Can a 22‐year‐old document hold the key to occupational therapy in mental health?

The factors influencing how allied health professionals are educated and the environments and systems in which these professionals work are in a constant state of change and disruption. Innovations in pedagogy (Nicola-Richmond et al., 2018), increased use of simulated learning environments (Imms et al., 2018), and the impact of COVID-19 on the education (Gustafsson, 2020) combined with health reforms and significant government initiatives like the Royal Commission into Aged Care Quality and Safety (Commonwealth of Australia, 2021), the ongoing Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, the Royal Commission into Victoria's Mental Health System (State of Victoria, 2021), and its related work focussing on workforce development strategies create opportunities and challenges for a discipline like occupational therapy.

An area that is gaining significant interest and momentum in the field of mental health and directly related to workforce development is the credentialling of health professionals to support best practice and ensure best health outcomes for people with a mental illness. Credentialling is defined as “a process used to verify the qualifications and experience of a clinician to determine their ability to provide safe, high quality health care services within a specific health are setting and role” (Australian Commission on Safety and Quality in Health Care, 2019). As such, credentialling can lead to positive outcomes for clients who will have access to services that are safe and of high quality delivered by competent and appropriately trained health professionals. However, credentialling can be an intricate process.

Eating disorders is one of many examples illustrating the complexity of credentialling. Eating disorders is an area of mental health practice where occupational therapists are outnumbered by more dominant professions like psychiatry and psychology. The complexity increases when the language used, like psychological intervention or psychological treatment, seems to focus on a specific discipline. The new eating disorder items included in the Medicare Benefits Schedule include occupational therapists as mental health professionals able to provide treatment to people with an eating disorder. Although this is undeniably an important advancement for our profession, all items are specifically about psychological treatment.

The National Eating Disorders Collaboration (NEDC) has been leading a nationwide credentialling project in collaboration with the Australia and New Zealand Academy of Eating Disorders (ANZAED) (NEDC, n.d.). The NEDC engaged with Occupational Therapy Australia (OTA) to ensure occupational therapists were included in this project. The NEDC sought and considered feedback from OTA to ensure the profession was represented as truthfully as possible. This means considering occupational therapists' ability to provide psychological treatment and to identify the impact of eating disorders on a person's daily life, ability to develop life skills, and engage in meaningful and important occupations. Collaborations like the one between the NEDC and OTA are essential to advocate for the unique occupation-based contribution occupational therapists make to eating disorder services while informing future professional development activities. It is critical for occupational therapists to engage in such strategic conversations because recovery from an eating disorder, or from any other mental health related challenges, does not happen in one professional's office only. Recovery happens in the real world. It happens at home, at school, in shops, neighbourhoods, and the community. It is in these contexts and environments that occupational therapist can best identify strengths, support skill development, and adjust environmental factors to promote occupational performance and participation.

In other areas of mental health and in line with the underpinnings of credentialling, the National Mental Health Workforce Strategy Taskforce, established in 2020 to lead the development of a 10-year National Mental Health Workforce Strategy, has identified issues in determining the competency required by the mental health workforce and associated regulatory mechanisms (Australian Government Department of Health, 2020). The issue of competency, and to some extent the legitimacy to be an integral part of the mental health workforce, is not limited to occupational therapy but suggests a thorough examination of the role of occupational therapists in mental health settings, how it is perceived by others, and how and where it is promoted.

When searching databases, websites, and published literature, several positive signs for mental health occupational therapy practice could be identified. The advocacy and representation of OTA on different mental health forum like the Medicare Benefits Schedule reviews for mental health and for eating disorders, the invitation to appear at the House of Representative Select Committee on Mental Health and Suicide Prevention, and the submission to the Royal Commission into Victoria's Mental Health System are just a few examples of these positive signs. Another positive sign comes from the Victorian Mental Illness Awareness Council in the form of The Declaration (VMIAC, 2021), a consumer-led collective vision about what should replace the current mental health system, that clearly includes occupational therapists. A 21.1% growth in the number of occupational therapists working in mental health reported by the Department of Health (2017) is also encouraging. Despite this growth, the challenges associated with poor career progression and limited recognition cannot be ignored.

This poses the following questions. If occupational therapy has such deep roots in mental health (Stoffel et al., 2019), why are we still justifying our presence as an active and valued member of the mental health multidisciplinary team? Is there a “problem” with mental health occupational therapy?

Could an answer to the challenges of credentialling, recognition of the unique occupation-based contribution of occupational therapists working in mental health, and advancement of our discipline in this area of practice lie in the defunct 1999 Competency Standards for Occupational Therapists in Mental Health (Occupational Therapy Australia, 1999)? Could this 22-year-old document that described the role of occupational therapy in mental health as “understanding and addressing the occupational consequences of mental health problems and mental illness; the occupational needs of people, who are at risk, and have mental health problems and mental illness; and the ways in which people's environments support and restrict their functioning, recovery, and occupational development” (p. 16) hold one of the keys to solving the “problem” of mental health occupational therapy?

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