Occupational Therapy for Middle-Aged Patient
the
By L. M. Mirrey, M.A.O.T.
Mrs.
Mirrey was Head Occupational Therapist of a large Psychiatric hospital for some years and is now Public Relations Officer for the Association of Occupational Therapists.
PSyCHIATRTC aims
treatment
today community patients as possible from our c hospitals. Emphasis on to return to the
as
jf-ny ofmrnunity j. Local
Psv com
and the commitment to Authorities provide anc* sheltered workshops have hospital staff to work with horizons than was possible
enaki
Wid
care
bef6r therapists, a|0?re- w'thOccupational professions, hay18 been the allied engaged in e
0
actively
lgar
re-
and planning treatment to that those patients who are w'" he equipped to cope With -ged the problems and stresses they ? ^eet outside the more sheltered en lronment of the hospital, tho CcuPational therapy encompasses aspects of rehabilitation conor a hom W't'1 mana8'n8 a J?h social anc* making good vital' ns-hiPs- These are the most Points to consider and like all ty0 people are com i- connected with bec Seated and difficult to approach needs individual vary [u ?ugh the problems may appear
Rising
Jscharr
Cer^e
al(iaUse
same.
^?ng-term patients psychiatric ^M?st iarge substantial
"|0e
hospitals population of
a
Pat'ents anc* extensive carr- ,,itation programmes are being ?ut all over the country for and much has already been aCLj In the past the majority of evetle patients were regarded as ca$e
rehah"^rm" the'ec'
hkely to remain in the Thus occupational aimed to help them live W0 PV and useful lives in hospital 'n situations which caused the iR least stress and where chronic sy^ Ptoms were likely to remain
hostv
were
thetPl(;a'-
hat)aPisls
dormant. This aim is still necessary for some patients but has proved totally inadequate for others. The medical and practical training in occupational therapy is directed towards adapting and grading occupations so that assessments can be made of patients' capabilities. Being concerned with rehabilitation, it is not surprising that realistic activities are more often used to make these assessments. Industrial units, clerical units and domestic units have been set up, to name only a few. The result is, that together with other members of it has the treatment team, been possible to help patients at all levels of the rehabilitation "ladder". The
purpose of this article is to idea of what occupational therapy is doing for those long-term who have patients improved sufficiently to be considered for discharge. Obviously most of them are the in the middle age group, majority being between 40 and 55 years of age. Arranging a rehabilitation course for such patients is complicated and can only be effective if there is full co-operation between doctors, nurses, psychiatric social workers, D.R.O.s, psychologists and occupational therapists, for besides the patient's mental state it is equally important to consider the work available in a particular district and whether the patient will be acceptable because of his age; if he is unable to return to relatives there is the problem of accommodation and social contacts. These may seem patent points but it is a serious matter to encourage a patient to make an enormous effort to free himself from institutional life and then to find there is little to offer in its place.
give
some
185
/
I
Emotional
and not to protect them from stres5' situations which they will have face sooner or later. In some hosp1'3 these discussion groups are backed sessions of a more psychotherapy nature. The doctor may be pr#6 at a painting group or drama which is aimed to help patie5 express their difficulties through different medium. Occasionally decided that the occupati^ therapists should fulfil a purely thef' peutic role and not be teachers in a sense. In such hospitals the occupational therapist will enga-. experts in various fields to instf* while the occupational therapy manipulate the treatment situation.
problems
symptoms ol" the Apart original illness, the most usual being apathy, there are other feelings which are common to most people of this age who have been seriously ill. The whole conception of making a new life seems frightening and impossible. In fact these emotional problems cannot be separated from the practical ones of training for a job and these are the problems which patients are helped to overcome in their work and leisure hours. The aim in occupational therapy is to provide a working situation which is really practical in conditions as near normal as possible so that the patient is not relieved of all responsibility. When difficulties arise, as they surely do, they can be sorted out with the help of the staff. For example, a patient who has a flat of her own to go to, intends to get a light industrial job when discharged. In the occupational therapy department she will have the opportunity of finding out whether she can hold down a job of this type and get on with her work-mates and employers. She will also be expected to run a flat in the hospital for a trial period and do her own budgeting, cleaning and cooking. Therefore occupational therapists are confronted with a dual "role". Not only do they have to provide work situations as near normal as possible but also a therapeutic atmosphere where difficulties can be sorted out and understood. This is the meaning of the term "occupational therapy". In some hospitals the problem of the dual role is overcome by running the special units I have mentioned strictly as workshops, setting aside certain periods of the day for discussion between patients and all the staff concerned with the rehabilitaare tion Patients programme. encouraged to voice their difficulties and to help each other and in this way problems which some patients are loath to express gradually come to the surface. Emphasis in treatment is based on letting patients accept responsibility for their lives from
Change
of attitude
This account would not be plete without mentioning the chawtr of attitude which is necessary on part of all the staff concerned in s^' a project. Tt is not easy to let pati^r be naWf One's independent. reaction is to be protective and support, and experience is required this work to know when to step and give advice. It has been that time spent by members of , treatment team in discussion is rea worthwhile. The therapist will pass on to other bers an opinion of a patient's ah'"to hold down a job. The psychfe1!, social worker will make enqui^ about accommodation (among other things) and the D.R.O. will information about work Nurses and occupational therap'5 ens11; work in close liaison to continuity of approach between life and work life. And lastly, mllC is being done by voluntary organ'5 tions to bridge the gap betW' hospital and community for th# patients. Some have visited patiel1. in hospital and others invited out to tea or even for a Other organisations have provided 1 centres for those patients who free to go out as they like but { nowhere to go. These contacts ha done so much to help patients come the fear of meeting new peoP
fo^.
occupatio'J.
fjL availa^
thejj
week^
av?
o^,
186
3
In this unwanted. group the unwanted lnS is uppermost in many patients' lnds. Often they have not the supinterest or affection of close atives who might provide incentive. p one finds feelings of guilt ?ut , being in hospital and having the family which has now the doors behind the patient. is not necessarily aimed at s r.e^ment g ^ese problems for many are in of that but many patients how to accept .these drawbacks ,ai"n and "live" with them. fe
.
feeling
>t'cu'ar
me reirt'.
age
a,ecIUently
c,neglected" -p0sed
leCaPable ^Se
of leisure
leisure time is as the work a patient during the day. Again, it j a bad policy to provide entertain^ ent, although patients should not be Pected to arrange highly social lives r themselves for this is not the n orrrial habit in this age group. The therapist will discuss ^ the patients their interests and obbies and be ready to assist in rangements if asked. The whole i
of
use
^Portant uertakes
as
.
w'.^pational
question of social contact is most important and staff closely observe their patient's progress in this direction. Training and experience are
essential to understand these subtle undertones which indicate so much about the way patients are thinking and The feeling. occupational therapist makes use of the training in psychology and psychiatry all the time in the activities arranged for
patients.
Most of the work undertaken by occupational therapists in general hospitals is directed towards helping the injured and disabled return to work efficiently and quickly and to help those with permanent disabilities lead as to independent lives as possible. The rehabilitation of the is long-term psychiatric patient similar, for them, too, independence is equally the aim. Occupational therapy is one of the professions registered under the "Professions Supplementary to Medicine Act (I960)". Occupational therapists work in hospitals, clinics and in domicilary work throughout the country. Further information may be obtained from the Secretary, Association of Occupational Therapists, 251 Brompton Road, London, S.W.3.
the
By L. M. Mirrey, M.A.O.T.
Mrs.
Mirrey was Head Occupational Therapist of a large Psychiatric hospital for some years and is now Public Relations Officer for the Association of Occupational Therapists.
PSyCHIATRTC aims
treatment
today community patients as possible from our c hospitals. Emphasis on to return to the
as
jf-ny ofmrnunity j. Local
Psv com
and the commitment to Authorities provide anc* sheltered workshops have hospital staff to work with horizons than was possible
enaki
Wid
care
bef6r therapists, a|0?re- w'thOccupational professions, hay18 been the allied engaged in e
0
actively
lgar
re-
and planning treatment to that those patients who are w'" he equipped to cope With -ged the problems and stresses they ? ^eet outside the more sheltered en lronment of the hospital, tho CcuPational therapy encompasses aspects of rehabilitation conor a hom W't'1 mana8'n8 a J?h social anc* making good vital' ns-hiPs- These are the most Points to consider and like all ty0 people are com i- connected with bec Seated and difficult to approach needs individual vary [u ?ugh the problems may appear
Rising
Jscharr
Cer^e
al(iaUse
same.
^?ng-term patients psychiatric ^M?st iarge substantial
"|0e
hospitals population of
a
Pat'ents anc* extensive carr- ,,itation programmes are being ?ut all over the country for and much has already been aCLj In the past the majority of evetle patients were regarded as ca$e
rehah"^rm" the'ec'
hkely to remain in the Thus occupational aimed to help them live W0 PV and useful lives in hospital 'n situations which caused the iR least stress and where chronic sy^ Ptoms were likely to remain
hostv
were
thetPl(;a'-
hat)aPisls
dormant. This aim is still necessary for some patients but has proved totally inadequate for others. The medical and practical training in occupational therapy is directed towards adapting and grading occupations so that assessments can be made of patients' capabilities. Being concerned with rehabilitation, it is not surprising that realistic activities are more often used to make these assessments. Industrial units, clerical units and domestic units have been set up, to name only a few. The result is, that together with other members of it has the treatment team, been possible to help patients at all levels of the rehabilitation "ladder". The
purpose of this article is to idea of what occupational therapy is doing for those long-term who have patients improved sufficiently to be considered for discharge. Obviously most of them are the in the middle age group, majority being between 40 and 55 years of age. Arranging a rehabilitation course for such patients is complicated and can only be effective if there is full co-operation between doctors, nurses, psychiatric social workers, D.R.O.s, psychologists and occupational therapists, for besides the patient's mental state it is equally important to consider the work available in a particular district and whether the patient will be acceptable because of his age; if he is unable to return to relatives there is the problem of accommodation and social contacts. These may seem patent points but it is a serious matter to encourage a patient to make an enormous effort to free himself from institutional life and then to find there is little to offer in its place.
give
some
185
/
I
Emotional
and not to protect them from stres5' situations which they will have face sooner or later. In some hosp1'3 these discussion groups are backed sessions of a more psychotherapy nature. The doctor may be pr#6 at a painting group or drama which is aimed to help patie5 express their difficulties through different medium. Occasionally decided that the occupati^ therapists should fulfil a purely thef' peutic role and not be teachers in a sense. In such hospitals the occupational therapist will enga-. experts in various fields to instf* while the occupational therapy manipulate the treatment situation.
problems
symptoms ol" the Apart original illness, the most usual being apathy, there are other feelings which are common to most people of this age who have been seriously ill. The whole conception of making a new life seems frightening and impossible. In fact these emotional problems cannot be separated from the practical ones of training for a job and these are the problems which patients are helped to overcome in their work and leisure hours. The aim in occupational therapy is to provide a working situation which is really practical in conditions as near normal as possible so that the patient is not relieved of all responsibility. When difficulties arise, as they surely do, they can be sorted out with the help of the staff. For example, a patient who has a flat of her own to go to, intends to get a light industrial job when discharged. In the occupational therapy department she will have the opportunity of finding out whether she can hold down a job of this type and get on with her work-mates and employers. She will also be expected to run a flat in the hospital for a trial period and do her own budgeting, cleaning and cooking. Therefore occupational therapists are confronted with a dual "role". Not only do they have to provide work situations as near normal as possible but also a therapeutic atmosphere where difficulties can be sorted out and understood. This is the meaning of the term "occupational therapy". In some hospitals the problem of the dual role is overcome by running the special units I have mentioned strictly as workshops, setting aside certain periods of the day for discussion between patients and all the staff concerned with the rehabilitaare tion Patients programme. encouraged to voice their difficulties and to help each other and in this way problems which some patients are loath to express gradually come to the surface. Emphasis in treatment is based on letting patients accept responsibility for their lives from
Change
of attitude
This account would not be plete without mentioning the chawtr of attitude which is necessary on part of all the staff concerned in s^' a project. Tt is not easy to let pati^r be naWf One's independent. reaction is to be protective and support, and experience is required this work to know when to step and give advice. It has been that time spent by members of , treatment team in discussion is rea worthwhile. The therapist will pass on to other bers an opinion of a patient's ah'"to hold down a job. The psychfe1!, social worker will make enqui^ about accommodation (among other things) and the D.R.O. will information about work Nurses and occupational therap'5 ens11; work in close liaison to continuity of approach between life and work life. And lastly, mllC is being done by voluntary organ'5 tions to bridge the gap betW' hospital and community for th# patients. Some have visited patiel1. in hospital and others invited out to tea or even for a Other organisations have provided 1 centres for those patients who free to go out as they like but { nowhere to go. These contacts ha done so much to help patients come the fear of meeting new peoP
fo^.
occupatio'J.
fjL availa^
thejj
week^
av?
o^,
186
3
In this unwanted. group the unwanted lnS is uppermost in many patients' lnds. Often they have not the supinterest or affection of close atives who might provide incentive. p one finds feelings of guilt ?ut , being in hospital and having the family which has now the doors behind the patient. is not necessarily aimed at s r.e^ment g ^ese problems for many are in of that but many patients how to accept .these drawbacks ,ai"n and "live" with them. fe
.
feeling
>t'cu'ar
me reirt'.
age
a,ecIUently
c,neglected" -p0sed
leCaPable ^Se
of leisure
leisure time is as the work a patient during the day. Again, it j a bad policy to provide entertain^ ent, although patients should not be Pected to arrange highly social lives r themselves for this is not the n orrrial habit in this age group. The therapist will discuss ^ the patients their interests and obbies and be ready to assist in rangements if asked. The whole i
of
use
^Portant uertakes
as
.
w'.^pational
question of social contact is most important and staff closely observe their patient's progress in this direction. Training and experience are
essential to understand these subtle undertones which indicate so much about the way patients are thinking and The feeling. occupational therapist makes use of the training in psychology and psychiatry all the time in the activities arranged for
patients.
Most of the work undertaken by occupational therapists in general hospitals is directed towards helping the injured and disabled return to work efficiently and quickly and to help those with permanent disabilities lead as to independent lives as possible. The rehabilitation of the is long-term psychiatric patient similar, for them, too, independence is equally the aim. Occupational therapy is one of the professions registered under the "Professions Supplementary to Medicine Act (I960)". Occupational therapists work in hospitals, clinics and in domicilary work throughout the country. Further information may be obtained from the Secretary, Association of Occupational Therapists, 251 Brompton Road, London, S.W.3.
