Empowerment and occupational engagement among people with psychiatric disabilities

Lived experiences: a focus group pilot study within the MentALLY project of mental healthcare among European users

BACKGROUND

Mental healthcare is an important component in societies' response to mental health problems. Although the World Health Organization highlights availability, accessibility, acceptability and quality of healthcare as important cornerstones, many Europeans lack access to mental healthcare of high quality. Qualitative studies exploring mental healthcare from the perspective of people with lived experiences would add to previous research and knowledge by enabling in-depth understanding of mental healthcare users, which may be of significance for the development of mental healthcare. Therefore, the aim of the current study was to describe experiences of mental healthcare among adult Europeans with mental health problems.

METHOD

In total, 50 participants with experiences of various mental health problems were recruited for separate focus group interviews in each country. They had experiences from both the private and public sectors, and with in- and outpatient mental healthcare. The focus group interviews (N = 7) were audio recorded, transcribed verbatim and analysed through thematic analysis. The analysis yielded five themes and 13 subthemes.

RESULTS

The theme Seeking and trying to find help contained three subthemes describing personal thresholds for seeking professional help, not knowing where to get help, and the importance of receiving help promptly. The theme Awaiting assessment and treatment contained two subthemes including feelings of being prioritized or not and feelings of being abandoned during the often-lengthy referral process. The theme Treatment: a plan with individual parts contained three subthemes consisting of demands for tailored treatment plans in combination with medications and human resources and agreement on treatment. The theme Continuous and respectful care relationship contained two subthemes describing the importance of continuous care relationships characterised by empathy and respect. The theme Suggestions for improvements contained three subthemes highlighting an urge to facilitate care contacts and to increase awareness of mental health problems and a wish to be seen as an individual with potential.

CONCLUSION

Facilitating contacts with mental healthcare, a steady contact during the referral process, tailored treatment and empathy and respect are important aspects in efforts to improve mental healthcare. Recommendations included development of collaborative practices between stakeholders in order to increase general societal awareness of mental health problems.

Understanding the meaning and use of occupational engagement: Findings from a scoping review

Introduction

It is theorized that occupational therapy practice is underpinned by the construct of occupational engagement, with a focus on examining the subjective meaning of occupation. The theoretical definition of occupational engagement presents significant challenges to its use, evaluation, and measurement within evidence-based contemporary occupational therapy practice.

Method

A scoping review was conducted to examine how occupational engagement is defined within occupational therapy literature and how occupational engagement is evaluated.

Results

Twenty-six journal articles were identified. Definitions were fragmented and inconsistent across studies. Key themes relating to definitions of occupational engagement included active involvement in occupation, finding value and meaning, balanced engagement, subjective experience of engagement, developing identity through occupation, and social and environmental interactions. Measures seeking to understand occupational engagement were varied across studies, with a consistent measure applied only in the area of mental health.

Conclusion

The lack of consistency in definitions and measurement of occupational engagement presents significant issues for occupational therapy practice and evaluation. There is a need for a common definition of occupational engagement to be applied in the literature. Outcome measures seeking to understand occupational engagement are also required; however, these rely on a clearly defined construct.

Empowerment, self and engagement in day center occupations: A longitudinal study among people with long-term mental illness

BACKGROUND

Day centers are a common form of mental health service internationally. They are aimed at enhancing occupational engagement and social relations, but there is a need to clarify the outcomes of day center programs, including the impact on important aspects of recovery such as empowerment.

AIMS

The aim of this study was to explore whether perceived empowerment changed over time among Swedish day center users and whether self-esteem, quality of life, socio-demographic data and self-reported diagnosis, type of program and level of engagement in day center occupations could predict future empowerment.

METHOD

The study involved a re-analysis of longitudinal data from 14 day centers, where measures of perceived empowerment and other individual factors were collected over a 15-month period. Non-parametric statistics were used, including Wilcoxon's signed-rank test and logistic regression analysis.

RESULTS

There were no significant changes in day center attendee empowerment scores. Self-esteem and level of engagement in day center occupations were found to be predictors of empowerment, together explaining 34% of the variation.

CONCLUSIONS

Developing empowerment in the day center context involves a complex interaction of individual, social and material factors. Potential barriers to empowerment are discussed along with considerations related to measuring empowerment as an outcome of day center programs.

Empowerment and occupation: A new perspective

Background.

The idea of empowerment permeates the occupational therapy literature yet has received little critical reflection from occupational therapy’s theorists.

Purpose.

This paper aims to explore the concept of empowerment and highlight a recent definition that resonates with occupational therapists’ core values.

Key Issues.

Empowerment is generally understood to be a process of bestowing power and giving ability to someone deficient in both. However, a new definition provides a framework for understanding how empowerment might enhance people’s capabilities.

Implications.

The World Bank’s depiction of empowerment fits well with occupational therapists’ beliefs in the importance of the ability and opportunity to “do,” providing a framework for action. This framework focuses on people’s capabilities: their freedom—or opportunity—to choose what they wish to do and to be and their ability to act on these wishes. Moreover, the World Bank’s assertion that empowered people have freedom of both choice and action suggests empowerment is a relevant concept for occupational therapists.