Occupational therapy practice in restructuring mental health services

Lloyd, Chris (2003). Occupational therapy practice in restructuring mental health services PhD Thesis, School of Health and Rehabilitation Sciences, The University of Queensland.

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Author Lloyd, Chris
Thesis Title Occupational therapy practice in restructuring mental health services
School, Centre or Institute School of Health and Rehabilitation Sciences
Institution The University of Queensland
Publication date 2003
Thesis type PhD Thesis
Supervisor Dr Kryss McKenna
Dr Robert King
Total pages 388
Collection year 2003
Language eng
Subjects L
321024 Rehabilitation and Therapy - Occupational and Physical
730303 Occupational, speech and physiotherapy
Formatted abstract
The impact of mental health reform on Australian mental health professionals is an area that has not been well studied. The introduction of mental health reform has resulted in new models of care and changed work practices for all mental health professionals. Occupational therapists, as with other health professionals, have been required to assume new roles and responsibilities. There has been an emphasis on developing a generic skill base in order to assume broad-spectrum mental health professional roles. This study sought to identify the current work activities carried out by occupational therapists and whether there is a discrepancy between their actual and desired work activities. In addition, this study attempted to identify the sources of pressure experienced by occupational therapists, and their job related feelings, specifically stress and burnout. As part of these aims, occupational therapists were compared with a cognate group of mental health professionals, namely social workers. The study comprised three interlinked cross-sectional studies, a preliminary study that used qualitative methods, and a main study and a supplementary study that used quantitative survey methods. The aim of the preliminary study was to explore the perceptions of occupational therapists employed in public mental health services concerning the impact of changes to work practices under the National Mental Health Strategy, in order to assist in the design of the main study. The participant sample consisted of 12 registered occupational therapists working in mental health in South- East Queensland. The findings revealed that occupational therapists were assuming different roles and learning new skills while at the same time using core occupational therapy skills. In particular, they enjoyed the increased variety in their work, the opportunity to develop new skills, and increased autonomy and responsibility. The participant sample for the main study consisted of 304 occupational therapists and social workers, a response rate of 76.6%. As hypothesised, the results indicated that occupational therapists and social workers were undertaking a greater proportion of generalist compared to specialist work. Specifically, nine of the 10 work activities undertaken most frequently were generic in nature. Also as predicted, both groups experienced a discrepancy between their actual and preferred work activities, with occupational therapists and social workers mostly wanting to undertake a diverse range of activities to a significantly greater extent than they currently were. Measured using the Mental Health Professionals Stress Scale, occupational therapists and social workers were found to be experiencing more stress than has been found for other groups but only on some dimensions, with social workers reporting more stress than occupational therapists, specifically in the area of workload, home-work conflict, and overall stress. As predicted, the stress was associated with the discrepancy between the kind of work participants wanted to do and the kind of work their job actually entailed. There were no significant differences between occupational therapists and social workers in terms of their levels of burnout, measured using the Maslach Burnout Inventory, which consists of three subscales, namely emotional exhaustion, depersonalisation and personal accomplishment. This finding was contrary to the hypothesis that, compared to occupational therapists, social work participants would experience higher levels of burnout as measured by the personal accomplishment dimension. Rather, it was found that both groups had high levels of emotional exhaustion, moderate levels of depersonalisation, and high levels of personal accomplishment compared to normative data. Higher levels of depersonalisation and emotional exhaustion were experienced in participants who spent more time working with an adult client group and carrying out administrative duties, as well as those who perceived a lack of support from management and were dissatisfied with opportunities for supervision. Participants who spent more time in a case management role experienced higher levels of depersonalisation. Higher levels of personal accomplishment were experienced by participants who had worked for longer in mental health and who carried out more senior administration, general clinical, and community development work activities. Overall, this study found that both occupational therapists and social workers wished to undertake more work activities than they currently were, and that they experienced stress and burnout while, at the same time, deriving a sense of personal accomplishment from their work. The aim of the supplementary study was to determine whether or not there are systematic differences between the two professions with respect to underlying emotional status prior to entering the workforce. The participant sample consisted of 164 final year occupational therapy and social work students at the University of Queensland, a response rate of 76.3%. Measured using the General Health Questionnaire, there were no significant differences between occupational therapy and social work students in terms of the presence of psychiatric symptomatology. The overall prevalence rate of symptoms of 31.7% was lower than that shown by comparable data for other student health professional groups. On the basis of these findings, there was no indication that individuals with psychiatric symptomatology were more likely to choose a career in mental health. A number of potential strategies for improving the work environment of occupational therapists and social workers may be derived from these findings. Relatively simple management strategies may include the provision of opportunities for developing informal colleague support networks, supervision and training in specific clinical skills as well as techniques such as time management and creating balance in one's working day. More complex organisational changes such as developing specialist services to differentiate staff function and encouraging staff to develop specialist skills may offer additional potential solutions.
Keyword Mental health services -- Australia
Mental health policy -- Australia
Mentally ill -- Deinstitutionalization -- Australia
Occupational therapy services -- Australia

Document type: Thesis
Collection: UQ Theses (RHD) - UQ staff and students only
Citation counts: Google Scholar Search Google Scholar
Created: Fri, 24 Aug 2007, 18:14:57 EST