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Introduction: This paper explores the way dominant discourses, and their associated practice knowledge dimensions, shape personal paradigms and occupation-based practice in mental health workplaces. Method: Narrative inquiry methods and narrative thematic analysis was used to explore the career stories of nine occupational therapists who had worked in mental health practice for more than five years. Findings: The main narrative themes to emerge were (i) living with the biomedical practice knowledge discourse, (ii) living with the psychological practice knowledge discourse and (iii) reflection as a strategy for maintaining occupation-based practice. These discourses created the need to reflect on practice and adopt strategies to avoid the marginalisation of occupational perspectives and occupation-based practice. The strategies used to cope with these discourses varied from acceptance and embracing of other discourses to resistance and rejection. Conclusion: This paper demonstrates that in some mental health workplaces there is a danger that occupational perspectives and occupation-based practice can become marginalised. Making visible the different discourses in mental health practice allows occupational therapists to analyse, better understand, and live with the tensions in their professional lives. This requires professional support strategies to be in place to maintain occupation-based practices and retain practitioners in the workforce. [ABSTRACT FROM AUTHOR]

This paper describes the factors affecting how psychiatric emergency teams (PET teams) evaluate and responded to, legitimated or discounted, the calls of community members. Such calls were processed on two distinct levels-the psychiatric and the practical. PET teams had a variety of policies and procedures for assessing the psychiatric "seriousness" of a case. On many occasions, however, the psychiatric ordering would be subordinated to organizational and personal factors. The paper concludes with a consideration of structural factors which promoted this subordination of psychiatric to pragmatic criteria for selection. [ABSTRACT FROM AUTHOR]

Introduction: An adequate quantity and quality of sleep is a necessary pre-requisite for optimal occupational performance and participation in everyday life. Occupational therapists in various settings encounter people who are affected by sleep problems, but the contribution occupational therapists can make to help those experiencing sleep problems has not yet been fully defined. Method: This paper reports upon a focus group study designed to elicit the views of occupational therapists working in mental health settings (where sleep disturbances are particularly prevalent) regarding their role in relation to sleep problems. Thematic analysis using a constant comparative approach was used to capture key themes. Findings: Occupational therapists identified sleep as a significant and persistent occupational problem for many of their clients, and acknowledged that sleep was often overlooked. Although they could identify a series of possible strategies to address sleep needs they were uncertain regarding optimal practice. Conclusion: Sleep is a valid and relevant area of concern for the profession. Given the findings of this study and the paucity of literature there is an urgent need to identify, design and evaluate occupational therapy assessments and interventions to address sleep problems in mental health and in other settings. [ABSTRACT FROM AUTHOR]

Statement of context: Driving can be important for enabling community participation. Mental illness and its treatment may disrupt fitness to drive, or people's opportunities for learning to drive. This paper reflects on practice improvements in an Australian mental health organization. Critical reflection on practice: Occupational therapists identified gaps in knowledge among the multi-disciplinary workforce about service users' driver status, how to identify and manage driving issues, and how to support their beginning or resuming driving during recovery. Implications for practice: The key initiatives: policy and practice guidelines, workforce training, driver assessment and consultation services, and service user information resources -- have become embedded supports within the organization for promoting safe driving. [ABSTRACT FROM AUTHOR]

Purpose: Much of the literature about the meaning and experience of work for people with mental health problems is limited in the extent to which individual perspectives are represented, because the evidence derives from studies that are mainly quantitative in design. This literature review focused on qualitative studies, which sought to elicit the experiences of returning to work with a mental health problem. Method: An electronic search of the databases SCOPUS, CINAHL and PsycINFO was carried out. Papers with a publication date between December 1989 and December 2009 were sought. This time period was chosen to reflect the developments in approaches to vocational rehabilitation that have developed during the last 20 years. Findings: The findings indicate that work holds multiple meanings for people with mental health problems, that there are advantages and disadvantages to working, and that many barriers to work exist. The crucial nature of support for the individual in accessing employment is emphasised, and what users want from supportive relationships is detailed. The findings suggest that barriers can beove rcome if theright support is available. Conclusion: The findings provide support for the involvement of occupational therapists working in vocational services, and offer some pointers for developing relationships with clients. Thefindings highlight the importance of exploring clients' feelings about work, including perceived barriers and benefits to working and provide a deeper understanding of the type of supportive relationship required by a person with a mental health problem who wishes to access employment. [ABSTRACT FROM AUTHOR]

Occupational therapists working in higher education have acknowledged the benefits of peer observation to their professional development and there has been discussion of its potential benefits in clinical settings. However, there is limited literature and no practical guidance on the implementation of observed practice within clinical practice. This action research study sought to develop a work-based observed practice programme for occupational therapists and physiotherapists in a United Kingdom mental health trust. Action research was chosen to enable the positive engagement of practitioners in order to co-create knowledge and to improve practice. Occupational therapists and physiotherapists with expertise of local practice and personal experience of staff development and clinical supervision formed a working group to develop and implement the programme. The group considered examples of similar programmes from higher education and addressed issues relating to the purpose, status and process of the programme. It also explored its relationship to existing preceptorship programmes and clinical supervision. This paper summarises the key steps of the observed practice process and the development of supporting documentation created by the working group. The observed practice programme was implemented at workshops in the autumn of 2009 to be followed by a formal evaluation. [ABSTRACT FROM AUTHOR]

Introduction: Impaired self-awareness is a significant barrier to successful rehabilitation. This paper presents a new guideline for practice, entitled Self-awareness Enhancement through Learning and Function (SELF). Description: The SELF is a newly developed guideline for practice, which incorporates the latest theoretical information from neuroscience, psychology and computer science regarding self-awareness, learning, cognition and care giving, with evidence of the importance of participation in occupation. The SELF provides clear evaluation and treatment postulates using therapeutic alliance, occupation, belief perspectives, brain education and compensatory strategies to improve self-awareness. Discussion: The current approach to the treatment of impaired self-awareness focuses on testing and performance feedback. This approach does not have evidence to support its effectiveness and there is some evidence that the approach actually contributes to emotional distress and increased denial of deficits. Conclusion: The SELF integrates the art and the science of occupational therapy to foster self-awareness in an empathetic and dignified manner. Occupational therapists are uniquely qualified, and should be leaders, in the integration of personal factors, environmental elements and occupations to improve self-awareness. The SELF provides occupational therapists with guidelines for using these interrelationships to restore self-awareness in a manner that builds confidence and skills. [ABSTRACT FROM AUTHOR]

The lives of women with an enduring mental illness have been little researched within occupational therapy. This study explored the experiences of five women living with enduring mental illness in their communities. The women were interviewed over a 2-year period using the life history method. Data were recorded and transcribed verbatim. The data set was analysed in two ways. First, from the narrative analysis, an individual unique narrative of each woman's life was created. Secondly, the data were analysed using the constant comparative method. This paper presents the findings from the constant comparative analysis. Six themes were identified, which lifted the veil on the experience of living with and surviving enduring mental illness. Each theme represented a section of the women's lived experiences: a specific frame of the bigger picture of their lives. The themes were present life, life roles, relationships, illness transitions, help and cultural context. The findings highlighted the complex life roles and needs of the women over time. They unveiled how the women became agents in creating a better life for themselves and others. Practitioners have a role to play in creating meaningful and safe environments that encourage social inclusion and recovery. [ABSTRACT FROM AUTHOR]

The development of crisis resolution/home treatment (CRHT) teams was outlined as a requirement in the National Health Service Plan (Department of Health 2000) and reiterated in the recent guidelines to have an impact on the provision of mental health care (Care Services Improvement Partnership [CSIP] 2006). The Home Option Service in Central Manchester, one of the first CRHT teams in the United Kingdom, provides support and a range of interventions, 24 hours a day, 7 days a week, for those service users experiencing a crisis in their mental health, as an alternative to hospital admission. The need for team working is explicit in the guidance statement to ensure fidelity and best practice for crisis services and it urges teams to provide clarity regarding their roles and responsibilities within the team approach (CSIP 2006). This paper illustrates a model for occupational therapists working within a crisis team in order to ensure that service users have access to occupational therapy when admitted to crisis care. Specific standards, in accordance with those outlined in the research and development strategic vision for occupational therapists in mental health (Association of Occupational Therapists in Mental Health 2006), have been identified to instigate a clear pathway for the stakeholders of crisis teams. A description of the development, implementation and evaluation of an integrated care pathway is provided, alongside a subsequent audit to measure the effectiveness of this model. [ABSTRACT FROM AUTHOR]

This study undertook a replication of the work conducted by Sumsion in 2004 in the United Kingdom regarding the application of a definition of client-centred practice. Twelve occupational therapists employed by a local mental health facility and working with adult outpatients participated in semi-structured interviews. Template analysis and open coding were used to analyse the data. The resulting concept map indicated that collaboration and meaningful goals were at the centre of client-centred practice and formed the two main categories of data. The therapist and the client were the protagonists in these categories, but the family, team and system also played major roles. A table within this paper outlines all the categories and themes that arose from the data. However, space limitations required a focus on only the category of collaboration and the therapist and client facilitators and challenges within this category. The therapists used both attitudes and actions to facilitate the client-centred process and the clients brought strengths to this relationship. Nevertheless, both groups faced many challenges that had to be overcome to enable the successful implementation of client-centred practice. [ABSTRACT FROM AUTHOR]

Two questions about professional practice rarely arise: the use of control in expert-client relations and the effect of different settings on the styles of practice. This paper presents the historical development of the mandates, for both control and advice, which pervade psychiatric practice. Though the presence of expertise always implies an element of control, usage varies according to opportunities and constraints provided by each setting. An analysis of control functions exercised by psychiatrists in coercive settings-institutions-leads to recognition of the application of control elements in the supposedly advisory setting of private practice. Patients meeting psychiatrists in different settings require differing kinds of protection against misuse of professional expertise. [ABSTRACT FROM AUTHOR]