Occupational Therapy, Gender and Mental Health: An Inclusive Perspective?

This article offers an understanding of how the gendered nature of occupational therapy has an impact on relationships between therapist and client, qualified staff and support workers, and occupational therapy managers and workers. It analyses the development of occupational therapy from its early, mainly female and middle-class, origins and explores how the profession has struggled to define its status and role to fit structures determined by the medical profession.

The tensions that these pressures have exerted on occupational therapy's original concerns with domestic and creative activities are considered, drawing on feminist theories and sociological interpretations of gender and professional development in the context of mental health.

It is argued that in trying to meet medicine's demand for a more scientific occupational therapy as well as orientate rehabilitation to returning clients to work, occupational therapists risk, first, losing sight of their core domestic activities and traditional caring roles and, secondly, devaluing the skills and abilities of their support worker colleagues.

The article suggests that occupational therapists should claim domestic activities as central to practice and reconsider the feminine principles of caring, connectedness and the importance of relationships to produce a wholly inclusive and reflective practice.

Home Assessment Visits within the Acute Setting: a Discussion and Literature Review

The emphasis on the effective and efficient use of finite resources within acute hospitals has led to close attention being paid to the length of patients' hospital stay and the assessment of risk in facilitating timely hospital discharge. Occupational therapy home assessment visits are valued by the multidisciplinary team as a means of assessing a patient's level of function and environmental risk to ensure safe discharge from hospital.

Occupational therapists' education and training and experience mean that they are well placed to predict levels of function postdischarge and to anticipate any problems that may occur in activities of daily living. However, for patients the home assessment visit can be a stressful and bewildering experience. The short-term focus on equipment provision combined with limited postdischarge intervention may not meet patient and carer expectations or concerns with longer-term issues.

Although there is a body of evidence to support this intervention, the requirement for evidence-based practice means that there is a need for additional research around the areas of optimal timing, selection of patient groups, therapist's rationale, patient and carer perspectives and any effect that home assessments may have on readmission rates. This paper discusses the literature in relation to the practice of home assessment visits from the acute setting.

Occupational Therapy and the National Health Service, 1948–1998

Much of the history of occupational therapy is associated with the history of the National Health Service (NHS). As the nation celebrates the 50th anniversary of the founding of the NHS on 5 July 1948, it is fitting to reflect on the development of the profession over the past half century and how it has adapted to the many medical, technological, demographic and social changes.

In 1948, the profession comprised a small band of mainly middle-class women, who worked under medical direction with long-stay patients in a hospital setting. In 1998, over 18,000 occupational therapists are state-registered. Having gained degree-entry status practitioners are increasingly self-directed and research-focused, and they work in a wide range of settings with all age-groups: a profession reflecting the ideals of the NHS to provide a service from ‘the cradle to the grave’.

Community-based occupational therapy services for children: a Quebec survey on service delivery

Community-based occupational therapy (OT) services are intended to promote social integration and minimize disability. The objective of this study was to describe community-based OT services for children in the province of Quebec, Canada. Specific aims included (a) to determine the proportion of Centres Locaux de Services Communautaires (CLSCs) that provide OT services to children, (b) to describe the nature of the services offered, and (c) to identify factors that are associated with the availability of these services. Surveys were sent to all CLSCs where at least one OT was employed. The response rate was 80%. Only 12% of CLSCs offered OT services to children on a regular basis (> or = 1 day/week). Home adaptations were the most frequent service offered, whereas health promotion was rarely addressed. Perceived obstacles to servicing children included prioritization of services to the elderly, limited funding, and shortage of OTs. CLSCs in rural areas and those with a psychologist had significantly more dedicated OT time spent for services to children. The findings suggest that community-based OT services for children in Quebec are poorly developed, which may negatively impact upon timely access to specialized rehabilitation services and may increase activity limitations and family burden.

Occupational therapy practice patterns with older Swedish persons at home

This paper explores and describes occupational therapy practice patterns during two periods for 89 elderly persons living at home. Occupational therapists working in one social welfare district in Stockholm, Sweden documented and reported every occupational therapy intervention provided. The results revealed that the elderly persons who received occupational therapy services during an extended period had an age span of 30 years, with a mean age over 80 years. They had several medical problems and were living in different types of settings. Occupational therapists provided a wide range of interventions, most frequently categorised as treatment, especially related to leisure activities. Irrespective of level of care, the median of interventions per person increased or was the same over time, and 72% of the elderly persons remained at the same level of care. Enabling occupation for elderly disabled person living in their home involves constantly adjusting to the current situation since the clients' capacities, goals and environment change over time. Therefore, occupational therapists need to have a client-centred approach working in home health community services.