The Unnoticed & Unrecognized Mental Health OT
Research conducted in 2014 showed that 2.4% of all Occupational Therapists work in a Mental Health setting. This percentage shows a significant decline from 5.2% in 2000. Two thirds of all occupational therapists surveyed typically work in three settings including hospitals, schools, and long-term care or skilled nursing facilities.
So why is it that many OTs do not work in a Mental Health Setting?
To answer this question we have to start at the beginning.....
Occupational Therapy started as a profession when individuals with mental illness were determined a threat to society. This began in the 18th century when asylums were developed to provide a "safe" space for these individuals to live away from society. In the 1800s, the benefit of occupational engagement was understood, ADL, and IADL participation was encouraged alongside arts and crafts. Arts and crafts were used as a way of promoting learning through doing, provided a creative outlet, and served as a way to avoid boredom.
Eleanor Clarke Slagle (1870-1942) is considered to be the “mother” of occupational therapy. In 1915 Slagle opened the first occupational therapy training program. The National Society for the Promotion of Occupational Therapy (NSPOT), now called the American Occupational Therapy Association (AOTA), was founded in 1917 and the profession of Occupational Therapy was officially named in 1921.
At this time, OT challenged the medical model. OT was focused on social, economic, and biological reasons that cause dysfunction. This then lead up to World War I and up until this time, occupational therapy had been concerned primarily with the treatment of individuals with mental illness. However, this changed. Entering into World War II, Occupational therapists needed to be skilled in constructive activities such as crafts, but also ADLs.
https://youtu.be/DbCwf2CzGvw
So I again ask why do only 2.4% of Occupational Therapists work in Mental Health?
IT PAYS LESS- Actually....significantly less than other settings. Often with limited to no benefits, limited paid time off, very little sick pay, and some places do not offer short or long term disability, maternity leave etc. This especially applies if you are employed in an outpatient community based setting. The majority of Mental Health Occupational Therapist salaries currently range between $62,500 (25th percentile) to $102,000 (75th percentile) across the United States. The average pay range for a Mental Health Occupational Therapist varies little (about $39,500), which suggests that regardless of location, there are not many opportunities for increased pay or advancement, even with several years of experience (zip recruiter). Low salaries are directly correlated to low reimbursement rates from insurance companies due to MH OT's not being recognized as behavioral health professionals or skilled rehabilitation due to providing psychosocial interventions. Also, in Mental Health settings many individuals come from a low socioeconomic status including poverty and homelessness. They can not afford to pay co-pays or privately pay for OT services. This is a discussion and a SOAP box for another time.
INTIMIDATION, DANGER, FEAR, & STIGMA - Many OT practitioners themselves are biased or have a certain negative attitude when viewing mental illness. Mental health settings can be viewed as frightening, disturbing, or dangerous. Many medical professionals including OT practitioners assume that many individuals with mental illness are aggressive, behavioral, and manipulative. The misconceptions, aversions, and the intimidation is enough for many OTs to not even shadow or observe an OT within this setting. This has resulted in now many OT students not wanting to have a Fieldwork placement in a MH setting. Which is adding to the decline of OTs working in mental health.
ROLE CONFUSION- Many other disciplines poorly understand our role of OT within a Mental Health setting. Often we are referred to as "art therapy" "group therapy" or even "counselors". As mentioned above, in our professions history we were known for relieving boredom for patients. This is partly due to the lack of evidence/research behind our traditional OT interventions. Without evidence it is hard to advocate for our role within a clinical setting or even within a multidisciplinary team.
As an OT specializing in Mental Health I can personally tell you how un-comfortable it is to feel surrounded by other OTs in which I slowly voice "yeah, I work in a community based mental health OT clinic". I am learning to not be embarrassed or ashamed of my own speciality. Being a MH OT is often a under recognized and under appreciate speciality even with in OT. So I am learning that when I am surrounded by other OTs I have to be open, honest, and to advocate for my speciality. Why? Because if more OTs do not take positions within MH settings.. my speciality could disappear. I am worried that as a profession we have lost sight of our history and core values. Each OT speciality whether that is pediatrics, rehabilitation, home health, SNF/LTG/TCU... I can guarantee you that as an OT practitioner you have had to provide psychosocial interventions even within your specific setting. We know there isn't physical health without mental health. I can guess that you may not be documenting your skilled psychosocial intervention. By not documenting it, the longer we will go as a profession without having psychosocial interventions reimbursed and researched. So if there is one thing to do after reading this...speak up and document it.
We are in a pivotal time of history and if we miss the chance to advocate or speak up for our speciality as Mental Health providers we may further eradicate OT from this setting.
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