Role of Occupational Therapy in Depression

Major Depressive Disorder is one of the most prevalent mental health disorders in this day and age. Depression is classified under the umbrella of mood disorders. The Occupational Therapist is a well-respected member of the multi-disciplinary mental health team (MDT). Occupational Therapy aims at promoting mental health through the use of meaningful, purposeful and enjoyable activities in order to maintain positive mental health, prevent mental ill health and recover from mental health challenges. As such Occupational Therapy has a distinct value in providing occupational based practice guided by expertise in occupational performance, activity analysis, work analysis and environmental analysis. Practitioners of this respected discipline encompass strong foundations in psychology, psychiatry and models of socio-emotional development, which enable achievement of holistic treatment programmes, which are personalised, beneficial and sustainable for the patient.

The World Health Organisation (WHO) 2001, advocated a public health approach to mental health. This approach emphasizes the promotion of mental health as well as the prevention of and intervention in mental health. This model provides a useful framework using a client centred approach to live a meaningful life within their community and reach their full
pre-morbid / pre-illness potential. This includes intervention in inpatient and outpatient settings.

However, as with any medical condition a thorough assessment guides intervention. Occupational therapy as a discipline takes a holistic approach to health and wellness. This simply put, means that it looks at the person as a whole. It takes both mental and physical health into account alongside independence and well-being. As such, assessment procedures are no different, and includes a detailed interview, screening activities, clinical examination and collateral information from family, friends and employers.

Payal Pawar, Occupational Therapist accurately described the following tools used to ascertain the claimant’s level of cognitive and socio-emotional functioning. However, this list is not exclusive and merely an indication of a few examples of the available testing options which I have elaborated on. This list is described as followed:

  • General Assessment of mental status using tests such as Mini-Mental State Examination, MOCA and Folstein Mini Mental Examination;
  • Assessments of cognition and affect– Allen Cognitive level Test, Beck Depression Inventory, Elder Depression Scale, and Hamilton depression Rating Scale;
  • Assessment of task performance and Assessment of occupational performance and occupational roles-Canadian Occupational Performance Measure (COPM) and Occupational Case Analysis Interview Rating Scale (OCAIRS), Keilhofners Model of Human Occupation, Assessment of Creative Ability.

According Occupational Therapist, Payal Pawar’s analysis of the role of the Occupational Therapist in treatment of Depression dated 9 June 2017, the Occupational Therapist assesses all areas of impairments. By taking a structured or unstructured interview with the patient and caretaker. The Occupational Therapist usually focuses on specific areas related to occupational therapy intervention, namely:

  1. Performance skills – cognitive, perceptual, psychological, and social. And their impact on performance in areas of occupation.
  2. Client factors and physical conditions or limitations that impact on functional behaviours and occupational performance.
  3. Identification of the roles and behaviours that are required of the individual either by society or for the achievement of his/her desired goals.
  4. Suicidal and aggressive behaviour.
  5. History of behaviour pattern.
  6. Individual’s goals, values, interests, and attitudes.
  7. Activities of daily living. 

The more commonly used methods of intervention are Lifeskills Training, Cognitive Behaviour Therapy, Group Therapy and Family therapy. 

  • Lifeskills Training

There are various skills which require assessment, education and consolidation in order to empower the client to cope with the challenges of mental illness. These skills include, but are not limited to Stress Management, Anxiety Management, Improving Self Esteem, Interpersonal Skills, Goal Setting and other topics which empower the client positively.

  • Cognitive Behavioural Therapy (CBT)-

Cognitive behavioural therapy is an evidence based psychotherapeutic approach used to positively change the way people think and behave. Occupational therapists uses CBT along with the purposeful and meaningful activities in a therapy setting.

  • Group therapy

A depressed person avoids the social interaction and may feel reluctant to meet others because of depressive ideation. Group therapy is widely used in an in-patient setting, and longterm out-patient therapy. Where the ultimate goal is one of improving social skills and providing a sense of shared autonomy and group cohesion directed towards this common goal, a group may be helpful. 

Therefore, in conclusion, it is evident that Occupational Therapy is integral in the treatment of individuals diagnosed with mental health conditions, and engagement in a well-structured treatment plan can facilitate recovery and the ability lead meaningful, purposeful, satisfying and productive lives. 

Ashnie Maharaj
Occupational Therapist
(BSc. Occupational Therapy (WITS) )
(Dip. Voc Rehab (UP) )
(Workwell Certified)
(Ergoscience Accredited)
(ABIME trained)

References-

  • Niraj Ahuja. A short textbook of psychiatry. 6th Ed.
  • Kaplan & saddock. Synopsis of psychiatry. 9th Ed.
  • Jennifer Creek. Occupational Therapy and Mental Health: Principles, skills, and practice.
  • Payal Pawar, Article dated 9 June 2017

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