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Towards an Understanding of Occupational Therapy Professional Practice Knowledge in Mental Health Services

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Towards an understanding of occupational therapy professional practice knowledge in mental health services Lynne Maree Adamson B AppSci (OccTher), MAppSci (OT), Grad Cert (Univ Teach & Learn) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy University of Sydney, NSW, Australia August 2011 Statement of authorship I, Lynne Maree Adamson, hereby declare that the work contained within this document is my own and no other person’s work has been used without due acknowledgement. This work has not been submitted to any other university or institution as a part or a whole requirement for any higher degree. Lynne Maree Adamson 29 August 2011 i Acknowledgements Many people provided inspiration and support to me in this journey across several years. I thank Colleen Mullavey O’Byrne for supervising and guiding me through the process. As colleague and friend, I am grateful for her wisdom and gentle encouragement. Special thanks are due to Joy Higgs who introduced me to new ways of thinking and inspired me with her experience and her view to far horizons. I appreciate the dynamic learning opportunities created through Joy’s leadership and the scholarly companionship of her colleagues and research students. To my family and special friends, I owe deepest gratitude for support and tolerating absence from my usual roles in life. Most of all, I thank Evelyne who inspired, challenged and supported me. My work colleagues deserve thanks for their understanding and willingness to share the high and low moments of postgraduate study. In my writing, I was assisted by Natasha Parkin who searched meticulously for missing details and helped me organise my words. My work was edited by Dr Margaret Johnson of The Book Doctor, to whom I express sincere appreciation. All procedures of the University Policy for Proofreading and Editing of Theses and Dissertations were strictly observed. I express appreciation to the occupational therapists who agreed to participate in the study. Their stories of practice and critique of my work were integral to my interpretation and writing. I admire the ways in which occupational therapists are pioneers in an ever-changing practice landscape. I especially thank Susan Esdaile who had the foresight to keep items of history, reflecting an era of education still remembered by many occupational therapists. Old photos initially awakened my interest in the history of occupational therapy in mental health services. I hope that in this document I have captured some of the hope instilled within a profession that believes in the importance of occupation as a positive contribution to life. Now I will move on, hoping to continue to link past and present as we create the future of occupational therapy. ii Abstract This study critiqued historical, philosophical and political factors influencing occupational therapy (OT) professional practice knowledge in the context of public mental health services located in Victoria, Australia. The research was situated within the interpretive paradigm of scientific inquiry, using a hermeneutic process to construct and interpret five texts portraying the evolution of OT in mental health services. A series of conversations with key occupational therapists yielded material for further critical interpretation. Ethical approval was received from the Human Ethics Committee, University of Sydney. The first constructed and interpreted text situated early mental health services within the unique background of Australian convict settlements, 1788 - 1868. OT emerged within institutional environments echoing this past. The second and third texts interpreted OT professional literature, presenting a timeline of practice within mental health services. Occupational therapists implemented their craft-based practice within the psychiatric institutions of the 1940s and 1950s. Through the next two decades, occupational therapists made efforts to align practice with medical paradigms of knowledge before returning to occupation as a core of practice knowledge in later decades. Following closure of institutions during the 1990s, occupational therapists were challenged by relocation of services to community-based, multidisciplinary environments. The fourth text portrayed an interpretation of four transitions of practice, reflecting challenges influencing professional practice knowledge through five decades of practice. The final text interpreted six strands of professional practice knowledge, representing unifying threads woven through these decades. The study concluded that OT had a quiet, yet consistent role within mental health services in Victoria. Gender, changing social views and practice environments were significant influences on the evolution of occupation as a core of practice. The study adds to deeper understanding of the importance of practice knowledge for the development of the profession in complex socio- political environments. iii Conference presentations related to this study Adamson, L., Higgs, J., & Mullavey O’Byrne, C. (2007). Contradictions and connections: philosophy and theory in mental health practice. AQR Conference: Qualitative Research and the Professions. 13 – 14 November. Melbourne: Monash University. Adamson, L., Higgs, J., & Mullavey O’Byrne, C. (2009). Convicts to community: mental health and occupation. University of Sydney Faculty of Health Sciences Postgraduate Conference. 4 November, Lidcombe, NSW: University of Sydney. Adamson, L., and Higgs, J. (2010). Mental Health Practice: who makes the team? Proceedings of All Together Better Health 5 International interprofessional conference. Seeing things differently: evidence and innovation in interprofessional learning and practice. (p. 215). 6 – 9 April. Manly, NSW. Adamson, L. (2010). From convicts to community action: tracing stories of mental health and occupation. Proceedings of 15th international congress of the World Federation of Occupational Therapists: Sharing the world of occupation from Latin America (p. 22). 4 – 7 May. Santiago, Chile. Adamson, L. & de Leeuw, E. (2010). What we do is our health. Proceedings of the International Union for Health Promotion and Education World Conference on Health Promotion: Health, Equity and Sustainable Development (p. 52). 11-15 July. Geneva. iv Acronyms AAOT Australian Association of Occupational Therapists ACL Allen’s Cognitive Levels AHMAC Australian Health Ministers Advisory Council AJOT American Journal of Occupational Therapy AOTJ Australian Occupational Therapy Journal AOTA American Occupational Therapy Association APA American Psychiatric Association CAOT Canadian Association of Occupational Therapists CATS Crisis Assessment and Treatment Services CCU Community Care Units CDT Cognitive Disability Theory CJOT Canadian Journal of Occupational Therapy COAG Council of Australian Governments CRS Commonwealth Rehabilitation Service EBP Evidence-based Practice ICF International Classification of Functioning, Disability and Health MOHO Model of Human Occupation MSTS Mobile Support and Treatment Services MTM Methods Time Measurement NGO Non government organisation NMHETAG National Mental Health Education and Training Advisory Group NMHWG National Mental Health Working Group NSPOT National Society for the Promotion of Occupational Therapy OT Occupational Therapy PDRSS Psychiatric Disability Rehabilitation Support Services PEOP Person Environment Occupation Participation TAFE Tertiary and Further Education UN United Nations VATMI Victorian Association for the Mentally Ill VICSERV Psychiatric Disability Services of Victoria WFOT World Federation of Occupational Therapists WHO World Health Organization v Table of Contents Abstract ............................................................................................................................................................. iii Chapter 1 Introduction .......................................................................................................................... 1 1.1 Mental Health Services and Health Professions .............................................................. 1 1.1.1 The emergence of occupational therapy as a profession. .................................. 1 1.1.2 Professions, knowledge and responsibility. ............................................................ 3 1.1.3 Statement of the research topic. ................................................................................... 4 1.1.4 Significance of the study. ................................................................................................. 5 1.2 Background to the Study: Mental Health in Society ...................................................... 6 1.2.1 An international context for mental health services. .......................................... 6 1.2.2 Australian mental health services. .............................................................................. 7 1.2.3 Public mental health services in Victoria. ................................................................ 8 1.3 OT: A Health Profession ............................................................................................................. 9 1.3.1 Description and definition. ............................................................................................. 9 1.3.2 Occupational therapy fields of practice. .................................................................... 9 1.3.3 Professional beginnings in the 20th century. ........................................................ 10 1.3.4 Professional challenge:
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