The Clubhouse: An Environment Where OTs Can Support Recovery

mental health sensory processing

       Occupational therapy’s distinct value in mental health lies in the emphasis on engagement in everyday activities, with the ultimate goal “to enable participation in personally and socially meaningful occupations that support health and well-being (Krupa, Fossey, Anthony, Brown, & Pitts, 2009, p.156). There are many settings within the community-based mental health service system through which occupational therapy has the potential support individuals labeled with serious mental illness (SMI), and a setting that stands out as an excellent fit is the Clubhouse.

          “Clubhouses are intentionally formed, non-clinical, integrated therapeutic working communities composed of adults and young adults diagnosed with SMI (members) and staff who are active in all Clubhouse activities. Clubhouse membership is open to anyone who has a history of mental illness. Membership is voluntary and without time limits. Being a member means that an individual is a critical part of the community and has both shared ownership and shared responsibility for the success of the Clubhouse” (McKay, Nugent, Johnsen, Eaton, & Lidz, 2018, p.29). A key feature of the clubhouse model is the work-ordered day, which refers to the expectation that staff and members work side-by-side, and the temporal flow of the clubhouse paralleling typical business activities and hours of operation of the working community where the clubhouse is located (Stoffel, 2011).

Painted Brain occupational therapy mental health     The clubhouse model implements several basic principles which emphasize individual strengths and potential, teamwork, the belief that work and work-mediated relationships support recovery, and empowerment through choice of activity (McKay et al., 2018, p.29). Clubhouses also provide support for gaining employment in the greater community through transitional employment, supported employment, or independent employment; participating in formal education; and connecting to resources in the community for health, finances, and housing. Also, 193 clubhouses responding to a survey regarding available activities reported offering some type of health promotion programming, including education on health, nutrition, and smoking sessions, and opportunities for exercise (McKay et al., 2018).

        Research has found many benefits to clubhouse participation. A study that compared clubhouse participants to participants in a program for assertive community treatment (PACT) found that “Clubhouse participants were employed more calendar days than PACT participants, worked significantly more hours, earned more during the study, and earned more per hour each week” (McKay et al., 2018, p.36). This same study also found that clubhouse participants reported greater quality of life related to social and financial aspects, and greater self-esteem and service satisfaction than PACT participants (McKay et al., 2018).

        Benefits of clubhouse participation are also found in the areas of physical health, rehospitalization rates, and social participation. A study on a 16-week structured exercise program implemented in a clubhouse called Genesis found that participants had significant improvements in aerobic capacity and perceived mental health, as well as positive changes in the domains of social and physical functioning, physical and emotional roles, vitality, and general health (Pelletier, Nguyen, Bradley, Johnsen, & McKay, 2005). A systematic review found results from 10 published studies that suggest clubhouse participants have lower rehospitalization rates, and the authors reasoned that evidence supported by at least 6 of the included studies suggest that Clubhouse participation may be beneficial in promoting social relationships by increasing social integration and supporting social competence (McKay et al., 2018).

mental health community
Photo courtesy of Fountain House

The first clubhouse, established in New York City in 1948, was known as Fountain House, and offered its members supportive experiences in job training, arts and crafts, and recreational activities; occupational therapists were involved in Fountain House by leading workshops in fabricating small items (Stoffel, 2011). The clubhouse environment presents an ideal setting for occupational therapists to support the recovery of individuals labeled with serious mental illness due to the shared principles between the clubhouse model of psychosocial rehabilitation and the foundational theories of occupational therapy. Occupational therapy is founded on the principle that engagement in meaningful activities provides structure to an individual’s day and purpose to an individual’s life, resulting in improved physical and mental wellbeing, while the clubhouse model implements principles that emphasize structuring participation around the work-ordered day and supporting recovery through engagement in work and work-mediated relationships.

 

       The clubhouse model of psychosocial rehabilitation offers an environment in which individuals labeled with SMI can enter the community and be viewed as having individual strengths and potential to lead personally satisfying lives. Clubhouse participation has been found to be beneficial for individuals labeled with SMI through bolstering employment and educational opportunities, enhancing social participation, and connecting individuals to resources for health promotion. The clubhouse goals of helping individuals engage in meaningful work, supporting the pursuit of employment and formal education, and engaging in culturally relevant social and recreational activities are consistent with the occupational therapy domain of engagement in occupation to support overall health and well-being (Stoffel, 2011). Through innovation and client-centered practice occupational therapists can implement services in clubhouse settings to support the recovery of individuals labeled with serious mental illness and facilitate the realization that all people can be positively contributing members of society.

Sharon Vincuilla, OTR/L

Occupational Therapy Doctoral Resident

PaintedBrain.org

 

References

Krupa, T., Fossey, E., Anthony, W. A., Brown, C. & Pitts, D. B. (2009). Doing daily life: How occupational therapy can inform psychiatric rehabilitation practice. Psychiatric Rehabilitation Journal, 32(3): 155-161. Doi: 10.2975/32.3.2009.155.161

McKay, C., Nugent, K. L., Johnsen, M., Eaton, W. W., &  Lidz, C. W. (2018). A systematic review of evidence for the clubhouse model of psychosocial rehabilitation. Administrative Policy in Mental Health, 45: 28-47. https://doi.org/10.1007/s10488-016-0760-3

Pelletier, J. R., Nguyen, M., Bradley, K., Johnsen, M., & McKay, C. (2005). A study of a structured exercise program with members of an ICCD certified clubhouse: Program design, benefits, and implications for feasibility. Psychiatric Rehabilitation Journal, 29(2), 89-96. http://dx.doi.org.libproxy1.usc.edu/10.2975/29.2005.89.96

Stoffel, V. C. (2011). Psychosocial Clubhouses. In C. Brown & V. C. Stoffel (Eds.), Occupational therapy in mental health: A vision for participation (Chapter 39, pp. 559–570). Philadelphia, PA: F. A. Davis Company.

 

 

Companionship with Dogs: An Opportunity to Support Resilience in Adults Labeled with Mental Illness

IMGP0644         The status of a person’s mental health is related to how the person copes with and responds to stressful situations, and occupational therapy is an integral component in the development of coping strategies that enhance abilities to effectively manage stress. Research on resilience to stress shows that social support through quality relationships is integral to maintaining optimal physical and mental health, such that “positive social support of high quality can enhance resilience to stress, help protect against developing trauma-related psychopathology, decrease the functional consequences of trauma-induced disorders, such as post-traumatic stress disorder (PTSD), and reduce medical morbidity and mortality” (Ozbay, Johnson, Dimoulas, Morgan III, Charnay, & Southwick, 2007, p.35). For example, a study involving Vietnam veterans found that individuals with high levels of social support were 180% less likely to develop PTSD than individuals with low levels of social support, and another study discovered that patients with acute and chronic cardiac illness displayed decreased depression when they utilized active coping mechanisms, which were preceded by high levels of social support (Ozbay et al., 2007). Research on the perspectives of adults labeled with serious mental illness has also revealed that participation in valued social roles provides individuals with a sense of meaning and purpose and is associated with increased self-esteem and decreased symptoms and hospitalizations (Deegan, 2005).

oxytocin stress relief petting a dog         On a neurophysiological level, the neurotransmitter oxytocin has been investigated as a component in the regulation of social attachment and promotion of positive social interactions, and findings conclude that oxytocin is associated with reductions in anxiety and reduced secretion of stress-related hormones (Ozbay et al., 2007). Therefore, increased levels of oxytocin may contribute to increased positive social interactions and subsequently increased development of quality social support systems.

     Occupational therapy interventions that promote the development of quality social support systems may be more effective when incorporating components that facilitate increased secretion of oxytocin. One way to facilitate this may be through animal-assisted interventions, specifically interventions that incorporate dogs. Physical interaction with dogs has been found to result in increased release of oxytocin in both humans and dogs (Beetz, Uvnas-Moberg, Julius, & Kotrschal, 2012). Not only can petting a dog promote the development of the ideal internal environment necessary to prime individuals for social interaction, but that same dog can establish an external environment in which other people are drawn to interact socially with the person who is next to the dog.

social interaction dogs animal assisted therapyStudies on the benefits of human-canine interaction have found that the presence of a service dog was associated with increased friendly social attention, smiles, and conversation from others for persons who use wheelchairs (Beetz et al., 2012), dogs provided a safe topic of conversation among dog owners who frequented a local park in the UK (Robins, Sanders, & Cahill, 1991), and in a study in Western Australia, 83.3% of owners who walked their dogs reported talking with other pet owners during those walks (Wood, Giles-Corti, & Bulsara, 2005). This presents an opportunity for occupational therapy interventions for adults labeled with mental illness, specifically when goals include boosting resilience to stress through the development of increased social participation and establishment of social support networks. However, this area of intervention has only been minimally studied and rarely implemented.

      In a study involving adults labeled with mental illness who live in a Canadian community, pet-owners demonstrated higher frequency of social interaction with neighbors than non-pet owners; however, of the participants in this study only 18.6% were pet owners, which is a considerable amount lower than the 53% of the general Canadian population who own a pet (Zimolag & Krupa, 2009). When looking at the numbers of dog-owners specifically, 15% of pet owners in the study by Zimolag and Krupa (2009) lived with one dog; again, this is significantly less than the number of Americans who live with a dog, which is calculated to be 36.5% of the general population (AVMA, 2018).  Of the non-pet owners in this study, 63.2% reported a desire to live with a pet due to hopes of experiencing companionship; and the three most frequently reported motivations for living with a pet in the pet-owner group were companionship, someone to love, and stress relief (Zimolag & Krupa, 2009). There appears to be a wealth of opportunity to facilitate increased resilience to stress in adults labeled with mental illness by establishing increased social support networks through supporting companionship with dogs.

petting a dog mental health occupational therapy Painted Brain Los Angeles   Occupational therapy facilitates resilience in the population of adults labeled with mental illness through the development of coping strategies to effectively manage stress, stress is managed more effectively when individuals have higher secretion of oxytocin and increased access to positive social support systems, and companionship with dogs is associated with increased secretion of oxytocin and positive social interaction with others. A substantial proportion of adults labeled with mental illness who live in the community may desire the companionship of a dog, and supporting companionship of dogs through occupational therapy interventions presents an opportunity to increase the frequency and quality of social interactions experienced by adults labeled with mental illness, such that they can establish increased positive social support networks, increased resilience to stressful situations, and ultimately increased overall well-being.

Sharon Vincuilla, OTR/L

Occupational Therapy Doctoral Resident

PaintedBrain.org

 

References

American Veterinary Medical Association (AVMA). (2018). U.S. Pet ownership statistics [2012 U.S. Pet Ownership & Demographics Sourcebook]. Retrieved from https://www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-pet-ownership.aspx

Beetz, A., Uvnas-Moberg, K., Julius, H., & Kotrschal, K. (2012). Psychosocial and psychophysiological effects of human-animal interactions: The possible role of oxytocin.  Frontiers in Psychology, 3(234): 1-15.

Deegan, P. (2005). The importance of personal medicine: A qualitative study of resilience in people with psychiatric disabilities. Scandinavian Journal of Public Health, 33(Suppl): 29-35. doi: 10.1080/14034950510033345

Ozbay, F., Johnson, D.C., Dimoulas, E., Morgan III, C.A., Charnay, D., & Southwick, S. (2007). Social support and resilience to stress: From neurobiology to clinical practice. Psychiatry, 35-40.

Robins, D.M., Sanders, C.R., & Cahill, S.E. (1991). Dogs and their people: Pet-facilitated interaction in a public setting. Journal of Contemporary Ethnography, 20(1):3-25.

Wood, L., Giles-Corti, B., & Bulsara, M. (2005). The pet connection: Pets as a conduit for social capital. Social Science & Medicine, 61, 1159-1173.

Zimolag, U., & Krupa, T. (2009). Pet ownership as a meaningful community occupation for people with serious mental illness. American Journal of Occupational Therapy, 63, 126-137.

Sensory Over-Responsivity: An Occupational Therapy Perspective on Mental Health

Occupational therapists are concerned with the ability of individuals to participate in meaningful activities that support both physical and mental health. As a health profession with a holistic lens, occupational therapy provides a unique understanding of the interaction between an individual’s physiological framework and the external environment. This interaction may result in increased or decreased participation in meaningful activities, depending on the individual person and the resources or barriers available in the environment. One framework that provides insight into this interaction is sensory integration. Dunn (2001) proposed a model of sensory processing that conceptualizes the confluence of two continua:  individual neurological thresholds for receiving sensory information and behavioral response strategies following sensory input. Neurological thresholds range between low (e.g. requiring very little sensory input to produce a response) and high (e.g. requiring much sensory input to produce a response); behavioral response strategies range between passive and active. “An active response works to oppose the sensory response and “right” the system. In contrast, a person with a passive response will respond in agreement with his or her sensory threshold” (Pfeiffer, Brusilovskiy, Bauer, & Salzer, 2014, p. 290).

Sensory Processing Occupational Therapy Mental Health

Each individual may present with either passive or active behavioral response strategies and either low or high neurological thresholds, resulting in patterns that Dunn (2001) described using the following quadrants:

low registration (high threshold + passive behavioral response),

sensory sensitivity (low threshold + passive behavioral response),

sensation avoiding (low threshold + active behavioral response) and

sensory seeking (high threshold + active behavioral response).

Studies have shown that engagement in activities, community participation, and social support vary among persons who present with different quadrants of Dunn’s (2001) Sensory Processing Model.  In a study that explored whether extreme responses on any of the four quadrants were independently related to differences in community participation, recovery, or quality of life, results showed that “individuals with self-reported higher levels of low registration and sensory sensitivity identified significantly less participation and perceived potential for recovery than did their peers with processing patterns in typical ranges. Individuals with higher levels of self-reported sensory sensitivity also reported reduced quality of life” (Pfeiffer et al., 2014, p.292). One explanation for this hypothesizes that for self-reported low registration, a high threshold response, “activities and environments do not provide the necessary intensity or variability to enable them to sustain attention…in contrast, over attention to stimuli in the environment in individuals with self-reported sensory sensitivity, a low threshold response, interferes with their ability to participate in activities of interest” (Pfeiffer et al., 2014, p.293).

dogbabiesIndividuals who identify with passive behavioral response strategies, therefore, seem to have greater difficulty participating in external environments, especially in the community and may be at higher risk for mental health problems. Similarly, some individuals who present with low neurological thresholds may also have difficulty modulating their neurological responses to the environmental sensory stimulation to which they are exposed. One type of sensory modulation difficulty is known as sensory defensiveness or sensory over-responsivity.

“A person is sensory defensive when he or she experiences the fight/ flight reaction to a sensation that other people do not experience as harmful. Sensory defensiveness can occur in one or more or all of the sensory systems, with varying degrees of severity. Like other disorders, the symptoms of sensory defensiveness are changeable, depending on stress and other environmental factors” (Abernathy, 2010, p.211).  The experience of sensory defensiveness or over-responsivity in daily life has been described as “irritating, overwhelming, disorganizing, and distracting” (Kinnealey, Koenig, & Smith, 2011, p.320), and is associated with increased experience of mental health issues such as anxiety and depression (Kinnealey et al., 2011). Research into the experiences of adults with sensory defensiveness illustrates the pervasive effect this sensory processing and modulation style has on participation in daily life, in regard to the choices the person makes for engagement in hygiene, leisure, employment, clothing, and interpersonal interactions. For example, “if a person has tactile defensiveness, he or she may not be able to tolerate anything touching his or her face, such as a flannel or water from a shower, which would influence the person’s ability to maintain hygiene” (Abernathy, 2011, p.214).

Results from a study that explored relationships between sensory processing style, symptoms of anxiety and depression, health-related quality of life, and social participation revealed that higher rates of sensory over-responsivity were associated with increased symptoms of anxiety and depression, and decreased rates of perceived social supports (Kinnealey et al., 2011).

sensory over-responsivity anxiety depression social supportConversely, “individuals with active response patterns engage in behaviors to counteract their sensory thresholds that, likely, allow them to adapt for similar participation, potential for recovery, and quality of life when compared with their peers without these extreme sensory processing responses” (Pfeiffer et al., 2014, p.294). Studies exploring relationships between sensory processing styles and participation or health-related quality of life found that self-reported sensory seeking was associated with increased participation, recovery, empowerment, and vitality (Pfeiffer et al., 2014; Kinnealey et al., 2011).

While individuals with sensory defensiveness or over-responsivity may be at higher risk for mental health symptoms, this is not inevitable. Interventions that promote sensory self-regulation and environmental modification, as well as increasing social support, can provide a foundation for increased quality of life. Interventions for children that focus on sensory regulation using the sensory integration approach have shown positive outcomes when establishing daily and weekly routines that incorporate customized patterns of social, motor, and sensory activities, and these same approaches may be helpful for adults (Kinnealey et al., 2011).  Interventions to address sensory regulation should enable and empower individuals through developing insight into a person’s sensory processing style, while also providing guidance in developing and maintaining social support networks. With a profound understanding of sensory processing, a foundation of knowledge in both physiological and neurological functioning, as well as expertise in daily habits and routines, occupational therapists provide an integral contribution to facilitating participation in meaningful activities that support both physical and mental health.

Sharon Vincuilla, OTR/L

Occupational Therapy Doctoral Resident

PaintedBrain.org

References

Abernethy, H. (2010). The assessment and treatment of sensory defensiveness in adult mental health: A literature review. The British Journal of Occupational Therapy, 73(5), 210-218. http://dx.doi.org.libproxy2.usc.edu/10.4276/030802210X12734991664183

Dunn, W. (2001). The sensations of everyday life: Empirical, theoretical, and pragmatic considerations, 2001 Eleanor Clarke Slagle lecture. American Journal of Occupational Therapy, 55, 608–620.

Kinnealey, M., Koenig, K. P., & Smith, S. (2011). Relationships between sensory modulation and social supports and health-related quality of life. American Journal of Occupational Therapy, 65, 320–327. doi: 10.5014/ajot.2011.001370

Pfeiffer, B., Brusilovskiy, E., Bauer, J., & Salzer, M. S. (2014). Sensory processing, participation, and recovery in adults with serious mental illnesses. Psychiatric Rehabilitation Journal, 37, 289–296. https://doi.org/10.1037/ prj0000099

Meaningful Activity: A Fundamental Component of Health, Social Inclusion, and Realizing Your Full Potential

 

meaningful activity occupational therapy mental health art cart

               Over the past few weeks I have had an opportunity to lead Painted Brain groups, in various locations around Los Angeles, for adults who will benefit from increased opportunities to socialize and engage in meaningful activities that elicit creative artistic expression. While this component of my position at Painted Brain is not considered ‘occupational therapy’ due to the service not being billed as such, I still approach this work through the lens of an occupational therapist. Thus, I continuously keep at the forefront of my mind the knowledge that adults labeled with mental illness “have been characterized as being at high risk for limited participation in meaningful activities, having few opportunities for emotional fulfillment and personal growth, and experiencing social marginalization” (Edgelow & Krupa, 2011, p.267). My mind also persistently appreciates the knowledge that “human beings define their lives, cultures, values, and worth through activities” (Breines, 1995, p. 3) and that “it is the interactions of everyday life, rather than particular interventions in mental health settings that are the primary medium through which recovery occurs” (Sutton et al., 2012, p. 142).

              In approaching the task of developing an occupational therapy service at Painted Brain, I have been studying the characteristics of being labeled with mental illness, and I have been developing an understanding of how these characteristics lead to lack of participation in meaningful activity and social isolation. Historically, boundaries have persisted that exclude adults who are labeled with mental illness and prevent participation in the everyday activities that lead to community integration, important social roles, and meaningful contribution to self and others; “a well-known example of exclusion for this group has been an historic deprivation from developing their true selves and potential because of being isolated in hospitals or cloistered in homes without something meaningful to do or be…” (Townsend, 2012, p.9). This physical separation from the greater community is exaggerated by lack of opportunity for meaningful doing, holistically being, or potentially becoming anything more than a person labeled with mental illness. Even when adults who are labeled with mental illness discover a means to reside physically within their communities, “community living for some and the deinstitutionalization of supports for others in North America leaves a vulnerable, impoverished group of adults as alienated and marginalized through poverty, drug addiction, stigmatization, abuse from others, isolation from friendships, and persistent, disturbing, disruptive mental symptoms” (Townsend, 2012, p.9). This causes individuals to fall into a cycle of disengagement from meaningful activity, increased time spent in sleep and passive leisure, and decreased productivity, which altogether lead to decreased social interactions, decreased physical activity, and limited community involvement (Krupa et al., 2010).

art cart creative expression social inclusion mental healthA more important realization, however, is that this disengagement and marginalization does not only negatively affect the population of adults who are labeled with mental illness, but universally concerns the health of all of us, because social exclusion is “created by structural determinants and large scale organizational practices, not individual circumstances” (Townsend, 2012, p.14). Therefore, social and occupational justice will advance when we as a civil society “organize universal rights to affiliations that include humans, other species, and control over one’s environment…without occupational marginalization or occupational deprivation” (Townsend, 2012, p.15).

                 What unique contribution then, can I as an occupational therapist make, in addressing the occupational and social needs of adults who are labeled with mental illness? One step is to develop a community-based service that not only provides opportunity for engagement in meaningful activities, but that also facilitates realization and understanding of the benefits to overall health and wellbeing that balanced participation will provide. A step further will be to exchange knowledge and evidence with other mental health providers, organizations, and the general population regarding the significance of engagement in meaningful activities to overall health; the right of all individuals to experience dignity, health, safety, and social inclusion; and the connection between meaningful engagement and social justice.

                The occupational therapy service at Painted Brain will take on a range of forms, including having a presence in Painted Brain’s community center, and by offering a group service that facilitates participation in a variety of and balance between activities of productivity, leisure, sleep, and self-care. Sutton et al. (2012) suggest that the “task of enabling occupation involves creating space for the ‘play’ of doing, that is, to open the interplay of being and world” (p.148).  The Painted Brain community center truly enables this “play of doing” by offering a space where people can freely engage in a variety of activities, make meaning through participation in creative expression, and that supports involvement in everyday life, which as Sutton et al. (2012) advise, should be a “central focus of occupational therapy practice” (p.148). art mental health occupational therapy social inclusion

               The group occupational therapy service is designed to facilitate reflection on current levels of activity, re-imagination of the self to set goals for activity participation, and reintegration into the greater community, such that individuals may break out of their cycles of inertia and resume movement toward realizing their full potential. The focus on the degree to which a person develops balanced patterns of activity and rest, a variety and range of meaningful activities and routines, and the ability to move around in the community and interact socially will be complemented by a group format that encourages active participation, promotes social support, and enhances opportunity for sharing of ideas and experiences (Krupa et al., 2010). Despite evidence that health professionals often have difficulty engaging the general population in behavior change and health-promoting activities, research on an activity-health intervention implemented by occupational therapists with a group of adults with serious mental illness found that this approach is effective in influencing occupational balance by resulting in increased time spent in general activity and decreased time spent in sleep (Edgelow & Krupa, 2011). At Painted Brain, occupational therapy services will soon be implemented, for adults who are labeled with mental illness, to provide increased opportunities to socialize and engage in meaningful activities that elicit creative expression, promote social inclusion and full community participation, and facilitate resumed movement toward realizing one’s full potential.

 

Sharon Vincuilla, OTR, CPDT-KA

Occupational Therapy Doctoral Resident

PaintedBrain.org

 

References

Breines, E. B. (2004). Occupational therapy: Activities for practice and teaching. London: Whurr.

Bullock, A., & Bannigan, K. (2011). Effectiveness of activity-based group work in community mental health: A systematic review. American Journal of Occupational Therapy, 65, 257–266. doi: 10.5014/ajot.2011.001305

Edgelow, M., & Krupa, T. (2011). Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness. American Journal of Occupational Therapy, 65, 267–276. doi: 10.5014/ajot.2011.001313

Krupa, T., Edgelow, M., Chen, S.-P., Mieras, C., Almas, A., Perry, A., Radloff-Gabriel, D., Jackson, J. & Bransfield, M. (2010). Action over inertia: Addressing the activity-health needs of individuals with serious mental illness. Ottawa, Ontario: CAOT Publications ACE.

Sutton, D.J., Hocking, C.S., & Smythe, L.A. (2012). A phenomenological study of occupational engagement in recovery from mental illness. Canadian Journal of Occupational Therapy, 79, 142-150. doi: 10.2182/cjot.2012.79.3.3

Townsend, E.A. (2012). Boundaries and bridges to adult mental health: Critical occupational and capabilities perspectives of justice. Journal of Occupational Science, 19:1, 8-24, doi: 10.1080/14427591.2011.639723

 

Finding Meaning in Everyday Life


         With a new appreciation for the complexity of challenges faced by the population of adults with mental illness in our society, I realize that I still lack  understanding of how occupational therapy can truly influence the recovery process. With the challenges so broad and complex, my empathic nature sparks concern for others in a way that motivates me to address every challenge. However, attempting to address all challenges will most like be effective in truly improving none, and since occupational therapy is my chosen field, a master of occupation I must be. This includes understanding how mental illness unfolds within the social, material, and environmental context of a person’s everyday life.  To develop a true understand of the occupational needs of the population of adults with mental illness who are served by Painted Brain, I began reading literature that explored the process of recovery and the meaning found in everyday activities from the perspectives of adults with serious mental illness.

       Recovery is the personal and unique process of growth and development in one’s attitudes, values, feelings, roles, and skills, that ultimately leads to a satisfying and productive life, despite the catastrophic effects of mental illness (Jacob, Munro, & Taylor, 2015). Occupational therapy is concerned with enhancing one’s ability to participate in life to the fullest capacity, and thus is an intervention to facilitate the process of recovery. For each population, and for each individual, recovery and living life to the fullest has a different meaning. To take this theoretical perspective one step further, occupational therapy is concerned with the meaning derived from engaging in activities that comprise an individual’s life. This construct of meaning that is central to occupational therapy, while being abstract and vast, is what drives my passion for this field, and as I found in the literature, it is also what makes engagement in occupations integral to the quality of a person’s life.

    Several studies that I read explored the experience of meaning derived from engagement everyday activities, from the perspectives of adults with serious mental illness. I found that several consistent themes arose from the literature that painted a picture of the lived experience of life with and recovery from serious mental illness. Interestingly, the meaning and the experiences of everyday life that I was reading about are not so different from the meaning and experiences that I find in my own life, and I hope that most people will also recognize this to be true. These themes include: maintaining balance and control, social connectivity, taking care of yourself, daily routines, and feeling competent and productive.

Maintaining Balance and Control occupational therapy recovery mental illness Painted Brain

       Engagement in a variety of activities is associated with a strong sense of self, while maintaining a balance between activities, especially between productivity and rest, contributes to having control over symptoms and is associated with increased wellbeing and quality of life (Argentzell, Hakansson, & Eklund, 2012; Eklund, & Argentzell, 2016). Engagement in activities is also positively correlated with having a stronger belief that the ability to control situational outcomes resides within the individual, and the foundational components of both engagement and locus of control contribute to constructing meaning and thus the continued maintenance of self and wellbeing that are integral to the recovery process (Bejerholm & Eklund, 2007; Jacob, Munro, & Taylor, 2015).

Taking Care of Yourself

    The process of taking care of one’s mind and body contributes to a great deal of meaning and enjoyment in life. Adults with mental illness described actively pursuing activities that contribute to self-care, including engagement in leisure, healthy eating, physical exercise, treating other people well, hobbies, appreciating beauty, relaxing, and resting (Argentzell, Hakansson, & Eklund, 2012; Borg, & Davidson, 2008; Leufstadius, Erlandsoon, Bjorkman, & Eklund, 2008).

Daily Routines

    In several studies, adults with mental illness spoke of the importance of having everyday routines, and that this contributed to providing structure to the day, continued mental wellbeing, a sense of normalcy, and feelings of pride in managing an independent lifestyle (Argentzell, Hakansson, & Eklund, 2012; Borg, & Davidson, 2008; Leufstadius, Erlandsoon, Bjorkman, & Eklund, 2008). Despite the mundane nature of everyday activities, such as paying bills, cleaning a home, and grocery shopping, these tasks contribute to overall wellbeing and support the recovery process by allowing for increased engagement and increased variety of activities.

Social Connectivity

       Social connectivity encompasses feeling fellowship and support through contact with other people, being needed by others, and fulfilling expected social roles, and these experiences lead to feelings of normalcy, competency, and acceptance (Argentzell, Hakansson, & Eklund, 2012; Borg, & Davidson, 2008; Leufstadius, Erlandsoon, Bjorkman, & Eklund, 2008). mental health occupational therapy Painted Brain Los AngelesAdults with serious mental illness find opportunities for social engagement through being in public spaces, being part of a family, and by taking care of pets. Unfortunately, also included in this discussion is the exclusion felt by people with mental illness, even by friends and family (Argentzell, Hakansson, & Eklund, 2012), which is why the Painted Brain community is so vital to the continued acceptance, competence, normalcy and recovery of adults with mental illness in Los Angeles.

Feeling Competent and Productive

     Activities that contribute to productivity and competency include paid or volunteer work, learning new skills, or caring for children, relatives, and pets. Regular engagement in productive and competence-eliciting activities are important to the recovery process and overall wellbeing because they lead to acceptance by society, a sense of contributing to the greater community, and increased socialization (Argentzell, Hakansson, & Eklund, 2012; Borg, & Davidson, 2008; Jacob, Munro, & Taylor, 2015; Leufstadius, Erlandsoon, Bjorkman, & Eklund, 2008).

      The themes found in the meaning of everyday life from the perspectives of adults with serious mental illness include maintaining balance and control, social connectivity, taking care of yourself, daily routines, and feeling competent and productive. As I reflect on the meaning that I strive to find in my own life, I am humbled by recognizing that these same themes are present. Another important comparison is that these themes are areas of everyday life that can be directly addressed through occupational therapy, and that can be contributed to through participation in the Painted Brain community. Both occupational therapy and Painted Brain contribute to these themes by appreciating the individualistic nature of the recovery process, the meaning derived through engagement in everyday activities, the importance of opportunities for social engagement, and the multi-beneficial nature of engagement in a variety of productive and creative occupations. Through developing a keen understanding of the meaning underlying everyday life for adults with serious mental illness, I have found a new appreciation for the fact that as humans we have more similarities than differences. Through the pursuit of developing occupational therapy services at Painted Brain, my hope is that I can promote a similar understanding by the greater community and decrease the pervasive stigma that is currently a barrier to people with mental illness in being able to live life to the fullest. 

Sharon Vincuilla, OTR, CPDT-KA

Occupational Therapy Doctoral Resident

PaintedBrain.org

 

Argentzell, E., Hakansson, C., & Eklund, M. (2012). Experience of meaning in everyday occupations among unemployed people with severe mental illness. Scandinavian Journal of Occupational Therapy, 19(1): 49-58.

Borg, M. & Davidson, L. (2008). The nature of recovery as lived in everyday experience. Journal of Mental Health, 17(2): 129-140.

Jacob, S., Munro, I., & Taylor, B.J. (2015). Mental health recovery: Lived experience of consumers, carers, and nurses. Contemporary Nurse, 50(1): 1-13.

Leufstadius, C., Erlandsoon, L., Bjorkman, T., & Eklund, M. (2008). Meaningfulness in daily occupations among individuals with persistent mental illness. Journal of Occupational Science, 15(1): 27-35.

 

Occupational Therapy’s Unique Value in Mental Health

          As Painted Brain’s initial occupational therapy doctoral resident, my task is to develop an occupational therapy service line that coincides with Painted Brain’s mission to provide opportunities for socialization and community integration to adults with mental illness. An initial step in this endeavor involves developing a deep understanding of why occupational therapy is perfectly suited for this work, and why a community-based organization, such as Painted Brain, is perfectly situated to offer this type of service.

Occupational therapy is a holistic health service that is integral to the recovery process, due to expertise in the areas of occupational engagement and participation, activity analysis, group dynamics, neurophysiology, environmental evaluation and adaptation, and psychosocial skill development. The term ‘occupation’ refers to a variety of activities that humans engage in on a daily basis, and these activities fall into categories such as “self-care”, “leisure”, “work or productivity”, and “rest”. A person’s state of health is related to the extent which a person is able to find balance between these categories of activities, as well as to the extent that the activities provide meaning to the individual’s life and opportunity for rich social connection; likewise, the ability of the person to engage in a balanced routine of meaningful activities in society is impacted by the state of the person’s health (Bejerhold & Eklund, 2007; Edgelow & Krupa, 2011).

Evidence shows that people with mental illness are at high risk for lack of engagement in meaningful activities, exclusion from important social roles, such as employment and parenting, and restricted engagement in community participation (Edgelow & Krupa, 2011). Barriers to engagement vary widely, and not only include the experience of symptoms of mental illness and the side effects of medications prescribed to treat such illnesses, but also include external factors, such as community resources, societal stigma and discrimination, and traditional mental health service delivery models that fail to view the person in a holistic manner.

occupational therapy

          Engagement in activities involves dynamic interaction between the person, the environment, and the activity itself. Thus, occupational therapy’s holistic lens is critical to providing interventions that facilitate balance in activity engagement. For example, the characteristics of the person (i.e. values, interests, age, culture) contribute to the choices that a person makes. The environment (i.e. where a person lives geographically, socioeconomic status, urban versus rural setting) delineate the choices that are available to the person. The chosen activity will affect the outcome of the experience due to the nature of the activity, the materials involved, and the meaning that emanates from the person’s interpretation of the activity. Over time, a continued routine and balance of meaningful activities, in environments that offer opportunity for social connectivity and important social roles, contributes to a person’s sense of self and overall well-being (Bejerhold & Eklund, 2007). A study by Bejerhold and Eklund (2007) found a positive correlation between occupational engagement and quality of life, and a negative association between occupational engagement and symptoms of schizophrenia. These results confirm the construct that people who have higher participation in a variety of meaningful activities experienced higher quality of life, but also illustrates that balanced engagement in meaningful activities is integral to the recovery of persons with mental illness.

Access to occupational therapy is a key factor in facilitating engagement and participation in meaningful activities for adults with mental illness. By providing access to quality occupational therapists, on both an individual and group basis, Painted Brain is augmenting its mission to provide adults with mental illness with opportunities for socialization and community reintegration. Ultimately, Painted Brain’s occupational therapy services will help individuals prevent mental health crises, develop and maintain mental health, and recover from mental health challenges, such that they may realize their full potential as positively contributing members of society.

References

Bejerhold, U. & Eklund, M. (2007). Occupational engagement in persons with    schizophrenia: Relationships to self-related variables, psychopathology, and quality of life. American Journal of Occupational Therapy, 61, 21-32

Edgelow, M. & Krupa, T. (2011). Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness. American Journal of Occupational Therapy, 65, 267-276. doi:10.5014/ajot.2011.001313