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Creek
s Occupational Therapy and Mental Health Occupational Therapy Essentials Sixth Edition Wendy Bryant
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For new editions, list copyright history of previous editions below.
First edition 1990
Second edition 1996
Third edition 2002
Fourth edition 2008
Fifth edition 2014
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described
herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a ma er of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
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Foreword by Jennifer Creek
The first edition of Occupational Therapy and Mental Health was commissioned in 1986 and published in 1990 by the Edinburghbased publisher, Churchill Livingstone. As the first editor, I had a vision from the beginning of a comprehensive textbook covering the theory and practice of occupational therapy in the field of mental health that would be a source of essential information for students and practitioners. In the preface to that first edition, I wrote that‘my primary intention in compiling this textbook has been to communicate to students and professionals the enormous potential of occupational therapy and to give them a clear picture of the scope of the profession (and) a firm grounding that will allow them to enter the profession with confidence and build on this knowledge as they gain experience’.
It has been more than three decades since that aspiration was articulated, and the scope of occupational therapy has expanded more than anyone could have imagined. In editions two and three of the book, the authors and I sought to keep up with this expansion, adding chapters on new areas of practice and including key developments in theory. We wanted to look forward, thinking at least as much about where the profession might be in five years’ time as about current practice. This means that for every edition, the content and scope of the book were examined, modified and updated.
One of the principles the book is based upon is that practice chapters should be authored or co-authored by practitioners. Occupations are performed within, and shaped by, social, physical and temporal contexts, and occupational therapy practice is always
situated in particular contexts. Only current practitioners can capture the essentially contextual nature of practice and the everyday challenges and affordances that the occupational therapist has to work with. Another principle underpinning the book is that occupational therapists should not limit themselves to learning a finite number of supposedly universal, profession-specific models for practice but feel free to draw on a wide range of theories: from psychoanalytical theory to social cognitive theory, from biomedical theory to occupational science and from complexity theory to social practice theory.
In 2005, while the fourth edition of the book was in progress, my daughter died and I was unable to continue working. Lesley Lougher, an experienced occupational therapy author and textbook editor, kindly stepped in to complete the editing process. One of the innovations we introduced in that edition was to invite service users to comment on chapters. We felt that the people who use occupational therapy services should have the last word on how useful and appropriate those services are. The idea was good but, for that edition, we only managed to elicit commentaries on three chapters.
For some years I had been trying to find someone willing to take over the book so that I could retire from editing. Lesley had the idea of bringing together an editorial team, and we invited Wendy Bryant, Jon Fieldhouse and Katrina Bannigan to edit the fifth edition. They all agreed to take it on, with some support from Lesley and me, and that edition was published in 2014. The editors remained true to the guiding principles of the book, bringing in new authors and introducing several new areas of practice. They also managed to include service user commentaries on 13 of the chapters—a great achievement. In my foreword to the fifth edition, I wrote that ‘the book does not present instructions for doing occupational therapy but aims to provide practitioners with a range of tools and techniques, including tools to support their thinking, from which they can select those most appropriate to particular contexts’.
For this edition of the book, the sixth, Wendy and Jon invited South African occupational therapist, Nicola Plastow, to be their coeditor. Prior editions included chapters by authors from different countries but having a non-UK, non-European editor on the team represents an important step forward. Some of the most exciting developments of recent years in occupational therapy theory and practice have been emerging from Southern Africa and South America, where practitioners are responding in innovative ways to the major social, health and occupational needs of those regions. These fresh, creative approaches to occupational therapy are revitalizing the profession, supporting both our growth within mainstream services and our expansion into other, more marginal se ings.
Producing a major textbook requires the editors to have a sound understanding of the field, up-to-date knowledge of current practice and a good grasp of the professional knowledge base. They also have to be skilled in organizing huge amounts of material and presenting complex ideas in ways that are accessible and comprehensible for readers. Furthermore, the editors have to stay abreast of the rapidly changing ways in which academic materials are published, stored, advertised, accessed and consumed. The quality of a textbook is judged by the people who read it, not by those who produce it.
For the sixth edition of Creek’s Occupational Therapy and Mental Health, Wendy, Jon and Nicola have had to make some big decisions about the content, style and presentation of the book. For example, they have restructured how the knowledge base of occupational therapy is presented, capturing both the essence of the profession as an entity, its form, and the complexity of occupational therapy as an intervention, its performance. The essence of the profession is found in our focus on the ordinary things that people do in their everyday lives and in our commitment to equity of access to occupation for all people. The complexity of intervention is expressed in the flexibility of the occupational therapist’s reasoning and capacity to respond
swiftly to changes in clients’ circumstances, whether those clients are individuals, groups or populations.
In this edition, there are commentaries by service users on 22 of the 29 chapters. For me, this is one of the most exciting features of the book: the authors and editors are confident enough in their knowledge and purpose to submit their work for critique by the people who use occupational therapy services.
It has been 37 years since Churchill Livingstone wrote to ask me if I would be interested in editing a new textbook on occupational therapy in the field of mental health. While the profession is still recognizably the same one in terms of its purpose and many of its methods, much has changed. It is satisfying to see that Wendy, Jon and Nicola have kept the focus on the book on current and future theorizing and practice, updating the text to provide a solid grounding for students and a reference for practitioners.
The profession of occupational therapy is still expanding into new fields and new countries. The theories, approaches and methods presented in this book are intended to be adaptable for different contexts. They will support practitioners in providing services that meet health-related occupational needs in ways that are effective, culturally relevant and acceptable to the people who use them.
Jennifer Creek
Foreword by Alison Faulkner
Many years ago, when a ending a therapeutic community-style day service, I met my first occupational therapist. I can still see her in the art room, standing over or emptying the kiln or sharing out the art materials. She was clearly a junior member of the team; she remained very quiet in team meetings, only speaking when spoken to. But when one of us was painting or working with clay, she was there in the background, someone to talk to, a nonjudgemental presence in an atmosphere that seemed to me to be all about judgement and fi ing in.
Looking back on my experience of mental health services since (and that first experience was some 40 years ago), I have rarely encountered an occupational therapist. Days on inpatient wards were relentlessly boring. In Chapter 21: The Acute Se ing, Katherine L Sims presents the role for occupational therapy as part of the multidisciplinary team for people in inpatient care, often focusing on ‘specific skills in individual and/or group sessions, aiming to prepare for discharge, prevent relapse and promote recovery and social inclusion’. In my experience of inpatient care, some patients talked about a ending groups, but I didn’t know what or where they were. There was either a selection process going on behind the scenes or just limited resources.
I came to think of occupational therapy, if I thought about it at all, as a poor relation of the mental health service. But then, in those days of relentless boredom on an inpatient ward, I had work to go back to – and perhaps that says it all, as is very well documented in Chapter 10: Perspectives on Using Services. The authors, Anne Laure-Donskoy and Rosemarie Stevens, discuss the
responsibilization agenda, the co-option of recovery and welfare to work policies, which shift the focus from occupation as a vehicle for recovery to occupation as a route into paid work. This is not a direction that many of us, as service users or survivors, would advocate. The underlying agenda, to move people back into paid work, speaks to a neo-liberal policy of productivity, as against seeking to understand and support someone in their mental health, community and life context. Of course, the essence of occupational therapy is to understand ‘occupation’ in its broader sense: as ‘all activities that are necessary for survival and human flourishing’ (Chapter 2). In this same Chapter, Wendy Bryant and Nicola Plastow explore ways of understanding the person holistically using the ‘doingbeing-becoming-belonging’ framework that incorporates basic needs as well as, for example, spiritual and creative needs. It is not all about engaging in paid work.
The depth and breadth of the experiences, subjects, se ings and interests covered in these chapters suggest a mature and learning profession. In the Occupations section, chapters cover physical activity, life-long learning, client-centred groups, creative activities, play, self-care, nature-based practice and work. The breadth of these activities is encouraging in the sense that you can feel the potential for everyone to find something to engage with. It is important to be aware of this potential, even if the reality of resources and austerity in recent years will have had a significant impact on what is available to an individual.
On a good day, then, occupational therapy clearly constitutes far more than the arts and crafts that I first encountered 40 years ago: it is about understanding people within their life context, engaging people in the community and rediscovering hope and meaning. I think it is significant that occupational therapists are encouraged to engage in reflective practice (see Chapter 3: Being a Therapist) and in understanding the meaning of ‘occupation’ in people’s lives. Indeed, reading this chapter made me think that many other mental health practitioners could learn something from the training of occupational therapists. I was particularly interested to read this
definition of occupational justice from the World Federation of Occupational Therapists, 2019:
‘the fulfilment of the right for all people to engage in the occupations they need to survive, define as meaningful, and that contribute positively to their own well-being and the well-being of their communities.’
[ Chapter 2 ]
A recent development in community mental health services is the community mental health transformation programme, as is touched on by Hazel Parker and Simon Hughes in Chapter 22: Community Practice. The transformation programme aims to create a more integrated service for people experiencing mental health difficulties in the community, merging primary and secondary care mental health teams with social care and local community voluntary sector organisations. There is an intention to create a local and less diagnosis-based service with greater connection to local communities (see www.england.nhs.uk/wpcontent/uploads/2019/09/community-mental-health-framework-foradults-and-older-adults.pdf). In the words of Parker and Hughes, the programme:
‘presents opportunities and challenges for occupational therapists to develop practice beyond addressing existing health problems and disability, for example, by working in a more proactive way within primary care services and particularly non-statutory services’.
I have recently been involved in an evaluation of the community mental health transformation programme in one locality. I found occupational therapists to be enthusiastic supporters of a process that gave them the opportunity to link proactively with local community groups and services in the interests of promoting a wider understanding of the social determinants of mental health. One of the key contributions that they can make is that they are ahead of the game in thinking outside of the diagnostic box and
focusing on people’s skills, interests and strengths. Perhaps with the status of diagnosis in mental health services potentially waning, the role and value of practitioners such as occupational therapists can be seen more clearly. If the transformation programme is implemented and resourced well, it could mean a significant opportunity for the occupational therapists of the future.
If you are one of those occupational therapists of the future, then I commend you to read this book, as and when a chapter becomes relevant to you, your mental health or your work.
Alison Faulkner, Survivor Researcher
Preface
Thank you for choosing to read this edition of Creek’s Occupational Therapy and Mental Health. In this preface, the editors will orientate you to the enduring focus of these textbooks, what is new for this edition and the context for it.
Like the previous five editions, this textbook offers diverse and critical perspectives on occupational therapy and mental health, rather than being a manual for practice. The chapters are organized with increasingly specific content, starting with how occupational therapy and mental health are understood across practice se ings, the context for professional practice and groups of occupations often used in therapy. Then, details of people and se ings are explored in the final nine chapters. Brief definitions in the glossary orientate the reader to terms used in occupational therapy and mental health. Rather than starting from a diagnosis, readers are guided to reflect on the people they are working with and their context and relevant occupations. For any practice scenario, insights into how to think and act can be gained from several chapters. Therefore the structure of the textbook reflects how occupational therapists consider a situation from many perspectives, centred on those of people engaging with occupational therapy to promote or address their mental health. Regardless of the practice se ing or diagnosis (if there is one) of the people they are working with, mental health is a concern for every occupational therapist.
In updating this book, other enduring aspects have been protected. People with direct experience of occupational therapy as service users, patients and carers have been involved as authors and commentators. Their experiences are also included with extracts and
references to blogs and other published sources. Many of these sources show how practice and theory are not separate but intertwine with very real implications for people’s lives. As with previous editions, many of our authors are practitioners who have wri en their chapters while also doing their job. To create and revise chapters which explore contemporary theory and practice in a clear and accessible way, the editorial process has involved many dialogues between us.
There are four new chapters in this edition. Three chapters replace the two theory chapters in previous editions. The theoretical grounds for occupational therapy and mental health are discussed in Chapter 2, followed by what is involved in being a therapist in Chapter 3. Structures for practice, such as the occupational therapy process, models and frames of reference, are explored in Chapter 4. The other new chapter is in the people and se ings section, focused on eating disorders (Chapter 28). In many chapters, current themes in mental health and occupational therapy have been discussed, such as trauma-informed care approaches, social prescribing and recovery-oriented practice. To encourage critical engagement with these and other established approaches and ideas, there are now questions for the readers at the end of every chapter.
Recognizing the international audience for this textbook, we encouraged authors to engage with more international sources and think beyond their own immediate practice context. We are delighted to be working with Nicola Plastow from Stellenbosch University, South Africa, as co-editor for this edition, who energized our efforts to question our sources and assumptions. With her involvement, new authors were recruited, so in this edition a third of them are based in countries other than the United Kingdom. We also aimed to recruit as many service user commentators as we could. Twenty-two of the chapters have commentaries, a big step forward in Jennifer Creek’s vision that people who have engaged with occupational therapy could share their thoughts and feelings on every aspect of it. The response to our regular appeals for volunteer commentators was so encouraging, and we particularly want to
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133. A F . [N ]
Stanley Jones, Claremont, St. Ann.
Anansi was very poor and he went out to seek his fortune, but he had no intention of working. He clad himself in a white gown. And he met a woman. She said to him, “Who are you, sah? an’ whe’ you from?”—“I am jus’ from heaven.” The woman said, “Did you see my husban’ dere?” He said, “Well, my dear woman, heaven is a large place; you will have to tell me his name, for perhaps I never met him.” She said his name was James Thomas. Anansi said, “Oh, he is a good friend of mine! I know him well. He is a big boss up there and he’s carrying a gang. But one trouble, he has no Sunday clo’es.” The woman ran away and got what money she could together and gave it to Anansi to take to her husband.
But he wasn’t satisfied with that amount; he wanted some more. He went on a little further and saw a man giving a woman some money and telling her to put it up for ‘rainy day’. After the man had left, Anansi went up to the woman and told her he was “Mr. Rainy Day.” She said, “Well, it’s you, sah? My husband been putting up money for you for ten years now. He has quite a bag of it, and I’m so afraid of robbers I’m glad you come!” So Anansi took the money and returned home and lived contentedly for the rest of his days.
[Contents]
134. T P - . [N ]
Vassel Edwards, Retirement, Cock-pit country.
There was a man at slave time had a wife, and the wife kept two other men. The husband of that wife was working out. One night, one came first and then the house-master came home. And they had a big jar called a pannier-jar, and the wife took the man and put him into the pannier-jar. Afterward the other man came [164]in, and when he saw the house-master was frightened and he told the house-master he had come to borrow the pannier-jar. The house-master told him he could take it, and the woman helped him up with the pannier-jar. And when he got part of the way, he said, “Poor me bwoy! if it wasn’t for this pannier-jar, I would be dead tonight!” The other man in the pannier-jar said, “Brar, same meself!” And he got frightened and heaved down the pannier-jar, mashed it up and killed the man in there.
[Contents]
135. A G . [N ]
William Cooper, Mandeville.
Anansi an’ Tiger were travelling. Anansi kill him old grandmother, him put him into a little hand-cart was shoving him t’ru de town. After him catch to a shop jes’ like out here, de shop-keeper was a very hastytemper man; an’ went in de shop an’ call fe some whiskey an’ give it to one of de shopkeeper carry it to his grandmother. An’ said he mus’ go up to de han’-cart an’ call twice. An’ de ol’ lady did not hear. So Anansi said to de shop-keeper him mus’ holla out to de ol’ lady; him sleeping. So de ol’ lady didn’t hear, he fire de glass in de ol’ lady face, an’ de ol’ lady fell right over. Then the shop-keeper get so frighten he cry out to Anansi, say Anansi mustn’t mek no alarm in de town; he will give him a bushel of money to mek him keep quiet.
So dem was going along an’ borrow a quart can from Tiger an’ was measuring dis money. Tiger said, “Where you get all dat money?” Anansi say, “I kill my ol’ grandmother.” Tiger, him went home an’ kill his grandmother an’ put her up in a little hand-cart an’ was goin’ along t’ru de town hollerin’ out to all de people, “Who want a dead body to buy?” So Anansi said to Tiger he shouldn’t do anyt’ing like dat; too foolish!
[Contents]
136. W B A . [N ]
Richard Morgan, Santa Cruz Mountains.
White Belly plant some peas. Hanansi come a White Belly yard and say, “Brer White Belly, dem peas not fat an’ you know what you do? if you want ’em to be fat, mek up little fire at de root.” Tomorrow morning when White Belly were come, every peas dead!
White Belly is a carpenter. He mek a box. He mek bargain wid de mudder; he say, “Ma, I gwine put you in dis ’ere box, [165]put some money in de box; den I will holla out “Me mudder died!” White Belly put de han’ ’pon de head, say, “Me mamma dead o-o-o!” Hanansi run come. White Belly say, “Ma, what you have to give me? Let good an’ bad see!” De box turn up an’ t’row out all de money. Hanansi go back home an’ say, “Ma, I wan’ a little water to wash me foot.” Mother carried the water come. He dip him feet in dere, say, “Good Lord, ol’ lady, you give cramp me!” Tek de mortar stick, lick ’im in de head. An’ cobb’e one box an’ put his mudder in an’ call out, “Me mudder dead!” White belly come. Hanansi said, “Ma, what you have to give me? Give me back good an’ bad see!” De box raise up an’ ’tamp him down flat. So Hanansi kill him ma, an’ White Belly mudder save.