Physical and Mental Health: Bridging the Gap

My first placement was on an acute medical ward. I remember being so disappointed when I found out. “I want a mental health placement” I complained (*insert foot stamping here*), having known for many years that this was the clinical area I wanted to go into. Through all the transfers, cups of tea and washing and dressing assessments, I grumbled to myself about how I’d rather be on a mental health ward, gaining “relevant” experience. I kept telling myself that the next placement would be better. And then I was allocated an intermediate care placement.

This time, I had six weeks of chair-based exercised groups, more transfers, environmental assessments, equipment (I spent a lot of time around toilets!)  and many more cups of tea. At some point during that placement, my attitude changed, and by the end of the placement, I didn’t want to leave.

And then I had a neuro-rehab placement. My strongest memories are of using a variety of activities (from cooking/baking to Wii bowling) to address individuals’ physical, cognitive, emotional and communication difficulties. I absolutely loved it. No longer was I looking at my practice in the reductionist way of “physical versus mental health” – I was looking at the whole person, and addressing the barriers to their occupational performance.

Fast-forward to present day. I got my wish: I now work in mental health. Yet I no longer keep mental and physical health separate in my mind. In fact, as an occupational therapist working in an eating disorders service, it’s vitally important for me to be aware of the physical health needs of my patients. While other members of my team take a more active role in physical monitoring, physical health is a constant consideration in my clinical reasoning. And now I’m grateful for the experience that I, in my ignorance, dismissed as “irrelevant” early on in my education.

When I read Miles and Morley’s (2013) article, I was struck by the following point:

Occupational therapists receive pre-registration education in both physical and mental health, placing them in an ideal situation to meet the holistic needs of all individuals (Terry and Westcott 2012). As careers progress, they tend to work as either ‘physical’ or ‘mental health’ practitioners, restricting assessments and interventions to their chosen field, and possibly becoming less confident in using skills outside their field when working with individuals with complex multiple conditions. (pg. 556)

No Health for Mental Health (Department of Health, 2011) identifies the improvement of physical health for people with mental health problems as a strategic objective. And, while I’ve been known to say “I’m a mental health OT”, the reality is: I’m an OT, and my education equipped me to address both the physical and mental health needs of my patients.

At a recent band 5 role development day, we were invited to share anonymised case examples of individuals we were working with who also had physical health needs. As I listened to suggestions from others in my group about the next steps I could take, it dawned on me: I would use the same OT process and core occupational therapy skills to address whichever needs were identified. And these needs are often complex and overlapping.

Not long after, I saw Alison Clements’ poster at the College of Occupational Therapists conference about how the South West Yorkshire Partnership NHS Foundation Trust provided training to their occupational therapists (working in mental health settings) to provide equipment. She kindly agreed to host an #OTalk tweetchat about meeting the physical health needs of people with mental health problems, which will be taking place on Tuesday 11th November 2014. Check out the #OTalk blog for more details.

References

Department of Health (2011) ‘No Health Without Mental Health: a cross-government mental health outcomes strategy for people of all ages‘ (Accessed: 10/03/14)

Miles H and Morley M (2013) ‘Developing mental health occupational therapy practice to meet the needs of people with mental health problems and physical disability‘, British Journal of Occupational Therapy, 76(12), 556– 559.

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