A couple of weeks ago, I was looking for motivational videos to inspire me to work on my laundry list of school assignments when I found this TED talk by therapist KC Davis. In her talk, she had shared her story about how she struggled with having the motivation to complete self-care tasks like washing the dishes, cleaning the house, and doing the laundry when she had her second child during the pandemic. When she shared her struggles online in a light-hearted TikTok, hundreds of thousands of people in her comments sections revealed that they also struggled with completing self-care. Yet in the ten years she has worked as a mental health provider and even longer as a recipient of mental health services, KC has only had one provider ask about how she was completing self-care activities, and that was at a psychiatric hospital as a teenager.
While KC doesn't reveal who this provider was during her TED talk, I had a pretty good idea of what her approach emulated once she started talked about reframing self-care tasks to fit a person's functional needs. Maybe a year ago, I would have thought KC's approach was new and innovative. Now I know that what she's describing already exists in a century-old profession called occupational therapy.
Compared to other health professions, occupational therapy is rather new. Started in the early 1900s, occupational therapists were originally reconstruction aides and started as volunteers to help the wounded soldiers during World War I. During the war, these soldiers often were in various states of shock from their injuries or listless as they waited for their wounds to heal in hospital beds for days. Influenced by the arts and crafts movement and the moral treatment movement, some of the reconstruction aides developed a care program based on the philosophy that actively involving patients in arts and crafts activities could heal the mind and body. Using this philosophy, the reconstruction aides engaged the wounded soldiers in crafts like crochet or basket weaving. With these techniques, the reconstruction aides were able to boost morale and ease tensions in the medical ward. Eventually training programs were developed internationally as more and more reconstruction aides were mobilized throughout the war effort. After the war was over, these reconstruction aides would be moved to mental health facilities, tuberculosis sanatoriums, and community setting workshops like the Hull House where the practice would continue to evolve and grow.
(Picture: Young girl sitting on the floor of an exercise play room with a female OT while smiling at the camera and playing with giant Lego blocks that are red, blue, green, and yellow)
Today, occupational therapy looks very different from how it began. OT providers can be found in a variety of settings such as hospitals, skilled nursing facilities, and early intervention. The activities that OT providers work on are not just arts and crafts but also activities related to school, work, sleep, and other activities of daily living. But the principles behind the profession are largely the same. When someone asks me what occupational therapy is, I tell them that it's a profession that helps people participate in the meaningful activities they do every day by taking into consideration the person's abilities, environment, and activity demands. Within mental health, that could mean that an OT working with a mother going through decision fatigue could collaborate on simplifying her home environment or creating a pre-determined plan for self-care tasks so that she didn't spend her limited free time thinking about what she should do next.
So if occupational therapy started in mental health, how come no one seems to know about mental health OT? Part of the issue is the lack of knowledge of occupational therapy services. In most settings, because occupational therapy has such a wide scope with seemingly different responsibilities in different settings, most people are not aware of the OT's role in healthcare teams. Another issue is that occupational therapists have been excluded from behavioral health as service delivery and payment models have changed. Based on the 2010 Workforce Study conducted by AOTA, only 2.9% of occupational therapists were working in mental health settings. Because of the lack of reimbursement from insurance companies, OT providers have seen fewer opportunities to provide services to those with mental and behavioral health challenges.
If this is the case, what can be done? One way you could help spread the word about mental health OT is by building support for the Occupational Therapy Mental Health Parity Act (S. 4712). The aim of this bill is to remove barriers to providing OT services for those with a mental health diagnosis by expanding access for those covered under Medicare or Medicaid. While Medicare and Medicaid already cover mental health OT services, this benefit has been underutilized for years given the lack of knowledge of OT's role in mental health. By contacting your legislators and asking them to support this bill, thousands of Americans who are struggling with having the motivation to complete self-care tasks can have access to a provider who knows how to help.
With that, I'll get back to work on my laundry list of assignments.
For more information, the American Occupational Therapy Association (AOTA) has further information about this bill and mental health OT in general in the links below:
Increasing Access to OT Services in Behavioral Health | AOTA
Mental health and well-being | AOTA
Occupational Therapy in Mental and Behavioral Health (aota.org)
A TEDx Talk by mental health OT Jill Martin about what is mental health OT:
The hidden magic of Occupational Therapy | Jill Martin | TEDxYouth@Haileybury - YouTube
References:
Workforce-trends-in-OT.PDF (aota.org)
What is Struggle Care? — KC Davis
