Occupational Therapy News OTnews April 2019 | Page 25

MENTAL HEALTH FEATURE
the importance therapeutic relationships was required to support the
implement of change towards client-centred practice.
The emphasis of therapeutic relationships within Connelly House
enables patients to be actively involved in their care and therapy, and
to develop insight into independently managing their wellbeing in the
long term.
With what may be considered a significant non-traditional change
in service leadership and culture, differing levels of support were
recognised; notably and understandably staff expressed anxieties
over the loss of the medical approach and nursing presence on the
ward.
It was considered that there was an underlying assumption that
individuals with a complex and enduring mental health condition
benefit primarily from a pharmaceutical approach.
This was appreciated within the context of the setting and the
complexity of medications required, which has traditionally been a
core domain of the nursing profession.
Furthermore, as inpatient occupational therapists conventionally
are not trained for managing or supporting the self-administration
of medication, this was acknowledged as a significant challenge for
change.
Additionally, without the presence of a recognised framework,
policy and procedures in place, initial validated concerns and
resistance to creating a bespoke training package was present
across site. the Model of Human Occupation, which informs the assessment,
intervention and discharge processes, as supported by national
guidelines for occupation focused practice in secure services (COT
2017).
Implementing this theoretical practice, however, was restricted
by the patients’ and staff’s understanding of occupational therapy
principles and theory, both on the ward and across site.
Common assumptions were that occupational therapy provides
an ‘occupying service’ or generic activities with the primary aim of
reducing boredom. This emphasised the requirement to increase
awareness of occupational therapy professional identity and core
skills in practice.
Similarly, the culture initially experienced at Connelly House
appeared to lack awareness of the benefits occupational
engagement can have on patients’ functioning and quality of
life.
Opportunities for meaningful engagement and role and skill
development were absent, which was likely to have contributed
to patients experiencing prolonged periods of isolation in their
bedrooms.
The need for an application of the educational approach to
increase staff understanding of occupational therapy practice was
essential in order to develop a pro-social culture of ‘doing’.
Similarly, patients struggled with understanding the purpose
for the change and the demands and expectations of therapeutic
engagement. This is contrary to the perception of the ‘discharge
gateway’ that Connelly House initially posed as within the Langdon
To create sustainable, meaningful change and to identify best
outcomes for patients and staff, a theoretical framework with
evidence and best practice guidelines is essential.
Occupational therapy theory has enabled Connelly House
to develop into an evidence-based service that functions with
occupation at its core. It utilises standardised models, such as hospital site.
The change in dimension of patients being expected to
take ownership of their care, identify their goals and work
collaboratively has required an educational and empowering
approach to be applied across site to support the pathway to
Connelly House.
Challenges to change
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