Jane Reynolds can’t imagine doing anything else: “I love working with people. I love hearing their stories. I love seeing how they can change their life with a bit of support.”
She makes it sound easy, but as an occupational therapist (OT) working as a community forensic mental health practitioner, Reynolds is tasked with engaging some of the hardest to reach service users: people with severe mental disorders, including severe and enduring mental illness and personality disorder, usually with a history of violent crime. “They don’t want to listen to country and western music, or dig a garden, generally,” she says.
Four years ago, Reynolds hit on the idea of a group in which clients can make films telling their own stories, delivered in partnership with the Educational Shakespeare Company, which works with offenders and marginalised people. The results – lower levels of anxiety and depression in clients and improvements in self-esteem and social functioning – have been, in her words, astounding.
Gone are the days when occupational therapy for mental health patients was all about basket weaving, says Hilary Williams, lead OT within the South London and Maudsley (SLaM) NHS foundation trust’s psychosis services, which employs around 50 OTs. Instead, their role within a multi-disciplinary team is about helping people lead lives that are as fulfilling as possible, by supporting them in different elements of their occupation: including self-care, productive roles in volunteering or education, and leisure pursuits.
“Our focus and premise is that engagement and meaningful activity is essential for good mental health,” Williams says. “The emphasis is very much around working in a collaborative way with the person using services, saying to them: what are your hopes and aspirations? What most people want to do is live as independently as possible, stay in their own homes and do things that are meaningful to them.”
While some will focus on activities they’ve done in the past, others will try new things. “What the OT will help them do is think about what it was that was really valuable and enjoyable for them, and how they can build on that as they start to think about their life outside the hospital,” Williams says.
The work of OTs in mental health has expanded hugely over the past decade, says Cheryl McMorris, acting chair of the College of Occupational Therapists’ specialist section for the field.
“It’s gone from someone [an OT] being in inpatients in the main mental health hospitals and in community services, into a lot more of the specialist areas like eating disorders, forensic services, prisons or trauma. The range has changed significantly.”
And as the focus has moved away from the idea of providing an activity designed to ameliorate symptoms – for instance someone with depression doing something with an “end product” to help overcome feelings of hopelessness – the training has changed too, says Sally Feaver, programme lead for Oxford Brookes University’s BSc and MSc in occupational therapy. “That approach translated educationally into teaching activities such as pottery or woodwork, and considering their benefits. Now the focus is on considering the person within their environment and the occupations that are important to them and that support their roles.
“For example, we would help our students understand the perspective of a young mother recovering from postnatal depression and how to help her to re-establish routines and skills that would enable her to fulfil her role.”
For Reynolds, who also runs a digital photography group for service users as part of her role with Northern Ireland’s Northern Health and Social Care Trust, an important part of the film-making sessions is the collaborative nature of the work.
“We run it like a therapeutic community so everybody is supporting everybody else,” she says. “It’s very recovery focused. That’s what occupational therapy is all about: recovering, and ensuring people can have a really good quality of life. My role is to help the guys I’m working with look at what their strengths are and help them see there’s a different way to do life.
“We get anecdotal reports back from families and carers who say ‘we’ve noticed such a difference, we get on so much better with them; we understand why they’ve behaved the way they have because they’re able to talk about it and express themselves more’.
“Some of the guys have said it’s been life-changing. That’s an amazing experience as a therapist.”