Occupational Therapy, and understanding what it really takes to recover

This week tweeters, bloggers, healthcare staff and charities are celebrating the work of Occupational Therapists delivering vital support to patients across the country every day. While being far from the most high profile group of NHS staff, OTs are the essential bridge between recovering from an illness in the clinical sense and actually regaining your quality of life and purpose.

Of course, rather than being led by media hype and the latest political hot potato in health, we're in the slightly more 'real world' position of hearing what matters to patients in their own words, and in their stories they have always recognised the part these supportive services play in getting them back on track.

With it being OT week, we wanted to hear what life and work was like as an OT in the ever evolving NHS. Who better to tell us than Claire Jones, who writes a professional blog through the eyes of an OT on health (particularly mental health) and Web 2.0 Technology. Like us, she absolutely sees the potential for recovery where the two overlap.

Claire very kindly agreed to write a short blog for us, and here she lets us in on a poignant moment during her career where self reflection gave her unique insight into how her work really makes a difference.

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The Knitting Group

I work as an Occupational Therapist (OT) in an Acute Mental Health Inpatient Unit. It’s a demanding role, with a very fast pace of work and a constant pressure on the service.

As part of my OT role, I facilitate group activity for people on the ward, supporting people with the greatest need of my help to engage in occupations such as a quiz, gardening, Tai Chi based exercise, baking, learning new skills, or developing the ability to manage symptoms.

Although some groups are serious, we have lighter hearted moments, too. People sometimes believe that if someone is experiencing acute mental ill-health that they are unable to find any joy. This is true for some; it’s considered a clinical symptom (called anhedonia if you’re interested) but it might surprise you to learn that there is also laughter on the Ward, sometimes.

I fondly remember a day when we were sitting in the lounge. There was a group of 8 of us and we had all started our own knitting projects. There were balls of brightly coloured wool decorating the coffee tables, and clack, clack, clack of knitting in progress. The staff are not necessarily the experts in OT groups; and in this case, I was pleased that we had some very skilled knitters within the group, able to support people still developing their skills (like me, and several of the service users). Some people were faster, some were slower, but we were all becoming absorbed in the activity. This is a state we Occupational Therapists call “flow”, and it has been shown that experiencing flow is central to well-being and heath.

Occasionally, the room was quiet as we all sat with our thoughts, just the clack, clack, clack of the knitting needles and the background noise of the TV. Sometimes, one person or another would ask for support, another might check out how their neighbour was doing and offer to swap colours, or to make a hot drink.

As the OT in the group, I am participating in the activity, but I am also assessing things like the concentration levels of the participants, how long they can go without losing focus, how they are in the social environment of the group, whether or not they are distressed during the activity by unwanted thoughts or hearing voices. I’m also mentally planning how I could develop the group, how to create the “just right” challenge for each group participant; and I’m keeping an eye on the time so that we don’t forget to go for lunch!

Being in the group changes me, just as it changes the other people. Through reflective practice, we can unpick our thoughts and feelings. We have to determine if they are threatening delivery of a truly equitable service, or if the issue at hand is just too “hot” to handle for us, personally. It can also serve to remind us of why we are doing the job we are.

I took a moment to look around the group and reflect.

Mental illness is a heavily stigmatised experience in our society, which is odd really, given that we have all experienced mental distress to a greater or lesser degree. Obviously, the people that I work with are having a particularly challenging time when they meet me in Acute Inpatients.

Sometimes, people who experience mental distress to this degree suffer doubly, because they self-stigmatise. They might be heard saying “it’s my fault”, or “who could love someone like me?” This goes to show just how pervasive in our society stigma towards mental ill-health remains. They may feel unable to focus effort in maintaining their social networks, and may become increasingly isolated and excluded in their society as a result.

Several days earlier, the people in front of me had been sitting absorbed in their own distress. They had been slouched or sat in their own chairs, not facing each other. They had hardly spoken to each other. They had the TV on, but I hadn’t seen anyone absorbed by what they were watching.

Now, in the knitting group, they were all alert. They had moved several chairs so that they had formed mini-groups, who were sharing skills, wool, and scissors. Group members occasionally got up to make a drink- several group members offered to make drinks for others when they did. There were experiences that were distressing- I could see people struggling with voice hearing, but I also saw people smiling at each other and at their projects. I heard them talking about inconsequential things, and about their families, and about their frustrations with knitting! They were offering great advice to each other about managing symptoms. I was particularly pleased to see several people who were very isolated and excluded in society participating on equal terms with others in the group, being included and valued by the other members.

I looked around the room, and at the group. In this group, there was laughter. There was learning of new skills. There was a sense of community and of connectedness, and of solidarity with each other in the face of the knitting “challenge”.

I felt absolutely I was in the place I wanted and needed to be. I was grateful for the privilege to work with these incredible people, who had experienced so much distress and were beginning their Recovery. I felt a satisfaction in being able to use my OT skills to help them.

Then, someone came along and told us that lunch was served. The moment passed, and we all packed away our projects and went for some food.

It can be easy for us in healthcare to get on with the most functional side of our job role, and almost forget about the impact of our activities, our tone and manner on the patients and service users we’re working with.

That’s why I’m such a supporter of Patient Opinion, giving the opportunity to create ways to facilitate communication between NHS Staff and the communities we serve.

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Thank you so much Claire for your blog. We're very proud and pleased to have you as one of our friends and supporters.

You'll find Claire on twitter at @ClaireOT and here's her professional blog.