Nise: the Heart of Madness (2016), an Interview with Roberto Berliner

A little over a year ago, I stumbled across a Brazilian film on Netflix called ‘Nise: the Heart of Madness’ (or ‘Nise: O Coração da Loucura’). It is based on the true story of Dr Nise da Silveira, a Brazillian psychiatrist who founded the occupational therapy department at Brazil’s National Psychiatric Centre. The film has won four awards, including Best Film Award at the 2015 Rio de Janeiro International Film Festival.

Roberto Berliner, who directed the film and wrote the screenplay, is also known for Herbert de Perto (2009) and Born to be Blind (2003). I caught up with Berliner, and asked him a few questions.

What can you remember about the first time you heard about Dr Nise da Silveira?

My first contact with Dr. Nise da Silveira was in the 1980’s at Circo Voador, a cultural center in Rio de Janeiro, at an event called “The Doctor’s Tea”, where she would show up once a month with her friends. The project of the film started much later, with the writings of journalist Bernardo Horta, who was Nise’s student and brother of Andre Horta, the film’s director of photography. Bernardo followed Nise closely for years when he was a part of the C.G. Jung study group, that used to happen at Nise’s house. He liked to observe her and take notes, not only of the things she said but also how she behaved. It was through those notes that I got to know Nise’s intimate moments.

You committed numerous years to telling this part of Nise’s story, and overcame many obstacles. What inspired you to make this movie?

Nise is one of those people that pushes the human race forward. She is a special person, a rebel, and the more I researched her life and talked to her collaborators, the more I knew this film had to be made.

In the history of Brazil, there are few women as important as Nise da Silveira. A feminist, a great doctor, a great humanist. A woman who battled against the system, against her status quo and with a very positive job, searched for the affection and understanding of others. She was a warrior. For a person to make a revolution in world history, she had to have a lot of courage, strength and determination. All she wanted was life, art. A woman who was able to perceive her great wealth on the fringes.

Nise had a very special history, so in the beginning I wanted to make a film about her whole life, because it was really rich and she was always going against the current.

As someone who has worked in psychiatric hospitals for many years, I sometimes forget what it is like for people to experience the environment for the first time. You spent time at the hospital that Nise worked at – the former National Psychiatric Center, currently Pedro II Psychiatric Center in Rio de Janeiro – as part of the research for your film. What did you experience and learn while you were there?

After being briefed intimately on the biography of the characters, and seeing the original artworks, the actors and I started the rehearsals in Engenho de Dentro, in the real place where the story took place, getting into the routine and feeling the energy of that place, inside the infirmaries or walking around the hospital. It was as if the artists came back to revisit their own works.

The film is a true story based on real people on the location where it all happened. Not many films have this opportunity. This gave the film an emotional charge that is very strong and positive. We were inside the hospital. In the house of “the crazy ones”, the “schizophrenics”, and the “misfits”. Our film is about them and our relationship was always truthful, respectful and insightful.

On hearing of her new role, Nise’s husband Mario remarks, “There is so much to do in this country, instead of having fun, cheering up the patient. Occupational therapy? Do you know what that is, Nise? Do you?”. This scene captures a common misconception of the occupational therapy role. What research did you and your colleagues do into occupational therapy?

We’ve talked to a lot of people that worked with Nise and with her clients in Engenho de Dentro, such as Martha Pires Ferreira and Almir Malvignier (both are also characters in the film). We also talked to the people who now run the Museum of Images from the Unconscious, Luiz Carlos Mello, Gladys Schincarios, Lula Vanderlei and Gina Ferreira, among others. All of them worked daily with Nise and had lots of stories to tell. We’ve also uncovered the medical charts from the patients who were treated by Nise and lots of notes from Nise and the rest of the staff. This was the basis for the screenplay, which has been through several iterations, with different approaches, and writers.

I first found out about this film because another occupational therapist recommended it in a Facebook group. The comments included: “This film is really inspiring, it has reminded me why I am an Occupational Therapist”, “What a fabulous film” and “What a magnificent film…. going to print some of the final comments out to help keep me grounded…. inspires me to keep strong…”  Is there anything you would like to say to occupational therapists watching your movie?

We need more people like Nise. Her story helps show that there are many ways to be happy in life and competent at work. It is not the position that money brings, nor the glory of art. All of this is fine,  but what made Nise a special person was the chance to give these people the chance to express themselves, to create, and through that artistic production, analyze, study and understand each other’s story. Nise was in the unconscious.

Finally, have you got any recommendations of resources for people who would like to find out more about the life and work of Nise da Silveira?

Here in Rio de Janeiro we have the Museum of Images of the Unconscious (Museu de Imagens do Inconsciente), founded by Nise in 1952.  Its purpose is to preserve all the artworks produced in the ateliers by Nise’s patients.

The Museum is a living center of study and research on the images and has a markedly interdisciplinary character, which allows constant exchange between clinical experience, theoretical knowledge of psychology and psychiatry, cultural anthropology, history, art, education.

The museum is not a past-oriented institution: in its ateliers, visitors create new plastic documents daily and share their experiences in living with employees, animals, students, researchers and visitors. This work allowed the emergence of artists who were soon recognized in the world of the arts. With this, its collection does not stop growing and updating itself.

They have a collection of more than 350 thousand works, the Museum has the largest and most differentiated collection of the genre in the world. It also holds the library and personal archive of its founder, Nise da Silveira, holder of the World Registry in the UNESCO Memory of the World Program.

Berliner’s film is currently available to watch on UK Netflix.

For more information about the occupational therapy profession, visit the Royal College of Occupational Therapists and World Federation of Occupational Therapists websites.


#TheOTShow: Eating sushi, building railroads and surviving the zombie apocalypse: using the new generation of board games in forensic mental health

I was recently approached about presenting at this year’s OT Show in Birmingham. My thoughts immediately darted to a new board games group I was trialling in the medium secure unit where I work. And each time I came up with a different idea, I felt the magnetic pull back to board games.

I’ve often asked myself why the idea of using board games in forensic mental health appeals to me so strongly. Is it because board games encourage you to focus your attention on something outside of yourself? That they provide a vehicle for interaction with others? The challenge or the immediacy of feedback they provide? The clarity of rules? Or because they have the potential to absorb you into a different reality, where you can experiment with different personas or ways of dealing with situations? Board games are awesome for all these reasons and more. And, even though I was an avid board gamer before trialling this group, the benefits of this group – both for assessment, and the outcomes individuals experienced – surprised me.

You can find the abstract for my session below. The presentation will take place on 22nd November 2018 11:15-12:00 at the NEC in Birmingham.

“Eating sushi, building railroads and surviving the zombie apocalypse: using the new generation of board games in forensic mental health”


Board games are experiencing a resurgence in popularity amongst adults – particularly millennials (Graham, 2016) – and the modern selection of games is constantly growing. Board games provide a way to connect with others through a shared activity, and social groups dedicated to board gaming are sprouting up across the world.

With this in mind, the medium secure unit at South London and Maudsley NHS Foundation Trust launched a twelve-week structured intervention group using engagement in modern board games both as “means” (intervention – Gray, 1998, pg. 358) and “end” (desired outcome/goal – pg. 357). Playing a different game each week, group participants (‘players’) are introduced to a range of game mechanics and types. Not only does this increase occupational understanding, but it also provides valuable opportunities for players to explore and develop their interests, skills, preferences and self efficacy.

This presentation will provide an overview of the group structure, and will include a case study highlighting outcomes from the intervention. The focus throughout the programme is on translating the occupation out of the group environment and into players’ individual contexts, and the presentation will explore practical ways to do so.

It is anticipated that this session will be of particular interest to clinicians and students working in mental health settings, however it may also be applicable to other clinical areas.


Graham, L (2016) ‘Millenials are driving the board games revival’, CNBC, 22 December [Online]. Available at: (Accessed: 14 April 2018)

Gray, J. (1998) ‘Putting occupation into practice: Occupation as ends, occupation as means’, American Journal of Occupational Therapy, 52(5), 354-364



5 Things You Should Know About Working with People with Eating Disorders

Having recently started a new role in eating disorders, and with Eating Disorders Awareness Week just around the corner, it seemed like a good time to collect my thoughts about working with people with eating disorders.


The majority of my eating disorders experience has come from working at an eating disorders day service and supporting occupational therapists working on eating disorder units (EDUs). I’ve also worked with people (men and women) with eating disorders who are not under the care of specialist services – for example, in acute inpatient mental health units, learning disability services and residential/supported accommodation.

Here are the top five lessons (in no particular order of importance) that I’ve learned so far while working with people with eating disorders:


1. Subjective experience of occupation matters.

Eating disorders affect every part of a person’s life. New occupations may emerge from the eating disorder, and the meanings of occupations can change (Elliot, 2012). People may feel guilty for engaging in enjoyable, restful or self-nurturing occupations and may avoid occupations or social situations that involve food. They might feel driven to be over-productive. And even though occupational therapists are trained in enabling people to participate in everyday activities/occupations (WFOT, 2012), we are at risk of failing to fully comprehend the challenges or meaning inherent in an individual’s occupations if we don’t take the time to fully explore them.

If there is one thing I’ve learned, it’s the importance of understanding every individual’s subjective experience of occupation. A collaborative approach to assessment is vital. Explore with people why they struggle with certain occupations or what motivates them to engage in others (even – or perhaps especially – if you see them as ‘unhealthy’ or ‘maladaptive’). Find out if challenges relate to occupational disposition (how a person feels about engaging in an occupation), occupational understanding (knowledge or understanding of methods or resources relating to an occupation), occupational performance (their ability to actually perform the occupation), or a combination of the three (Park, 2014). Having a thorough understanding of where the challenges lie and why mean you can work with the individual to develop a plan that is meaningful and relevant.

For more information on occupation/occupational therapy in eating disorders, visit the following links:


2. What you say and how you say it matters.

In my experience, you can discuss just about anything with people if you go about it the right way, but it is also very easy to (with the best intentions) say the wrong thing, especially if you are inexperienced or don’t know the person well. If you are new to eating disorders, time spent learning about helpful language is well worth the investment. Trust me.

The articles below are a good starting point, and you can also ask individuals with eating disorders or your colleagues what they think is/isn’t helpful to say. As always, it is important to get to know the individuals you are working with – what is helpful for one person may be unhelpful for another – so open conversations about language/helpful strategies are the way to go.

There’s no shortage of articles on the topic:

One of the most useful approaches I learnt was motivational interviewing. There are many books and YouTube videos on the topic, and you may also be able to find face-to-face training. Visit the following website for an introduction to the skills:

As important as language is, the most important thing is your relationship with someone and your willingness to support them. You may say the wrong thing (we all do!). Someone may prefer for you to be silent, but still want you there with them. Or you may be in a situation where you have run out of things to say, and all you can do is sit with someone. Often, your actions or tone of voice mean more than the words you use.


3. Loved ones matter.

Wherever you can, involve a person’s loved ones in their care. Even something as simple as listening to a loved one’s concerns can make a big difference. Ask who a person has in their life and how they feel about their families, partners and friends being involved in their care. Find out what support is available locally for families, partners and friends and share this information with them.

Here are a few resources:


4. Always hold onto hope.

The theme for this year’s Eating Disorders Awareness Week is ‘Early Intervention’.  I’m really excited about the results of the First Episode and Rapid Early Intervention for Eating Disorder (FREED) trial from South London and Maudsley NHS Foundation Trust that showed the benefits of speeding up eating disorders treatment, and can’t wait to see the findings from their new FREED-UP trial.

While early intervention is vitally important, the majority of my experience has been in working with people with severe and enduring eating disorders. Regardless of the severity of someone’s illness, or the extent of their prior contact with mental health services, continue to hold hope that they can get their life back and achieve their goals. Because people can and will surprise you.


5. Make sure you look after yourself. 

Eating disorders are tough. They are tough for individuals, loved ones, and care teams. And it will be tough for you. Everyday can feel like a battle between the person’s eating disorder and healthy self, and the physical risk posed by eating disorders can be frightening for everyone involved. The work requires patience, persistence, resilience and reflection.

There will be times where you feel like you are not good enough. Other times, you will feel strong emotions of anger, sadness, frustration, fear… you name it. You may even find that your own relationship with food is affected.

Working with people with eating disorders, you need to look after yourself. Use supervision and support available to you, including any staff support/supervision groups. And practice what you preach – invest time and effort into your own wellbeing and occupational balance.

For me, working with people with eating disorders has been an incredibly fascinating and rewarding experience. And I hope if you work with people with eating disorders, you will find the same!


Other useful resources:


5 accounts to follow on Twitter:


If you or someone you know are affected by eating disorders, you can contact b-eat (the eating disorders charity) via the following methods:


Telephone: (free, and open 365 days a year, 4pm-10pm)

Adult Helpline: 0808 801 0677

Youthline: 0808 801 0711


Adult (over 18):

Youthline (under 18):

Message Boards


What are the top five things you think people should know about working in the field of eating disorders? Are there any other resources you would recommend? Leave a comment below!

The Hidden Depths of Occupational Therapy in Eating Disorders – LSBU Student Conference

Following on from our presentation at the College of Occupational Therapists Eastern Region ‘Dark Side of Occupational Therapy’ study day, Mary Cowan and I met today to prepare our presentation for the London South Bank University student conference. The theme of the conference is ‘The Power of Occupation: Maintaining Professional Identity in the Face of Change‘ and it will take place at the university on Friday 3rd February 2017. We are very excited about this presentation, as it is on a topic very close to our hearts – occupation focused practice with people with eating disorders. As always, we will be using  metaphor in our presentation. This time, it will be the metaphor of an ice diver.

Click here to download a PDF of the slides

Click here to read tweets from the day


Image from

‘Eating Disorders and Occupational Therapy: the Hidden Depths’

The Step Up to Recovery programme (South London and Maudsley NHS Foundation Trust) is an occupational therapy-led intensive day service for people with long-standing eating disorders. The programme seeks to understand individuals’ subjective experience of their eating disorder and its impact on their everyday life and work with individuals towards their goals.

The service is underpinned by the assumption that “occupation is as necessary to life as food and drink” (Dunton, cited in Mandel et al., 1999, pg. 12) and that it has the power to transform lives. This presentation will explore the impact that eating disorders can have on individuals’ occupational lives, for example creating new occupations, or infusing existing occupations with illness-derived meaning (Elliot, 2012). This will include a discussion of the concept of the dark side of occupation (Twinley, 2013).

Delegates will gain an understanding of some of the challenges in remaining occupation-focused in practice, and consider foundations that enable occupational therapists to stand firm amidst constant change (Molineux, 2011).

Learning Outcomes

* Understand the power of occupation in eating disorders and its impact on health and wellbeing

* Understand the value of exploring the dark side of occupation in eating disorders

* Understand the challenges to remaining occupation-focused in practice and identify strategies to ‘stand firm’


Elliot, M.L. (2012) ‘Figured World of Eating Disorders: Occupations of Illness’, Canadian Journal of Occupational Therapy, 79(1), pp. 15-22. DOI: 10.2182/cjot.2012.79.1.3

Godfrey, N. (unpublished) ‘The Occupational Impact of Anorexia Nervosa: Altered Occupational Meaning, Motivation and Engagement’, MSc Dissertation

Lock, L. and Pepin, G. (2011) ‘Eating Disorders’ in Brown, C. and Stoffel, V. (eds) Occupational Therapy in Mental Health: a Vision for Participation. Philadelphia: FA Davis Co. pp. 123-142

Mandel, D.R., Jackson, J.M., Zemke, R., Nelson, L., Clark, F.A. (1999) Lifestyle Redesign: Implementing the Well Elderly Program. AOTA Press: Maryland

Molineux, M. (2011) ‘Standing Firm on Shifting Sands’, New Zealand Journal of Occupational Therapy, 58(1), pp. 21-28

Cowan, M. and Sorlie, C. (2016) ‘Exploring the Dark Side of Occupation’ presentation at College of Occupational Therapists Eastern Region ‘Dark Side of Occupational Therapy’ study day, 30th September 2016. Slides available at this link

Turner, A. and Alsop, A. (2015) ‘Unique Core Skills: Exploring Occupational Therapists’ Hidden Assets‘, British Journal of Occupational Therapy, 78(12), pp. 739-749. DOI: 10.1177/0308022615601443

Twinley, R. (2013) ‘The Dark Side of Occupation: a Concept for Consideration’, Australian Occupational Therapy Journal, 60(4), pp. 301-303. DOI: 10.1111/1440-1630.12026

Call for #EDAW15 Volunteers: Eating Disorders and Occupational Therapy Q&A’s

Last year, @pd2ot and I hosted an #OTalk tweetchat about occupational therapy and eating disorders for Eating Disorders Awareness Week (#EDAW14). We had 63 participants, and tweets from the chat made 659,387 impressions.

Eating Disorders Awareness Week is a chance to raise awareness and understanding of eating disorders, challenge stereotypes and stigmas and raise funds for Beat.

This year, Eating Disorders Awareness Week (#EDAW15) will run from Monday 23rd February – Sunday 1st March 2015. To coincide with this, we will be hosting another #OTalk on Tuesday 24th February.

Acknowledging the fast pace of tweetchats and challenge of fitting complex answers into 140 characters, we’re looking for volunteers with eating disorders experience (clinical or personal) to:

  1. Answer questions from last year’s chat, and any leading up to this year’s chat, to be collated on this Storify (submissions can be anomymous), and/or
  2. Be available from 8-9pm GMT on Tuesday 24th February to respond to questions on the #OTalk hashtag

If you’re interested, please leave me a comment below.

If anyone has new questions relating to occupational therapy and eating disorders, please add them in the comments below too.

Here are last year’s questions (you can also find them on the Storify, along with their answers so far):

@GeekyOT how occupation can help, where does ED sit in terms of affective or psychosis disorders (for want of a better word) #OTalk — Rachel (@OT_rach) February 18, 2014

.@GeekyOT I’d like to understand what an occupational approach to working with people with an ED looks like in practice #otalk 1/2 — Kirsty Elf Stanley (@kirstyes) February 18, 2014

It has made me think though, has working in ED changed your thoughts/feelings/perceptions of your own body in a +ve/-ve way? #OTalk — Lucie Greenham (@JeSuisLucie) February 18, 2014

12 Days of #OTalk (2014)

As 2014 draws to a close, I find myself reflecting on another fantastic year of #OTalk. One of the things I love most about #OTalk is how it brings such a diverse range of people together to talk about really varied topics. Below are some of my favourite chats of the year. While I’ve only included three tweets from each chat, the full transcripts are available on the linked blog posts.

Which 2014 chats stand out for you?


1. On the 7th of January, #OTalk gave to me: the ‘Speaking of Suffering‘ tweetchat (@BrunelOT3 and @Helen_OTUK)

This chat stands out because I was reading the book ‘Psychoanalytic Thinking in Occupational Therapy‘ at the time, co-written by Lindsey Nicholls (the host of this chat). I remember being completely immersed in the conversation.

2. On the 18th of February, #OTalk gave to me: the Occupational Therapy and Eating Disorders tweetchat (@pd2ot and @geekyOT)

This chat was significant for me because I was a few months into my first eating disorders post, and still getting to grips with many of the questions asked during the chat. As I reread the chat transcript while writing this blog post, I realise how much more I’ve learnt since then, and I look forward to taking the conversation further in the next chat about eating disorders on 24th February 2015.

3. On the 18th of March, #OTalk gave to me: theInterpersonal Skills: Intangible or Teachable?tweetchat (@bobcollinsOT and @geekyOT)

The underlying question of this chat – whether interpersonal skills can be ‘taught’ – is one that I’ve often come across. This was an interesting chat, enhanced by contributions from other professions including nursing and physiotherapy.

4. On the 25th of March, #OTalk gave to me: the ‘Social Isolation and Loneliness‘ tweetchat (@gillygorry)

I was sad to miss this chat, but found it a very engaging transcript to read as the conversation developed in many directions. As a result of reading this, social isolation and loneliness has been closer to the forefront of my thinking.

5. On the 1st of July, #OTalk gave to me: the Occupational Therapists’ Attitudes, Knowledge and Implementation of Evidence-Based Practice‘ tweetchat (@helen_otuk)

This chat led on from a presentation we gave at the College of Occupational Therapists conference in Brighton. As someone who is really interested in research and evidence-based practice, I would have found this chat interesting anyway. But seeing the evolution of discussions from the conference and out into our virtual community added an extra layer of interest for me.

6. On the 8th of July, #OTalk gave to me: the ‘Appreciating the Experience of Using Health and Social Care Services for Some Older Gay People‘ tweetchat (@rebeccatwinley and @geekyOT)

I found this chat particularly exciting because it was intended to stimulate thinking for a chapter in the 2016 edition of Occupational Therapy Without Borders book. Having seen an earlier #OTalk chat feature in Rebecca Twinley’s (2012) article on the dark side of occupation, I hope 2015 will hold more developments like this!

  7. On the 5th of August, #OTalk gave to me: the ‘Good Practice in Healthcare for Migrants‘ tweetchat (@otsinlondon and @geekyOT)

Having written my dissertation on international relocation, this is a topic that really interests me, and I loved hearing about good practice from across the world.

8. On the 26th of August, #OTalk gave to me: the ‘Service User Involvement‘ tweetchat (@pixiegirle and @geekyOT)

Many of the people who made up this chat are both occupational therapists and service users, and I loved the mix of personal and professional experiences of involvement.

9. On the 11th of November, #OTalk gave to me: the ‘Meeting the Physical Health Needs of People with Mental Health Problems‘ tweetchat (@AHP_SWYPFT, @OTLeeds and @geekyOT)

I’d been reflecting on this topic for some time, so enjoyed thinking about it with others.

10. On the 18th of November, #OTalk gave to me: the ‘Occupational Alienation‘ tweetchat (@DrWMB and @geekyOT)

What I particularly liked about this chat was that it was hosted by someone who had worked on developing the concept, and that participating in the chat helped clarify it further in my mind.

11.  On the 25th of November, #OTalk gave to me: the ‘Authentic Occupation‘ tweetchat (@OTLeeds and @geekyOT)

Through participating in this chat, I had a bit of a lightbulb moment and gained a more robust understanding of what makes an occupation ‘authentic’.

12. On the 9th December, #OTalk gave to me: the ‘Raising the Profile of Activity in Acute Mental Health‘ tweetchat (@OT_LisaB and @kirstyes)

My final placement and first post after graduating were both on female acute mental health wards. Tweets from clinicians using the Vona du Toit Model of Creative Ability (VdT MoCA) particularly caught my attention, as this is the model I used, and I’m looking forward to a chat about the VdT MoCA on March 31st 2015.

#otalk OT’s in our area concentrate on getting ppl off the wards and rehab at their homes rather than doing ward based activties — Dai Davies (@Dai2584) December 9, 2014


Thank you everyone for making #OTalk what it was in 2014. Looking forward to many more interesting chats in 2015 and beyond!

Announcement: New Role!

Before you jump to conclusions, I haven’t left my job!

I’m currently on the train back from the College of Occupational Therapists Mental Health Specialist Section (COTSS-MH) meeting in (freezing cold, but ever-beautiful) York, and will be taking over as communications officer. It’s been a really fun and informative day, and I’m looking forward to getting to grips with my new role.


I appreciate that not all my followers/readers are OTs or UK-based, so here’s some more information:

Specialist Sections are branches of the College of Occupational Therapists that provide professional direction and leadership for occupational therapists working in specialist areas of practice. They share information, network and promote good practice.


If you’re an occupational therapist or OT student and wondering if you should join COTSS-MH, see the College of Occupational Therapists website for membership benefits which include:

  • Access to a national and international network of occupational therapists working in mental health
  • An e-newsletter published three times a year which includes articles, book reviews, research development and reports
  • Regular study events – this includes the “Evidencing Excellence” COTSS-MH conference in Liverpool (19th & 20th March 2015) (hashtag #cotssmh) and an eating disorders study day a little later in the year
  • Networking access to practice based networks

Watch this space!

Following #TheOTShow from afar: mental health sessions

I love live tweeting from conferences. Not only does it help me to focus, it also makes me feel connected to other delegates – and to people reading from the comfort of their own homes. Today, I was one of those far-away people: reading tweets from the OT Show in Birmingham with my dog on my lap.

To help me keep track of the sessions I was trying to follow (several ran simultaneously), I created a Storify of the mental health-specific sessions I ‘watched’. Tweets from the following sessions are available >> at this link << (opens in new window):

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.


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.

5 Ways Physiotherapists Influenced My Practice

This week’s #OTalk is about reflecting on our own experiences of health and social care. I wrote a blog post entitled ‘When Occupational Therapy Goes Right‘ for a previous #OTalk with a similar topic a few months ago. When I revisited it today, I realised that I had neglected to reflect on my own experience of services in the post.

photo credit: Amir Kuckovic via photopin cc

I’ve used physiotherapy services for several years. Each course of treatment has been with a different physio, and I’ve experienced a variety of approaches as a result.

Two physios really stand out in my mind. The first, a specialist physio in the NHS, took time to feed back his assessment to me, explaining the anatomy and physiology behind my presenting complaint and what this could mean in terms of prognosis and self management. Although I’d been seen by several physios before, this was the first time I actually understood what was going on with my body. As my course of treatment came to an end, he explained how I could continue to increase the challenge level of my exercises over time. I still use those handouts, 3 years later.

The second physio who made an impression on me worked in private practice. Perhaps unsurprisingly, he offered me a range of treatment options. He gave me information about the evidence base and his clinical reasoning for each option, and I felt like I had a very real say in my treatment plan.  This was the first time I felt like a partner, rather than a patient. While he followed our overall plan, he adjusted his treatment each week based on my feedback.

With both physios, I valued the time they took to make sure that I was fully informed. By doing so, they moved me from being a patient who was dependent on an ‘expert’ clinician, to an empowered individual, knowing how to manage my own health and what would warrant further input from services.


So how has this influenced my practice?

These experiences were so different to others I’d had in healthcare, and they’ve made a real impression on me – so much so that I strive to foster those qualities in my own practice wherever I can.

  1. Being treated as an individual was a positive experience for me. When the physio took time to understand my unique context and adapted his treatment according to my feedback, I felt understood and treatment was more meaningful. I’ve noticed that, as a clinician, it has become increasingly important for me to be flexible in my approach, listening to my service users and working collaboratively with them to develop plans. I take time to individualise my written care plans, and make sure that each of my service users has a copy of their plan, which we review together regularly.
  2. Having opportunities to make choices in my treatment – even if they were about ‘small’ things – was valuable. Part of working collaboratively for me now includes explaining what I can offer as an occupational therapist, and discussing with individuals how they want to use their individual sessions with me.
  3. When my physio spoke about the evidence base for his practice, it gave me confidence in his professional judgment and enabled me to make decisions about my own treatment. As a result, it is really important to me that I spend time consuming current research relating to my clinical area and interventions.
  4. Rather than taking their professional knowledge for granted, and assuming that I understood (or didn’t need to know), these physios explained their clinical reasoning to me. This was an empowering experience. When I’ve attempted to replicate this in my own work – for example, by explaining some of occupational therapy’s core assumptions and theory and how this relates to the individual I’m working with – this has been received very positively. I’ve realised that this can also be valuable with colleagues, who may understand my role yet not understand the underpinning knowledge/philosophy (and why would they?).
  5. Each of my courses of physiotherapy treatment have been short-term, with significant gaps in between. I valued recommendations and resources for managing my health post-physiotherapy. This made me feel more in control and less dependent on an ‘expert’ clinician. In my own practice, it is now important to me that my service users develop skills and tools to ‘be their own occupational therapist’ when they leave my service.