Developing Optimal Mental Health Teams - Dissertation Example

 Developing Optimal Mental Health Teams Introduction. In an era when both the medical needs and the medical costs of the poor and elderly seem tobe spiraling out of control, it is vital that every member of a health care team be utilized for a combined maximum of efficiency and quality. One area of particular frustration can be the extended time it can take to recover from physical injuries, or surgeries, and to return to work. This is the province of the occupational therapist, whose contributions to the well-being of the patient can make the difference between a successful return to productivity, or an indefinite period of inability to work, or even regain motor functions, which can lead to a host of other conditions – particularly those involving mental health. And so the question that this dissertation seeks to answer is to discern the existing role of occupational therapists in community mental health teams, and to identify ways in which those teams are seeking to improve the ways in which they utilize occupational therapists. Research will focus on both qualitative and quantitative analyses on the ways in which occupational therapists most optimally contribute to their community’s mental health programs. Literature Search Process. Initial research was conducted using Internet search engines. The following search terms were used on all of the search resources listed below: occupational therap*, community mental health, occupational therap* community mental health. Source: scholar.google.com Articles Found Duplicates Rejected Term #1 372 194 172 Term #2 512 406 80 Term #3 171 96 51 Source: PubMed Articles Found Duplicates Rejected Term #1 241 201 33 Term #2 489 411 51 Term #3 202 188 7 Source: OMNI (Organising Medical Networked Information) Articles Found Duplicates Rejected Term #1: 23 2 16 Term #2: 34 28 4 Term #3: 4 0 3 Source: ScHARR (School of Health and Related Research) Articles Found Duplicates Rejected Term #1: 8 5 2 Term #2: 12 9 3 Term #3: 4 3 1 Access dates were 19 January 2006 and 22 January 2006. Given the high number of articles and books found, it was important to establish some criteria for including or rejecting particular sources. Articles published before 1995 were rejected, on the basis that they were not sufficiently recent to reflect the current state of mental health care, or to reflect current trends and improvements in the occupational therapist’s role. Also, articles had to have been published in European, Commonwealth, or North American sources, since many areas outside those regions have cultural and social conditions that are too dissimilar to provide a valid context for discussion of the role of the occupational therapist. To maintain the focus of the research question, articles were also eliminated that discussed affective factors of occupational therapy as a career. Articles about interdisciplinary factors affecting mental health teams or programs were eliminated if they did not specifically mention occupational therapy as an area of consideration. I used the CASP checklist on several of the qualitative analyses that I chose; during the literature review, I will detail that process for one of the articles that I chose. Literature Review. The first section concerns patient/client concerns of the role of the occupational therapist in a community mental health program. Sumsion’s article (2005) interviewed nine occupational therapy clients in a structured setting, using a detailed questionnaire to see whether or not they perceived their overall mental health treatment as “client-centred” using template analysis. Using the CASP system, this article passed the standards for a qualitative research article. It did state the aims clearly in the introduction; the methodology was appropriate – in order to gain insight into client attitudes, detailed questioning is often necessary, particularly when the questions deal with subjective experiences. For this reason, the research design was appropriate. The recruitment strategy was also appropriate, since participants were only chosen who had significantly detailed experience of the mental health system, but were also sufficiently lucid to provide meaningful results. The study was conducted independently of the treatment facility, so the questioners had no interest in the outcome of the questions, nor did they have any existing relationship with any of the clients questioned. The questioning was permitted by the facility itself as well as by government administration. While an interview pool of 9 may be considered on the small side in this setting, there is a clear elucidation of how the themes derived from the data. The one clear finding was that having client-centred care was important to the pool of participants. While this may seem to be an obvious conclusion, it does underscore the need for emphasis on client care in a health care system that is increasingly focused on costs and efficiency. The next section focused on the Canadian Assertive Community Treatment (ACT) and similar programs designed to assist people with ongoing or one-time losses in motor skills and functionality to maximize their productivity and quality of life. Krupa and Whippey wrote a series of articles about the way this team could be of use, particularly the role of the occupational therapist as a liaison among the other members of the team, working most directly with the patient and then interfacing with other members of the team to give the best care (2002, 2003). They ended with a 2003 study concerning “daily time use” of occupational therapy patients and found that those patients still lag behind the general population in terms of “active leisure” – in other words, they spend much more time sleeping and watching television than the rest of the population; the article also concludes that occupational therapists could help these patients find more productive uses for their time, and called into question the way that occupational therapists prioritize their cases, a problem which Harries and Gilhooly (2003) also take up. In their research, they found that occupational therapists spent only about 25% of their time focusing on occupational dysfunction, but instead spent the majority of their time focusing on patients more likely to commit acts of violence. Additionally, they found that there is little consistency among occupational therapists as a group as to specific priorities as to assignment of cases, beyond managing the potentially violent. Their implication is that there are far too many clients who are not violent, but who still need considerable treatment, who are being ignored in this way. Cockburn and Trentham also study problems inherent in the prioritization of cases, with particular interest in social inequities – prioritization of cases that deny or delay care for the elderly, the poor, and minority cases. Their findings urge a more equitable method of case management that would guarantee the same level of care to a higher percentage of the population. Davis and Kutter write on a similar topic in a study focusing on improving basic life skills for homeless women in need of occupational therapy care. They write that occupational therapists can play a significant role in assistive housing programs to make sure that homeless women receive the care that they are entitled to. There is also a considerable amount of ongoing research concerning management philosophies for the future of mental health treatment, and for occupational therapy in particular. The current climate of cost control and efficiency of care mandates that, if providers want to maintain a consistent level of treatment quality and compassion, they must plan their resource and time allocations even more carefully than they had before. This need becomes even more urgent, given the fact (noted above) that clients still desire the perception that care is centered on them; that their well-being is the provider’s first priority, as opposed to a profit margin, or a statistical total. Cook (1995) writes about the particular struggles that an American occupational therapist faced in attempting to introduce an innovative outpatient system that would place clients in the workplace sooner than traditional practices had. Medical bureaucracies are among the most entrenched, at times, and any change brings not only the usual collection of egos accustomed to having done the same thing, year after year, but new specters of liability, particularly in the climate established by the Consumer Protection Act of 1987. Connolly (1995) writes about a possible way to manage costs – by mixing treatment and education of providers. His study encompassed over 5000 hours of direct care provided by students of nursing and recreational therapy to clients of occupational and other forms of therapy, and found that levels of client satisfaction did not suffer adversely as a result of the use of students in such areas of care as were seen as not compromising the quality of care. Other areas of managing the costs of occupational therapy within the context of mental health programs included the movement of many psychiatric treatments into home health care (Biala 1998); utilizing a case management philosophy when contemplating occupational therapy (Krupa 1995); using paraprofessionals to teach life skills to schizophrenics as opposed to more expensive, inpatient psychiatric treatment (Liberman 1998); and, similarly, moving psychiatric patients from traditional treatments to community involvement(Strong 1998). These last two articles found that involvement in life skills training and work in the community had a more beneficial influence on patient progress than the traditional chemical treatments had – this opens a tremendous opportunity for occupational therapists to shape a new paradigm for the way that many of the mentally challenged are viewed, in terms of their value to society. The new opportunities for occupational therapy in the arena of public health have arisen largely in an ironic fashion. Had the costs of treating many of the mentally handicapped not come to seem as a burden on the public health budget, there may not have been a push to find other ways to treat them. This dissertation seeks to build on existing literature that shows the opportunities that exist in the field of occupational therapy, with an eye toward identifying particular opportunities that show the most promise, and recommending those opportunities that will maximize patient dignity, satisfaction, and overall improvement of condition, while keeping costs at such a level to make those opportunities attractive to those in charge of managing budgetary restraints. Occupational therapy patients are not the most attractive constituency within the health care population. They do not suffer from terminal diseases, but they do suffer, often for months or even years at a time, from motor infirmities that seem incomprehensible to the main population. They often are made to appear lazy, or slow, and are often ridiculed, when they have conditions that are just as insidious, just as painful, and just as difficult to recuperate from, as those who suffer from the more well-known diseases and syndromes that rake in contributions in the millions for research and treatment. This research will identify opportunities for occupational therapy to improve the lives of patients to such a degree to more than justify itself as a study. Works Cited Biala, K. 1996. “Psychiatric home health: the newest kid on the block.” Home Care Provider, 1/4, 202-204. Cockburn L., Trentham B. 2002. “Participatory action research: integrating community occupational therapy practice and research.” Canadian Journal of Occupational Therapy, 69/1, 20-30. Connolly, P. 1995. “Transdisciplinary collaboration of academia and practice in the area of serious mental illness.” Australia/New Zealand Journal of Mental Health Nursing, 4/4, 168-180. Cook, J. 1995. “Innovation and leadership in a mental health facility.” American Journal of Occupational Therapy, 49/7, 595-606. Davis J., Kutter C. 1998. “Independent living skills and posttraumatic stress disorder in women who are homeless: implications for future practice.” American Journal of Occupational Therapy, 52/1, 39-44. Harries P., Gilhooly K. 2003. “Identifying occupational therapists’ referral priorities in community health.” Occupational Therapists Interests, 10/2, 150-164. Krupa T., Clark C. 1995. “Occupational therapists as case managers: responding to current approaches to community mental health service delivery.” Canadian Journal of Occupational Therapy, 62/1, 16-22. Krupa T., McLean H., Eastabrook S., Bonham A., Baksh L. 2003. “Daily time use as a measure of community adjustment for persons served by assertive community treatment teams.” American Journal of Occupational Therapy, 57/5, 558-565. Krupa T., Radloff-Gabriel D., Whippey E., Kirsh B. 2002. “Reflections on…occupational therapy and assertive community treatment.” Canadian Journal of Occupational Therapy, 69/3, 153-157. Liberman R, Wallace C, Blackwell G, Kopelowicz A, Vaccaro J., Mintz J. 1998. “Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia.” American Journal of Psychiatry, 155/8, 1087-1091. Strong S. 1998. “Meaningful work in supportive environments: experiences with the recovery process. American Journal of Occupational Therapy, 52/1, 31-38. Sumsion T. 2005. “Facilitating client-centred practice: insights from clients.” Canadian Journal of Occupational Therapy, 72/1, 13-20. VanLeit, B. 1996. “Managed mental health care: reflections in a time of turmoil.” American Journal of Occupational Therapy, 50/6, 428-434. Read More