There’s a place for occupational therapy beyond councils and the NHSFebruary 8, 2016
As I approach the end of my studies and move towards my first job as an occupational therapist (OT), the question of professional identity is important and challenging to me. This year I have spent time at two large charities, on a youth engagement project and at a homeless hostel, working and evaluating non-traditional roles in occupational therapy. The experience has been eye opening.
A non-traditional role is one in an environment where there haven’t been occupational therapists or where other similar organisations don’t typically make use of OTs. The College of Occupational Therapists suggests while the majority of occupational therapists work for the NHS, a growing number are now found in other places – such as homeless hostels.
I’ve seen first-hand the value of occupational therapists working in these places. We are active problem solvers, dual trained in both mental and physical health, take a strengths-based approach and naturally work across the health, social care and third sectors. These are all valuable for service users, who often have complex backgrounds and multiple barriers to maintaining their health and wellbeing.
At the homeless shelter I saw that individuals often struggle to access healthcare services and feel they are stigmatised by society. The hostel staff work hard to support residents to attend a myriad of appointments and navigate the complex systems of benefits, housing support and probation. But with high demands on support workers’ time, they are often forced to focus on the most essential needs, rather than working with the resident on the challenges they feel are important. This can seem like an exercise in firefighting – dealing with one crisis after another – rather than stepping back to look at the big picture, and then trying to take steps to prevent crises occurring.
Many residents seemed stuck and frustrated with their situation. For some there were challenges around developing basic living skills like cooking, job skills or organising yourself. Other people found it hard to set and work towards realistic goals and to create a daily routine that suited their needs. These are areas occupational therapist naturally address through assessments, models and evidence-based interventions.
At the youth engagement charity some of the same themes emerged, although with a different client group. Here I supported young people to evaluate the balance of different occupations in their life, and think about the changes they needed to make to create a more satisfying life. This took a range of formats; from women’s empowerment groups to individual work discussing activity wheels.
In both settings I could clearly identify needs that could be addressed by occupational therapists. But many charities are struggling to retain existing funding, let alone find extra money to pay an occupational therapist. Where there is funding for health and social care professionals in charities like homeless hostels, it is limited. This can mean roles are filled with cheaper, and consequently less experienced professionals.
But it’s not all doom and gloom. There are also pioneering charities who are creating non-traditional occupational therapy roles. For example, Pathway, a not-for-profit company in London, has formed teams of specialist healthcare professionals, including occupational therapists, to support homeless people in hospitals.
In non-traditional roles it can be hard, particularly for newly qualified or inexperienced occupational therapists, to protect the things that make the occupational therapy role distinct. As a profession often misunderstood, there is a delicate balance between being a flexible team player, and really making the most of the skills we are specially trained in. This includes occupational science, grading and assessing barriers to engagement and measured goal-setting with clients.
A senior health professional I spoke to said groups like homeless people desperately need active OTs to question how they access services, advocate on their behalf and support their complex needs. I agree; it is hugely important for occupational therapists to serve marginalised groups through non-traditional roles. But it needs to be a group effort from professionals at every level of their career, not just idealistic new OTs like me.