2007) Is vocational rehabilitation a transition to recovery?  British Journal of Occupational Therapy, 70(2), 60-66
• Kielhofner G (2002) Model of human occupation.Theory and application,3rd edition.  Maryland: Lippincott Williams and Wilkins
• Lloyd C, Ren Wong S, Petchkovsky L (2007) Art and recovery in mental health; a qualitative investigation. British Journal of Occupational Therapy, 70 (5), 207-214.
• Mee J, Simsion T (2001) Mental health clients confirm the motivating power of occupation.  British Journal of Occupational Therapy, 64(3), 121-128.
• Nagle S, Valient Cook J, Polatajko HJ (2002) I’m doing as much as I can: Occupational choices of persons with a severe and persistent mental illness. Journal of Occupational Science, 9(2), 72-81
• Nayar S, Hocking C, Wison J (2007) An occupational perspective of migrant mental health: Indian womens adjustment to living in New Zealand.  British Journal of Occupational Therapy, 70(1), 16-23.