Posted by: Fiona Breytenbach | 2020/01/29

Response re: OTs role - Prof Simpson

I’m sorry your experience of OTs has been so terrible! Clearly you’ve come across some wholly useless ones and others that feel they can diagnose conditions. I completely agree that a doctor should diagnose conditions and prescribe medications and OTs in this regard need to work within their scope. However I felt your article comparing psychologists and OTs quite off the mark with regard to our role in psychiatry. Similarly to medicine, OTs are trained to work in various fields, psychiatry being one of them. An OT would assist a person with Bipolar mood disorder in various occupations of their life that are usually affected, such as returning to work (providing return to work assessments, advising employers on reasonable accommodations, work hardening skills), home reintegration (budgeting/finances, routines, health maintenance), social participation (communication) and very rarely ADLs (bathing, dressing, etc which would more commonly be addressed in areas like stroke rehab). For example, our department runs a coffee shop- psychiatric patients prepare food, interact with real customers and manage the shop in a simulated, supportive work environment. It’s in these real-world scenarios that skills like communication, managing triggers and implementing strategies really translate into true community reintegration. The MDT work very closely and will report back to each other on how he/she copes or what the goal of therapy (through all disciplines) is. Unfortunately many HCWs only know us for helping with ADLs or think we keep patients from getting bored (because, hey who doesn’t want to make cakes and coffee all day!). Although your history of OT is correct, it moved toward an evidence-based approach decades ago - however it has always adopted a social model of disability as opposed to the biomedical model. I hope that in future your experience of OTs change!

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Our expert says:
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- 2020/01/31

OK, it wasn't an article, but a response to a reader's question, but that's not the issue.  But as it seems as though your concerns relate to comments made three years ago, current readers may not be familiar with any issues here.
Actually, over the decades I've had many lovely experiences working with some very fine OT's, especially in hospital rather than private practice.
It seems that we actually agree on many points, as I expected,  and I generally appreciate your summary of what good OT's do.  Including a potential role in helping people with severe Bipolar Disorder.  The original question seemed to imply a choice between a Psychologist and an OT in helping someone with major Bipolar Disorder.  I'd hope that this would not be a choice a patient or family would have to make ( though I suppose it might occur in private practice ).  Based on my experience I would prefer both, but if it were a forced choice, I'd rather choose an experienced psychologist, if we could not provide access to both.
Yes, the history of our fields of work has shown major change in the last few decades, and not only in OT.  Social Workers used to be the Lady Almoner, with her main role being assumed to be the disbursement of charitable funds ( and the assumption that they would be ladies and not even occasionally gentlemen ) ; and not long back, Psychiatrists were called Alienists, as well as a much larger vocabulary of abusive terms !
All along, the best in each of these complimentary professions worked towards finding the essence of what they could most usefully contribute.
It sounds as though the patients lucky enough to have access to the services you describe are indeed fortunate.  If only such services were available to all who might benefit from them.

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