Occupational Therapy News OTnews May 2020 | Page 57

MENTAL HEALTH FEATURE
‘It was very much going back to basics and using the Model of
Human Occupation to explain what it is that I do,’ says Amanda. ‘I
did a presentation for my team and created some case studies of
what I could provide for them. It opened up a few doors, as they
now come and consult me rather than just going, “this person needs
occupational therapy”. I think I’m quite lucky as my team are open to
learning and like hearing about it.’
The people Amanda supports include Paula*, mother to a new
baby, as well as a toddler and a four-year-old. Amanda has worked
to support her and help manage her obsessive compulsive disorder.
‘A lot of my work has been around enabling her to get out to the
community so she can get out to groups before her toddler starts
nursery,’ says Amanda. ‘And we have to think about all her children
in perinatal terms – while we are not commissioned to work with
them, her behaviours at present have an impact on them, so we
work with different agencies to ensure everyone is supported.’
Roles like Amanda’s are so new that how they work in practice
is still developing, so teasing out what these new roles mean in What do perinatal occupational therapists do?
practice has led RCOT to develop new training in partnership with
Health Education England.
Research indicates that members moving into perinatal roles are
often highly experienced in other fields, typically from adult mental
health roles, but that they are new to a sector with few established
ways of practice for occupational therapists.
‘There is lots of experience among the staff coming into these
roles, and they are often excited to get to set up a new service,’ says
Sally. ‘And there are lots of transferable skills too – co-occupation
is the one unique bit. But there is support needed in having the
confidence to apply those existing skills to these new situations.’
A project reference group of 10 occupational therapists was set
up to develop the training and drew on member experiences, with
input from academics and a service user.
A networking day in March 2019 also helped flesh out the
issues facing the field: a lack of established pathways, tools and
resources, leaving members unsure what their role could be an how
they should do it; a lack of confidence in transferring their existing
skills to perinatal care; and a lack of understanding among other
professionals as to what the occupational therapist role is.
That last point was proving a serious barrier for new staff.
Indeed, Health Education England has recognised that perinatal
occupational therapists risk becoming generic practitioners, and that
women and families may therefore not benefit from occupational
therapy skills and expertise.
The result has been occupational therapists feeling they were
losing their sense of professional identity and feeling disillusioned,
uncertain and frustrated in their new roles.
The new training is therefore designed to help members to
understand both what they can do in their roles, and how they can
communicate that to others. mother and baby to do together.
• Physical ability, and supporting pre-existing physical
conditions.
• Ensuring community access such as by supporting
confidence in public transport and getting out.
• Tackling social isolation with supportive networks and
links into the community.
• Managing symptoms – such as practical ways to manage
anxiety.
• Managing sensory needs, including for the many cases of
previously undiagnosed autism that come to light with the
sensory challenges of a new baby.
Supporting mothers in inpatient services
While most new members to the field will work in the community,
there are also some new posts in inpatient mother and baby units.
• Self-care, as people can struggle with looking after
themselves when their mental health is under stress.
• Roles, including the shift in identity from working to being
a parent – as well shifts back to the workplace later on.
• Helping to establish routines to support the the mother
and family’s wellbeing.
• Employment and study, such as supporting reasonable
adjustments back into the workplace.
• Making sure the home environment is safe for mother
and baby.
• Leisure, to ensure a sustainable balance of occupations
and to give the mother time to herself.
• Household management, such as budgeting, cooking
and menu planning.
• Relationships, including the supporting relationships with
family and partners.
• Bonding, by ensuring there are positive activities for the
Clare Hooper works as a clinical specialist occupational therapist
at a unit in the Barberry in Birmingham, and was also one of the
reference group that developed the training. She describes the
changes in the sector as ‘long-awaited investment’.
Clare started 16 years ago on a two day a week secondment,
which later expanded to four days a week. Now, she also has two
band five occupational therapists on the ward, as well as
four band six occupational therapists working in community
teams. ‘I hadn’t expected it to happen quite as quickly as it did,’
she says.
The mothers who Clare works with require inpatient admission
for a variety of issues, including post-natal depression, post-partum
psychosis and the exacerbation of longstanding issues including
personality disorders.
‘These women are often struggling with their transition into
motherhood as a result of their illness getting in the way of the
natural process of getting to grips with motherhood and all the
changes that brings,’ says Clare. ‘And they are of course not in the
home environment, so in a way that an occupational therapist might
see someone in the community, these women are often in an alien
environment.
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