Functional assessment in mental health: lessons from occupational therapy

Do the management and functional outcomes of the surgically treated spinal fractures change in suicidal jumpers?

PURPOSE

The aim of the study was to determine the effect of trauma etiology on the management, functional outcomes and psychiatric characteristics of suicide jumpers and patients who accidentally fall from height.

METHODS

89 patients (48 accidental falls and 41 suicidal jumpers) who had undergone spinal surgery were included in the study. The patients were evaluated clinically and radiologically. Visual Analog Scale (VAS), Roland Morris Disability Questionnaire (RMDQ) and McGill Pain Questionnaire (MPQ) were performed for functional evaluation. BECK hopelessness scale (BHS), BECK depression inventory (BDI), and SF-36 scales were used for the psychiatric evaluation. All outcomes were compared between suicidal jumpers and accidental falls.

RESULTS

The RMDQ and ODI questionnaires stated a higher disability in the suicide jump group (p = 0.001 and p = 0.029, respectively). However, the VAS and MPQ questionnaires did not differ in significance between groups (p = 0.182 and p = 0.306, respectively). The SF-36 scale showed that physical function, role emotional, vitality and mental health subdomains were worse in the suicide jump group (p = 0.001, p = 0.029, p = 0.014 and p = 0.030, respectively). BDI scores were significantly higher in the suicide jump group while no difference was observed between the groups in terms of BSH (p = 0.017 and p = 0.940, respectively).

CONCLUSION

Psychiatric disorders are more common in patients in the suicidal jumpers. The presence of underlying psychiatric problems adversely affects the postoperative functional outcomes of patients with surgically treated spinal fractures. A multidisciplinary approach together with raising awareness in this way can improve the clinical outcomes after orthopedic treatment, even if there is physical disability.

Supports that help me to live well in the community: experiences of people living with schizophrenia

INTRODUCTION

People with schizophrenia are more likely to be hospitalised than any other psychiatric diagnosis. Occupational therapists working in mental health are often required to assess and recommend supports that will assist people with schizophrenia to live successfully in the community. There is little research exploring consumer perspectives regarding the support they find useful to stay out of the hospital. The aim of this study was to explore what supports people living with schizophrenia identify as helping them to live in the community and stay out of the hospital.

METHOD

Qualitative data were collected via semi-structured interviews with adult consumers (N = 18) diagnosed with schizophrenia. Data were thematically analysed using constant comparative analysis methods. Inductive analysis was followed by a deductive phase of analysis.

FINDINGS

Participants highlighted personal-, occupational- and environmental-focused supports. Person-focused supports addressed cognitive and psychological needs. Occupation-focused supports included assisting people to manage daily life with a mental illness; engage in social activities; and engage in meaningful activities. Environment-focused supports included access to financial security; accommodation security; and community of choice. In addition to types of support, participants highlighted the importance of quality of support including the need for flexible; timely; and non-judgemental support.

CONCLUSION

These results emphasise the multifaceted nature of support required by people living with schizophrenia to stay out of the hospital. Both type and quality of support are important. People in this study were able to clearly articulate the types and qualities of support that were important to them. Occupational therapists may benefit from greater collaboration with consumers during assessments of support needs and the development of recommendations. Further exploration of how occupational therapists identify people's multifaceted support needs is required.

The effect of occupational therapy on anxiety, depression, and psychological well-being in older adults: a single-blind randomized-controlled study

PURPOSE

To evaluate the effect of occupational therapy on anxiety, depression, and psychological well-being in older adults.

METHODS

This study is a single-blind, randomized-controlled prospective experimental study conducted with 84 older adult individuals, 41 in the intervention group and 43 in the control group, in a nursing home. Occupational therapy was applied to the patients in the intervention group, and all patients were followed for a week. In the study, data were collected using the Participant Information Form, Geriatric Anxiety Scale, Psychological Well-Being Scale, and Geriatric Depression Scale.

RESULTS

The mean age of the participants was 68 years in the intervention group and 70 years in the control group. While 65.9% of the participants in the experimental group were male, 65.1% of the control group was male. The post-test anxiety scores of the participants were lower in the intervention group than in the control group (7.0 ± 4.2 vs. 16.7 ± 10.9) (p < 0.001). The post-test psychological well-being scores of the participants were higher in the intervention group than in the control group (47.9 ± 6.8 vs. 38.4 ± 6.5) (p < 0.001). There was no statistically significant difference between the depression scores of the intervention group and the control group (6.9 ± 3.7 vs. 6.2 ± 5.4) (p = 0.468).

CONCLUSIONS

In this study, it was determined that after occupational therapy was applied to older adults, their anxiety decreased and their psychological well-being increased, while there was no statistically significant difference in their depression levels. Occupational therapy, with a focus on decreasing anxiety, is a potential approach that can improve older adults' health, psychological well-being, and coping skills.

CLINICALTRIALS

GOV ID

NCT05576558.

The Connelly House approach: occupational therapists facilitating the self-administration of medication in a psychiatric rehabilitation in-patient ward

SUMMARY

This paper explores the potential for occupational therapists (OTs) to manage medicines and support patients in an in-patient psychiatric ward to effectively and safely self-administer their medication. Connelly House is an occupational therapy-led six-bed, open psychiatric rehabilitation in-patient ward supporting people transitioning from being in-patients to living in the community. Policy, process, governance and training needs are identified and discussed. Positive feedback was received from patients and staff involved with the service development, opening the door for OTs to manage medicines and support the self-administration of medication on other psychiatric rehabilitation in-patient wards using focused occupational interventions.

Mental health consumers’ perspectives on using an occupation-focused assessment to initiate change in everyday activities

Introduction

Engagement in meaningful activities is central to recovery for people with mental health conditions. The aim of this study was to examine the utility of an occupation-focused assessment, the Daily Experiences of Pleasure, Productivity, and Restoration Profile, as a means to guide engagement in meaningful activity.

Methods

Eight consumers who were receiving services from a community-based behavioural health centre utilized the Profile to set and work towards self-identified goals. Data derived from audiotaped sessions, notes, and a focus group were analysed using an iterative content analysis process.

Results

Three themes emerged: completion of the Profile was ‘burdensome, but right on’, moving from insights gained to choosing and working towards a goal required guidance from the therapist, and insights gained from the Profile supported some changes in actions and perspectives.

Conclusion

The findings support preliminary utility of the Daily Experiences of Pleasure, Productivity, and Restoration Profile to guide engagement in meaningful activity among people living with mental health conditions. Moreover, the support and guidance of the occupational therapist is critical. Continued examination of the use of the Profile is warranted to help support occupational therapy’s role in promoting recovery for people with mental health conditions through meaningful activities.

Evaluation of executive functions and everyday life for people with severe mental illness: A systematic review

•Assessment tools have progressed from measuring specific components, to more comprehensive assessments.•Performance-based tools, has the potential to include an EF index as part of the test scoring.•Most researchers either chose short versions of the assessment tools to address the subjects' attentional capacities.•Using more than one evaluation method enabled to draw a more precise picture of the function.

Establishing an occupational therapy assessment clinic in a public mental health service: A pragmatic mixed methods evaluation of feasibility, utilisation, and impact

INTRODUCTION

Employment of occupational therapists in generic roles in public mental health services (PMHSs) constrains capacity to undertake discipline-specific activity meaning consumers may be unable to access valuable occupational therapy assessments and interventions that could promote recovery. Establishing a dedicated occupational therapy clinic has been identified as one way of improving care provided and outcomes for organisations, therapists, and consumers. To inform such developments, this paper reports evaluation of feasibility, acceptability, and sustainability of a pilot clinic established within a PMHS.

METHODS

An observational evaluation was used combining quantitative and qualitative data collected from service documents, clinic records, and in semi-structured interviews with 42 stakeholders. Quantitative data were used to describe referrals and flow through the clinic. Framework analysis of qualitative data examined the process and outcomes of referrals and enabled understanding of acceptability, perceived impact and areas for improvement.

RESULTS

Substantial ground work, particularly stakeholder engagement, and redistribution of resources enabled establishment and successful operation of an assessment clinic for 12 months. Assessments were completed for 68% of the 100 accepted referrals, with the remainder in process or unable to be completed. Stakeholders agreed that the clinic enabled clinicians' timely access to specialist assessment, improving care for consumers. Occupational therapists valued the opportunity to deploy and develop discipline-specific skills and when there was some impact on work flow of occupational therapists' 'home teams', team managers judged the investment worthwhile. Strong leadership by the discipline lead and support from team managers who enabled allocation of occupational therapists to the clinic were critical to success.

CONCLUSION

An occupational therapy assessment clinic can be established and operate successfully within a public mental health setting. Redistribution of resources supported increased efficiency and consumer access to specialist interventions that support their recovery.

Technology-Enabled Assessment of Functional Health

The maturation of pervasive computing technologies has dramatically altered the face of healthcare. With the introduction of mobile devices, body area networks, and embedded computing systems, care providers can use continuous, ecologically valid information to overcome geographic and temporal barriers and thus provide more effective and timely health assessments. In this paper, we review recent technological developments that can be harnessed to replicate, enhance, or create methods for assessment of functional performance. Enabling technologies in wearable sensors, ambient sensors, mobile technologies, and virtual reality make it possible to quantify real-time functional performance and changes in cognitive health. These technologies, their uses for functional health assessment, and their challenges for adoption are presented in this paper.