Tuesday, 11 September 2012

Occupational Engagement in Mental Health Recovery.

One of the major challenges I have to try an overcome at work is motivating the individuals whom I work with to engage in their recovery process. Individuals who have enduring mental health conditions often lack motivation and the drive to effectively move forward in their rehabilitation.
After discussing with the head OT where I work about how I could best motivate the service users on my ward to engage more in occupations and activities, we began to speak about the different stages of recovery for individuals. When thinking about recovery it is crucial to apply a client centred approach to formulating treatment plans. There is no one size fits all solution to recovery in Mental Health and so a knowledge of the different stages and ideas surrounding the recovery process can aid OTs and other health professionals in gaining a greater understanding of the needs of their service users.

A recent article published in the Canadian Journal of Occupational Therapy (June 2012, 79(3), pp.142-150) explores different stages in occupational engagement in Mental Health Recovery. I found the article an interesting read and it certainly helped me understand more about the process of engagement in recovery and has developed the way in which I am going to formulate treatment plans for my service users in the future.
This blog post is going to be a brief discussion about the article.

“A phenomenological study of occupational engagement in recovery from mental illness.”  
Sutton, D.J., Hocking, C.S., and Smythe, L.A. (2012).

The purpose of this article was to explore the experience and meaning of occupation for thirteen people who self-identified as being in recovery from mental illness. Recovery narratives were collected from participants in conversational interviews that were recorded and transcribed. These transcripts were then analysed and the finders were as follows:
·         A range of experiences were evident in the recovery narratives and these have led to implications for practice being that all forms of occupational engagement, from disengagement to full engagement can be meaningful in the recovery process. The article calls for therapists to understand these different modes of engagement in order to support their service users through recovery.
The findings of the article were most interesting. The authors explained how a range of occupational experiences emerged from the participants stories. Four points in the recovery continuum of engagement were proposed, there are; disengagement, partial engagement, everyday engagement and full engagement. Each of these were characterised by particular dynamics and each have the potential to support service user’s recovery.  Below is a brief summary of the four points.


This is the stage where individuals completely disengage or cut themselves off from everyday occupations. Individuals in this stage described themselves as feeling numb and having lost all intentionality for being in the world. During this point the absence of routine occupations and everyday living can cause a potential loss of meaning and sense of self. This point in an individual’s recovery can act as a kind of asylum which protects the individual from the demands of the outside world. Stripping back everyday existence and disconnecting from routine occupations can create space for individuals to gain a fresh perspective and reconnect with their volitional foundations of everyday life.

Partial Engagement.
This is the stage where individuals could not engage themselves full in the everyday world however could connect in some way with the immediate world around them. Individuals in this stage often express it as a slow process which provides a grounding for them in the future. Partial engagement ideally creates a space of respite where individuals can gradually get back in touch with the everyday world by slowly engaging more in occupations. The process of occupations in this stage are more about the process than the enjoyment or outcome.

Everyday engagement
This is the stage where individuals enter everyday engagement which involves having direction and increased commitment, meeting expectations and synchronising with others space and time. It is about individuals learning how to be a part of something shared and engage more in community and social situations.

Full Engagement
This is the stage which sees individuals create a sense of flow through deep engagement in meaningful occupations. It is characterised by focused attention, great enjoyment and integration of the individual with their environment.

I feel that from having an understanding of these four points in recovery and recognising that individuals dwell in them at specific and often varying times can help therapists when planning their treatment plans for service users. I particularly like the first stage mentioned, disengagement, this is a stage which I see often with my service users and this article has provided me with a new way of looking at their current place in their recovery process. Before reading this article I had not viewed disengagement and the characteristics of this as being a very positive stage and struggled with knowing where to start really with my service users in this stage. This article has given me a deeper understanding of disengagement in the recovery process and how it can be looked on a positive part of the process and therefore how it can be a springboard for individuals to more onto a more functional area of occupational engagement.

Having a picture of the four stages of occupational engagement in the back of my mind when thinking about my service users, I feel, will help me to formulate both individual and group activities and opportunities on my ward. I am looking forward to returning to work tomorrow and thinking more about these stages and how I can incorporate some of the ideas which the article explored in my practice.

Happy OTuesday!


Sutton, D.J., Hocking, C.S., and Smythe, L.A. (2012). A phenomenological study of occupational engagement in recovery from mental illness. Canadian Journal of Occupational Therapy, 79, 142-150, doi: 10.2182/cjot.2012.79.3.3


  1. Hi Katie,
    Very interesting read and definitely helpful to look at service users' disengagement as a period of healing. I'm a support worker for people with mental illness and one of the biggest challenges that I face is trying to motivate people. I often think that those who do not want to engage in activities or support is mostly due to anxiety or a belief that they cannot do it. This belief has often been instilled in people who have been in mental health services for a long time, when the service itself was not recovery focussed.
    Sounds likes you're really enjoying your job. I hope all is well with you. Laura

  2. Hi Laura, great to hear from you!
    Thank you for your comment, am excited to hear about your new job role. I completely agree with the comments you make. Often I think it is a sense of anxiety but also a loss of hope, especially for those who have been in services ,in particular as inpatients, for years. Don't give up on trying to motivate those who you work with - just seek to find the hook which is going to start their engagement.
    I am enjoying my job yes - It's incredibly challenging though. Hope life in NZ is treating you and Kit well. Best wishes, Kate.