OT mission: to fight occupational injustice

Whilst on my recent placement in an emerging area of practice I began to understand the term Occupational Injustice as I saw for myself the effects that being homeless and on the margins of society has on what you can and can’t do and the impact this has on health and well being.

I recently presented on this as part of a university assignment on holistic occupational therapy and so in this post I will use some of the material from that piece of work.

Firstly I would like to share a poem I found on the Shelter (2013) website that really highlights a lack of meaning and purpose in the lives of people without a fixed address because of the occupational deprivation they face which leads to occupational alienation.

Grim awakening

Morning has once again broken

And I have rudely been awoken

By roar of cars, buses and vans

Sidewalk littered with empty cans.

Another restless night passed by

Under the canopy of a wet sky.

After the pavement was my bed

Just a long, aimless day ahead

Thinking of what should be done,

Another senseless battle to be won,

And what I can and can not do

Is this nightmare really, really true?

Just a false hope at the next bend.

Oh! When will it all come to an end?

Joseph Ribicki (Shelter, 2013)

I also constructed this cycle, using the work of Hammell (2008) to show the relationship between oppression, occupation and wellbeing from a theoretical standpoint

As occupational therapists we accept there is a link between engaging in meaningful and purposeful occupation and positive health and well being, but a problem arises when we understand that access to meaningful and purposeful occupation is not universal and is in fact very challenging to many groups of people. It is my hope that the potential of  OT with the homeless is acknowledged and this becomes a growing area of practice. Being homeless is a very complex problem and presents barriers to  every activity of daily living, from the most basic of human needs such as restful occupation and eating to accessing education and employment. It is no wonder that this population experience an extremely high rate of poor mental and physical health and that substance abuse is prevalent.

I am extremely grateful to have been able to have a placement in a role emerging setting, it really broadened my horizons and made me realise that there are many groups of people and issues to address that could benefit from our skills and service away from traditional settings. I believe that pioneering for occupational justice is one of our callings as occupational therapists, and there is much work to do.

Seeing the BIG potential of occupational therapy

I can’t quite believe it is twelve months since my last post, I feel sad that I have not found the time to write more because lots has happened on my occupational therapy journey that I would like to share on here.

I have volunteered on a project that aimed to use occupational therapy to address the needs of carers, I presented at the College of Occupational Therapist’s annual conference in Glasgow, started working as clinical support on a psychiatric ward and have been on a role emerging placement working with the homeless population.

I am now in my final few months of my degree so not long until I have my OT ‘wings’… I’m just trying to work out where these wings will take me for my first post… mental health or physical health setting? Community or inpatient? National Health Service, Social services,private sector or third sector? The variety of work as an occupational therapist seems endless as more and more people and organisations become aware of occupational therapy what it REALLY is and how we can benefit society with our beliefs that people are what they do and engagement in meaningful occupation is linked to positive health and well being.

My recent six week placement working with the homeless saw my placement buddy and I going into an organisation that had never had an OT service. We gave a presentation during the first week and asked the staff what they thought OT was, we asked again at the end and it was great to see that we had transformed their perceptions and furthermore they could really see the potential of OT in this setting.

I am going to write a piece on my experiences on the placement and how it challenged my thoughts around occupational therapy practice within the traditional medical model, highlighted the relationship between oppression, occupation and well being and developed  my passion for working towards occupational justice, I feel as occupational therapists it is our duty to do so.

I’m hoping to update this blog more regularly as I approach the next stage of this journey and become a qualified occupational therapist.

Hopelessness – a barrier to recovery?

As part of my recent adventure into using social media for professional development I have become a tweeter (@LouiseHeskethOT). Yesterday a fellow tweeter (@WayofRecovery) wrote ‘Some fear that promoting hope of recovery for everyone with severe mental illness is false unrealistic and colludes with denial of illness’. I replied to this with ‘it depends how people understand recovery, as I understand it it doesn’t mean cure’.

This got me thinking about a recent placement I went on in mental health and the clients I had met who were so full of hopelessness that they will ever be able to live the life that they want to because of their mental illness. They basically had come to accept that schizophrenia/depression/anxiety/personality disorder/obsessive compulsive disorder was the card that they had been dealt in life and therefore had resigned them-self to the role of a sick person who will never be able to engage in the activities and roles that they would love to; to be employed, make new friendships, sustain a relationship, go to college, go clothes shopping, go to the gym, go to the cinema and so on.

I would argue that it is more unrealistic to fill a person experiencing mental health problems with the idea that they can’t recover than to fill them with the hope that they can, I believe that everybody has the capacity to regain at least some well-being when they access the right support.

As occupational therapists we often see clients who although may have had a medical perspective and treatment for their condition the lack of psycho-education and psycho-social support  really shows. I met a client who although had had an inpatient stay and was on medication, really lacked understanding about their illness. They told me that they relied on the information included by the drug company in the box with their tablets for information on their diagnosis. This was the same person that when I asked about employment they replied ‘I can’t work because I have a mental health condition’.

Another client who had been in services for a very long time yet was deteriorating rather than recovering told me that medical specialists had told her that they just don’t know what to do with her.

As cuts are made to health and social care budgets the criteria for receiving intervention from services such as  occupational therapy is becoming more restrictive, and due to cuts in staff waiting lists are getting longer. This means that when clients do eventually reach us there is often an absence of a positive outlook and from an OT’s perspective their roles and routines have been severely impacted upon. In a lot of cases the illness and it’s symptoms are manageable through medication yet the impact the illness has had on everything the client once valued – their job, their friends, their family, their partner, their social life is just as debilitating as the illness itself.

What is the answer? As a student on placement I had limited time with my clients but I did try to intervene the best that I could. It was basic stuff really – printing information off from websites such as Mind and NHS about the client’s condition but being selective when I did this in terms of reading the way it was worded;  if I didn’t think it would be well received by my client then going to another source and finding something more suitable. Going to mental health charity websites to find case-studies of people that do manage to live a satisfying life with a mental health condition and printing these off. On an even more basic level I told one client directly that I did believe she can recover and reflected on the things we had managed to achieve together since my placement began and how that should give her hope for the future.

My next point maybe fruitless in an economy where funding is being axed across the board. I feel that our profession needs to take a pro-active approach in addition to the re-active approach that currently exists. By this I mean earlier intervention from an occupational therapist. My dream is that every GP surgery would have an on-site OT service so when somebody goes into their surgery with symptoms of a mental health condition instead of only being given a prescription for drugs they are also referred to us where we could make a full assessment and make a decision whether OT would be of benefit. At this point I imagine some clients could be at the stage where their activities of daily living, roles and routines are at risk of being impacted upon but have not been wiped out. They could walk away filled with the knowledge there is hope, hope that this fearful illness is manageable with the right support and that life can go on.

So to go back to that tweet, in my opinion it is not the ‘hope of recovery’ that is dangerous but rather the ‘hopelessness of recovery’; the client’s belief that  that they can not achieve a life that is meaningful and satisfying to them because of mental illness can be the barrier that prevents them from doing exactly that.

The start of my journey

Whilst chatting with somebody yesterday they asked me the question ‘Why OT?’ so I thought it might be an idea to share the story of how my journey into occupational therapy began.

One morning as I was sat on a bus on the way to work one of my mum’s old friends got on and sat down next to me. During the conversation I asked how her daughter was and she told me that she was at university studying to be an occupational therapist. I had never heard of occupational therapy before and so went on to ask for more information.

Basically that little chat was the start for me, I liked what I heard and looked into it further. I started to realise that I had stumbled across the career that I had been looking for all of my life, it was a penny-drop moment. It was a while before I actually did anything about it though and a lot happened in the couple of years that followed. I had my second baby girl Daisy and then I became very unwell with postnatal depression.

It was only during my recovery that I decided I was going to take the first step towards becoming an OT.

I rang the university asking if my current qualifications would be suitable to get me on the degree and when to apply – I applied to UCAS was offered an interview and then was offered a place. I couldn’t quite believe it especially as I had no health or social care experience. What I did have though was passion and that had been ignited during that regular bus journey all those years ago.

So as people say, the longest journey begins with a single step and that first step is often the hardest one to take.

What an amazing journey it has turned out to be.

As OTs we help people say ‘I can’

♥ this short film. As OTs we can help people to say ‘I can’.

Know thyself, know thy client

So continuing on from yesterday’s theme of ancient wisdom I want to look at the idea of know thyself a little deeper and also introduce the idea know thy client and what this means in the world of occupational therapy.

I have a big birthday coming up in April and as I near my 30th I have done a lot of reflecting on the last 10 years and I have come to realise that I have so much more insight into myself than when I was 20. I feel that I know myself so much better, what makes me tick, what I value, I’m aware of my habits, what I’m good at, what I enjoy doing and where I enjoy doing it.

Oscar Wilde was quoted as saying ‘with age comes wisdom but sometimes age comes alone’ and I have to say that I agree. I don’t think insight comes as a matter of course but instead comes from a process of contemplation and self-evaluation throughout our life-course. Just as we would use assessments to get to know our clients, we should be prepared to also look at ourselves as part of our self management and emotional well-being.

Being familiar with OT models such as the Model of Human Occupation means that I now often look at my life through OT spectacles and I think that is partly why I feel I know myself quite well. I question whether I would have such understanding if I wasn’t an OT student.

Activities such as meditation and yoga have long been attributed to finding our inner being but I suppose it is different for everybody… personally I find taking time for myself away from the hustle, bustle and technology of modern life for quiet reflection does it for me whether it be a warm bath with lovely oils or a long walk.

As occupational therapists we are guided by the concept of client centred care. To provide therapy that is tailored to meet an individual’s needs you really have to know your client and help them to know them self.  Models of practice do assist this but on my last placement I found that establishing a therapeutic relationship was key. One day I accompanied a client to an appointment that she needed to attend and it was on the walk there and back that I learnt the most about her – a really informal chat in the most natural of environments.

How do you get to know thyself and know thy clients? I would love to hear.

What the Ancient Greeks taught us

After my exam yesterday I wanted to really switch off and what better way than the combination of comfy clothes, sofa and TV. I have a bit of an obsession with Ancient Greece so I got a little excited to see that Delphi: The Bellybutton of the Ancient World was on BBC 4. Delphi was the hub of the Ancient world and where people would come from afar to seek guidance from the god Apollo through the oracle at Delphi. Kings and Emperors would come to ask for their fortunes to be told – whether to invade, whether their empires will fall and so on.

As I progress further into my OT journey I find that I see the values of occupational therapy popping up all of the time (even when i’m trying to switch off from studying!) Elaborate statues and monuments in-scripted with messages from the gods were erected around Delphi and two of the most famous read know thyself and nothing in excess… how very OT of them.

It seems our philosophy can be traced back thousands of years  to the time when civilisation was born, yet it is still so relevant today.

Delphi and Athens are definitely on my travel wish list.