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The occupational therapy profession has a long-standing dilemma over how it is perceived and understood both by lay people and by health and social care disciplines. The roots of the dilemma appear to lie in the disparate nature of clinical practice among client groups; for example, to the uninitiated, occupational therapy with the person who has a dense hemiplegia looks very different from occupational therapy with a group of depressed young men in prison. The reason for the uniqueness of each individual's occupational therapy package is that, unlike some health care professions, occupational therapy does not usually work directly with ill-health or disability, but with the occupational need engendered by ill-health or disability – i.e. with occupational deprivation or disruption or imbalance. Primary signs and symptoms of ill-health and disability may have some similarity from person to person, but occupational need is always unique. Occupational therapists' tools are the ordinary, often mundane, occupations of daily living. Thus, what occupational therapists do can sometimes appear neither therapeutic nor health-driven, and herein is the profession's greatest difficulty – conveying to the professional person as well as to the lay person the potential of everyday activity to embrace the complexity of ill-health and disability and to restore and maintain health and well-being. Occupational therapists continue to make a unique and potent contribution to health care, but the dilemma of the profession's public persona continues.