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The Evolution of Occupational Therapy for Mental Health

Occupational therapy is ‘an active method of treatment with a profound psychological justification’, variously linked to moral, punitive and economic rationales. The 20th century codification of the profession was assisted by key individuals, wartime experiences and social context. An assumed mind-body interaction underscored the adoption of occupational therapy within psychiatry, but attention and resources were weighted in favour of its uses in physical rehabilitation.

The development of occupational therapy for mental health was amongst issues discussed at the History of Psychiatry and Psychology Postgraduate Conference at UCL. Emerging research based on analysis of primary source material used Bethlem as a case study for exploring the establishment and acceptance of this field. Archived hospital records were used in conjunction with relevant scientific literature, and interviews with former Bethlem nurses.

Evidence suggests a modest tradition of occupation for health at Bethlem, initially driven by the social and intellectual environment, and postwar, by economic concerns and fresh input from Maudsley staff within the new Joint Hospital. Pioneering work addressed the damaging effects of prolonged hospitalisation within a framework of bourgeois acceptability; later efforts concentrated on teaching transferable and vocational skills. Enthusiasm of individual proponents was stymied by medical disregard of occupational therapy, limiting activities offered and perpetuating amateurish stereotypes of the profession. However, it was proposed that today’s services evolved from former philosophies and practices, having weathered challenges from inside and outside the hospital gates.

Key themes included the social class and gender of therapists and their patients; global and interdisciplinary sharing of knowledge, changing methods and aims of occupational therapy, and calls for professional accountability. The institutional and wider significance of findings were discussed.

Although one should not over-generalise from case study evidence, the research broadly highlighted the range of factors involved in the conceptualisation and recognition of new fields of expertise. It also illustrated fluctuating motives underlying outwardly similar practices, whilst psychiatry’s ‘inheritance’ of occupational therapy from its hitherto physical – and often transient – uses, reinforces the ‘Cinderella service’ trope. Despite recent augmentation of occupational therapy’s status within psychiatry, there is an ongoing challenge of integrating treatment approaches within mental health care. Further insights can be achieved through continued engagement with current and historical literature, together with the oral histories of those involved in delivery of mental health services during the 20th century.