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Roots of recovery: Occupational therapy at the heart of health equity

Community mental health

Mental health problems can influence education, development, employment and physical health. Early intervention is vital in providing effective support and better recovery outcomes. Occupational therapists are leading in innovative mental health service design to reduce the pressure on primary care and ensure timely interventions.85

Marginalised people experience a ‘triple barrier’ regarding their mental health needs, with higher rates of mental health problems, difficulty in accessing services and a poor experience of mental health interventions. Gradients of social disadvantage correlate to much poorer mental health outcomes.

Occupational therapists are a significant part of the mental health workforce in the UK. Approximately a third of all occupational therapists are embedded in statutory mental health services across the lifespan. By focusing on social justice, lived experience, access and joining up services, meaningful change can be created.86

Being able to access local and community-focused mental health support from occupational therapists is crucial. Occupational therapists can offer bespoke mental health interventions where required, in the context of care pathways which are co-produced and co-delivered with people who use services. Barriers to meeting mental health needs such as drawn-out referral processes should be addressed with flexible access such as self-referral and advice clinics. Occupational therapists can also offer advice and consultation across wider services, shaping multi-agency and flexible services around occupational needs rather than mental health diagnosis.

Occupational therapists:

  • Are uniquely trained to address both mental and physical health working across all ages and at all stages of people’s mental health recovery.
  • Address employment and education needs - collaborating with occupational health services, employers and education providers to support and maintain good mental health.
  • Improve the physical health of people with mental health problems, incorporating and promoting healthy occupations.
  • Work with people that are underserved by health and social care services, such as those experiencing homelessness, to offer tailored mental health support.
  • Help to create services that are informed by lived experience and focused on functional benefit. This translates interventions into meaningful change in the person’s everyday life, ensuring their personal goals are achieved.
  • Work with communities to build social environments that facilitate positive relationships, confidence, and healthy routines for occupational participation.

Key components for delivery

Establish and support occupational therapists where they can:

  • Provide tailored access points to early occupational therapy intervention and advice across statutory and voluntary organisations, particularly for people facing multiple barriers.
  • Address employment needs for people with mental health problems and their employers.
  • Inform decision-makers in statutory and voluntary services at a local strategic level, to shape and focus services for greater impact.
  • Offer training in life skills for those at risk of becoming or already part of the criminal justice system.
  • Participate in local strategy and service planning to address mental health inequalities, focusing on early intervention and positive changes in everyday lives that will gain better outcomes.
  • Improve engagement, empowerment, and recovery for, and understanding of, marginalised people with mental ill health.

Return on investment

  • Improvement in mental health leads to better attendance and engagement with education, with the ongoing benefits which that brings. This tends to go hand in hand with positive lifestyle changes such as healthy eating and exercise. People who experience this are less likely to require ongoing input from GPs and long-term mental health services.87
  • Stress, anxiety and depression are responsible for almost half of working days lost in Britain each year.88 Individual therapy such as stress management offers a 3:1 return on investment. Vocational rehabilitation for people with poor mental health and support for employers increases work attendance and confidence, with resulting personal, organisational and economic benefits.89

Case study: Tackling inequalities experienced by people with Autism - Cheshire and Wirral Partnership NHS Foundation Trust

Autism is a lifelong neurodevelopmental condition. Most autistic people do not have a diagnosis, which calls for greater awareness and recognition in healthcare settings. Autistic people can present to any mental or physical health service with a co-occurring condition. Often teams do not feel confident in knowing what reasonable adjustments may be helpful in supporting a person to access or engage in an intervention.

Autistic people are more vulnerable to a range of co-occurring physical and mental health conditions yet getting the best treatment for them can be hampered by differences in communication, social interaction, and presentation as well as help-seeking behaviours, which can lead to secondary conditions and premature death.90

Awareness

Approximately 80 per cent of autistic people experience mental health problems.91 Improved recognition of autism and use of reasonable adjustments to make mental health services more accessible and effective can improve health outcomes and reduce the significant health inequalities faced by autistic people.

Action

The Autism Service at Cheshire and Wirral Partnership NHS Foundation Trust has been co-designed to provide diagnostic and post-diagnostic support to autistic people and their supporters across Cheshire and Wirral. The occupational therapist worked with autistic people, their families, colleagues and commissioners to co-design and develop a predominantly occupational therapy/psychiatry diagnostic and post-diagnostic adult autism service, recognising the importance of making every contact count within the resources available.

The service provides practical recommendations and specific strategies to improve a person’s ability and confidence to function day to day, manage their stress and their vulnerability to mental illness. The occupational therapist works with people to clearly articulate specific reasonable adjustments to reduce any distress caused through misunderstandings and misinterpretations and to support them to engage in health interventions, employment and education. These reasonable adjustments are clearly noted on a person’s electronic health record and are shared with their GP.

Advocacy

Outcomes:

  • Mental health teams in the trust report being more autism-informed in their interactions, providing a better patient experience with improved care and outcomes.
  • These experiences have been fed into national policy and practice92, supporting services across the country, ensuring that the needs of autistic people are not overlooked and health inequalities for autistic people are addressed.

References

85   Connolly D, Anderson M, Colgan M. Montgomery J, Clarke J, Kinsella M. (2018) The impact of a primary care stress management and wellbeing programme (RENEW) on occupational participation: A pilot study.  British Journal of Occupational Therapy Volume: 82 issue: 2, 112-121. Available at: https://doi.org/10.1177/0308022618793323

86.  Pinfold V (2021) The unequal mental health toll of the pandemic. London: The Health Foundation. Available at: https://www.health.org.uk/news-and-comment/blogs/the-unequal-mental-health-toll-of-the-pandemic

87.  Chamberlain E, Truman J, Scallan S, Pike A, Lyon-Maris J. (2019) Occupational therapy in primary care: exploring the role of occupational therapy from a primary care perspective. British Journal of General Practice 2019; 69 (688): 575-576 DOI: https://doi.org/10.3399/bjgp19X706517

88.  Health and Safety Executive (2019). Health and safety at work: summary statistics for Great Britain 2019. London: HSE. Available at: https://www.hse.gov.uk/statistics/overall/hssh1819.pdf

89.  Deloitte (2020) Mental health and employers: refreshing the case for investment. London: Deloitte. Available at: https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/consultancy/deloitte-uk-mental-health-and-employers.pdf

90.  Camm-Crosbie L, Bradley L, Shaw R, Baron-Cohen S Cassidy S (2019) ’People like me don't get support’: Autistic adults' experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism, Volume: 23 issue: 6, 1431-1441. Available at: 10.1177/1362361318816053

91.  Harper G (2020) Covid-19 is widening the inequalities faced by autistic people – but this is not inevitable.  London: Centre for Mental Health. Available at: https://www.centreformentalhealth.org.uk/blogs/covid-19-widening-inequalities-faced-autistic-people-not-inevitable

92. Department for Education and Department for Health and Social Care (2021) Policy paper: The national strategy for autistic children, young people and adults: 2021 to 2026. London: DfE/DHSC. Available at: https://www.gov.uk/government/publications/national-strategy-for-autistic-children-young-people-and-adults-2021-to-2026/the-national-strategy-for-autistic-children-young-people-and-adults-2021-to-2026