RA-mental-health-1-blog Occupational Therapists Addressing Mental Health in Physical Rehabilitation

Mental health is a core aspect of the individual’s functional level that must be considered throughout the occupational therapy treatment regimen. According to an article in the American Journal of Occupational Therapy entitled, “Specialized Knowledge and Skills in Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice“: 

“The foundations of occupational therapy are rooted firmly in psychiatry. The profession brings a habilitation and rehabilitation perspective to mental health services in keeping with increased emphasis on recovery and functionality directed toward participation in daily life occupations.”

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Considering this fundamental correlation between mental health and occupational therapy, we are going to cover the subject in-depth in a short blog series. This article is the first of the two-part series and it lays the foundation for the next one to come. 

Factoring Mental Health into Physical Rehabilitation

Occupational therapists (OTs) practicing in a mental health setting are not as ubiquitous as are those who treat in physical rehabilitation, yet patients’ mental health needs require the same attention regardless of where we practice. How can OTs working in physical rehabilitation incorporate mental health interventions in their treatments when this isn’t a primary diagnosis or treatment goal?

Mental health in occupational therapy is sort of a catch-22 these days: a profession whose whole-person centered philosophy naturally addresses mental health needs finds itself hard-pressed to justify medical necessity and to delineate its role as it overlaps with other social service and mental health professionals. As many insurers aren’t often keen to deeming mental health interventions in OT as medically necessary (and therefore reimbursable) unless administered in a distinct mental health setting for the treatment of a clinically diagnosed mental illness, the prime market for practicing OTs is in treating physical disabilities and injuries. OT practice in inpatient and outpatient mental health care settings is currently much less frequent, now seeing fewer OTs staffed as part of the patient care team.

Yet, it remains that patients with mental health needs (which, when left untreated, affect their functional independence) are not always admitted for care in a distinct mental health setting as this may not be their primary diagnosis or treatment concern. It may be the case that patients are, for example, being treated in physical rehabilitation for a physical injury and can have a mental health condition (officially diagnosed or not) or, in the least, present a number of psychosocial factors that influence their treatment. This, in fact, is typically the case and OTs thus address patients’ mental health issues much more regularly than may be realized.

Mental health and physical rehabilitation are actually connected in such a symbiotic, synced relationship that one inevitably affects the other over the course of treatment. We see this evidenced most clearly when we consider that each patient naturally comes from his/her own unique background and since rehab therapy is inherently interpersonal, we naturally come to observe how an individual’s personal story and their mental state affect their interactions with us and their response to therapy. This ultimately has great influence on the efficacy of our treatment interventions and on the patient’s overall experience. In this way, a patient’s state of mental health becomes as much a part of the treatment plan in physical rehab as are biomechanical assessments and interventions. As OTs, we thus inevitably find ourselves in a constant position to assure our patients’ positive therapy experiences and outcomes.

Mental Health Matters

Generally speaking, mental health is not defined by the presence of an official clinical diagnosis. The CDC defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” This definition established by the CDC parallels exactly OTs’ overall end goal for each of their patients. In this context, then, it’s easily apparent that in everyday practice, and regardless of practice setting, mental health is automatically a prime factor in our evaluation and treatment interventions.

In a most basic sense, we’ve all had the experience of seeing how our thoughts affect our actions; we’ve witnessed negative thoughts lead to negative behaviors and positive ones reciprocated in the same vein. The significance of OTs considering patients’ state of mental health lies in the effect it has on our selection of clinical interventions, how we administer them, and how effective (or ineffective) our patient care can be.

For patients beginning a physical rehab program with the comorbidity of a mental health condition (e.g., depression), their symptoms are likely to present during treatment sessions: the patient who is depressed may consistently decline participation in therapy, lacking motivation or the desire for improvement; or, he/she may cooperate with performing therapeutic activities though without genuine or interested effort, therefore preventing maximum gain from treatment. In either case, the decreased quality of participation will prevent the patient from making true progress. In some cases, a lack of quality participation can result in the patient being discharged for lack of demonstrated progress. In such cases, patients could potentially be undertreated and therefore increase their risk for injury or further functional decline.

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In another case example, a patient may exhibit a level of distrust toward others where such a distrustful or tense relationship with their therapist could prevent their quality participation in their treatment plan. Such a disposition could have been influenced by any number of personal experiences or circumstances and regardless of the limited extent of knowledge we may have regarding patient behaviors, we do know patient behaviors exist, and we can see the negative impact they can have on patient progress. Naturally then, it would behoove OTs to consider ways to address mental health and psychosocial issues in a way that produces positive outcomes for the patient.

Stay tuned to our blog to catch the second article in this series which focuses on how occupational therapists connect the mind and body.