Straying From Roots
Mental Health in the OT curriculum
By: Lily Harrington
I remember the day we got our first fieldwork placements. The room buzzed with excitement, everyone sharing with their peers what placement they had received. The pediatric placements beamed, while the physical rehabilitation placements exchanged high fives. Of course, there were few who were upset with their placements and asked to trade, but everyone was pretty content. The last paper was handed out, and I was yet to receive one. “I’ll speak with you after class,” my instructor said, patting the empty space on my desk. After a seemingly never-ending lecture, I followed my professor into her office, where she delivered the news that changed my OT career forever. “I’m placing you at Warren State Hospital”. My stomach dropped to my knees. I was devastated.
When I first came into OT school, I was dead set on working in peds. Every semester, when a new OT professor would ask us what context we wanted to work in, I confidently answered “pediatrics, preferably early intervention”. I aced every test thrown my way in pediatrics. I knew every infant reflex, stage of development, milestone, you name it. I spent hours creating and studying hundreds of flash cards centered around childhood development. After all, if I knew this material by heart, my transition from student to clinician would be a breeze. My second semester, we had Psychosocial Rehabilitation. I was pretty ambivalent at first. I knew this wasn’t what I wanted to do, but it was a class I had to pass. One day in lecture, we watched a video on Philadelphia State Hospital, most commonly known as Byberry. You would assume this was the moment where my passion for mental health ignitied- that the deplorable conditions and horrific stories flipped a switch in my brain to tell me to fight for the underdog- but what happened was quite the opposite. After that day, I was so shaken up by what I watched that any idea of possibly being interested in mental health disappeared. I dreaded going to that class, dreading hearing another story of maltreatment or a psychosis induced murder. Luckily for me, however, the professor barely touched on any diagnoses, let alone any OT interventions. Every other class was brimming with wonderful information, but this one fell short. I drug through the class, listening to the professor ramble about rock stars, syphilis, and other irrelevant anecdotes. The only intervention we learned was medication. The professor urged us to keep a copy of a medication list used for certain diagnoses to reference in our role as non-prescribing practitioners. When the final exam rolled around, the entire class did so poorly the administration made an exception for us to take it again. We had learned absolutely nothing about OT in mental health, which may have been the reason when I heard I’d be placed in a State Hospital, panic took hold.
If there’s anything more I’m afraid of than spiders, it’s being unprepared- And that’s exactly what I was when I walked into the 140 year old asylum. I try to blame the 30 minute crying fest during my first day commute on the poor weather conditions and recent passing of a family member, but I knew it was because I was terrified of making a fool of myself. Other students I had talked to in my after-meeting-panic that fateful fieldwork day expressed they too were worried about not knowing what to do, but felt they had some sort of general idea. I, on the other hand, walked into work knowing only that benzodiazepines treat anxiety and that penicillin was used to treat syphilis. What if my supervisor was a fan of teaching by humiliation? What if I said the wrong thing to a patient experiencing psychosis and got my head knocked off? My mind was racing with all the things I could do wrong, and I’m sure if you were placed in mental health, you were in a similar position.
Luckily for me, my supervisor was warm, understanding, and patient. I’m telling you this story for a couple of reasons. One, because I find it interesting that although OT started in mental health, it’s seen as an untraditional placement. Not once did I hear a resounding “I want to be in mental health when I graduate!” as I did with pediatrics. The stigma that surrounds mental health in everyday life seeps into the OT curriculum, and not just my own. In talking with many OT practitioners and students, I noticed a common theme of feeling deeply unprepared or not educated at all about behavioral health, which is why most shy away from it. It’s no one's dream to work with schizophrenia or the like- until it is. Second, I’m telling you this because choosing to work in mental health may be the best decision of your professional life. I know it was for me.
Being graciously shoved into Warren State was the time in my life where I actually felt comfortable in my skin as an OTA. I exuded confidence, unlimited patience, and genuinely looked forward to going to work everyday. It was there I learned that connecting with my patients and witnessing their little victories was what gave me the most amount of joy. I remember one defining moment in my fieldwork that let me know I was in the right clientele. There was a resident of the facility who spent most of her time in a psychotic state. She was unaware of her surroundings, spent most of her time speaking rapidly and incoherently, and never responded to stimuli. Everyday, no matter what state she was in, I’d say hello. Around a month into my placement, the resident was sitting outside her room as she usually did. She was speaking gibberish, but as I said hello, she took a moment to pause and say “Hello, Lily” before continuing on. Those weeks of the simple gesture of saying “hello” had made a bigger impact than I had ever realized. Many people and even staff wouldn’t have given her the time of day- but as OTs, we know the importance of a little gesture.
So even though you feel unprepared, undereducated, and absolutely terrified, mental health can be the most rewarding clientele you work with. As an advocate for mental health and OT, use your platform to spread awareness about the profession in mental health. You could create a social media post and share it with your OT student friends, or even offer to speak to a class. Your words and knowledge could be the deciding factor for a student to pursue mental health. As one of my professors once said, “mental health isn’t for everyone. Either you love it or you hate it”. Take your passion, and ignite it. There will always be pediatric OTs to go around, but you, my mental health OT, are one of a kind. Never forget that.
References
https://www.aota.org/About-Occupational-Therapy/Professionals/MH.aspx
https://covalentcareers.com/resources/mental-health-and-occupational-therapy/
