Disability
Feature in the 1990s to shift staff attention from medication and symptom management . They wanted staff support to address many different aspects of life and hold onto hopes of better times ahead .
Recovery-oriented approaches are now established in mental health services , but compulsory treatment and detention and prolonged austerity continue to undermine the rights of service users .
Friend or foe ?
Many professional theories of occupation appear to be consistent with the social model and recovery-oriented approaches , enabling people to overcome barriers in everyday life to achieve their goals .
Co-production presents opportunities to work in partnership . Yet occupational therapists have to adapt their theories to align with organisational priorities and the continuing dominance of biomedicine .
Mostly we work with individuals rather than activist groups . Historically , we have responded to changes in laws about disabled people , rather than campaigned with them .
Changing the law
Legislation guides people about what to do ; for example , where to park , or who can be an occupational therapist . Once a law comes into force , it is often interpreted locally . Inequalities and injustices come from interpretations about rights and responsibilities , particularly for people who have less resources and power to influence society .
Historically , people unable or unwilling to work inevitably became poor , including disabled people . Poor Laws led to workhouses being introduced , where people were expected to develop work skills so that they could re-join society . If they did not make progress because of apparent lack of effort , they were judged to be undeserving .
The belief that some people deserve state support and others do not , persists in contemporary discussions about welfare ( Beresford 2015 ). Disabled people repeatedly have to prove they deserve or are eligible for help . Occupational therapists have had to determine eligibility , especially in social care , since 1970 .
Social care occupational therapy
Following the Chronically Sick and Disabled Persons Act ( 1970 ) social services departments were set up , each with a medical officer overseeing community occupational therapy . Of the 3,672 occupational therapists registered to practice at the time , a small minority worked in the community ( Kimmance and Chick 1973 ).
They were based in hospitals , day centres and sheltered work units , as well as the new social services departments . Therapeutic work mainly involved providing equipment . Some occupational therapy staff
… when recovery and rehabilitation are aligned with a person ’ s goals , rather than organisational , professional or political aims , lives are transformed . Questioning eligibility criteria is part of challenging ableism .”
were co-ordinating diversional activities as a response to social issues .
The 1974 Housing Act made funding available for housing adaptations , but it was not always sufficient . So many people were eligible for aids and adaptations that occupational therapists were gatekeepers for when funding for public services was cut ( Underwood 1981 ).
Organisations tended to define disability by impairment , rather than societal barriers , and occupational therapists were unhelpful if prescribing assistive equipment without fully exploring the issues first ( Eakin 1985 ).
To find out more about those issues , OTs such as Dr Maggie Winchcombe took up opportunities to work in partnership with disabled people ( see profile ).
The Disability Discrimination Act ( 1995 ) made it illegal to discriminate against disabled people in employment and public facilities . In a comprehensive critical review , Craddock ( 1996 ) argued that OTs could see themselves as a resource for disabled people , rather than for their employers .
McCormack and Collins ( 2010 ) observed that the gatekeeping aspect of occupational therapy undermined client-centredness . When aware of the limited resources , including occupational therapists time , a disabled person may resist detailed discussions of their issues . If decisions about eligibility and resources involved disabled people , rather than being imposed on them , they could become citizens rather than clients ( Swain and French 2010 ).
Current tensions in practice and eligibility
Historically , occupational therapists have recognised the tensions for practice from changes in legislation . Our ableism , or personal , professional and organisational assumptions , can be revealed in our approach to eligibility and attitudes to disability .
As gatekeepers for public services and resources , occupational therapists often determine eligibility through their assessments .
In acute care , where there are pressures on beds , preparation for discharge is given priority by focusing on short-term safety in survival occupations . In mental
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