Important Note: In this article, I will use the term “Occupational Therapy Practitioner” (OTP) to refer inclusively to both Occupational Therapists (OTs) and Occupational Therapy Assistants (OTAs). This distinction is important because “Occupational Therapist” refers specifically to professionals with advanced education, training, and responsibilities. OTs hold a master’s or doctoral degree, while OTAs are required to have an associate degree and work under the supervision of an OT. If the term “OT” is used in the article, it will be to highlight a role or responsibility specific to Occupational Therapists that differs from that of OTAs.
Disclaimer: The views and opinions expressed in these contributions are those of the individual authors and do not necessarily reflect the views of Recovery.com.
Occupational Therapy in Mental Health and Substance Use Recovery: An Introduction
Mental illness and substance use disorders impact more than just a person’s thoughts and beliefs about themselves, others, the world, and their relationships—they also greatly affect an individual’s ability to participate in daily life. Many mental health conditions can make it challenging for a person to get out of bed, brush their teeth, shower, make breakfast, care for themselves and others, and engage at work or school. While most mental health and substance use recovery centers have therapists and other psychiatric practitioners who can support processing trauma, emotional regulation, medication management, and inner child healing, very few have specialized professionals who can support skill building to enhance engagement in everyday life. This is where Occupational Therapy (OT) comes in.
Occupational therapy practitioners (OTPs) are experts in helping people build skills needed to manage day-to-day life. These skills include decision making, time management, goal setting, communication, cooking, organization, establishing daily routines, as well as many others.
OTPs focus on practical, personalized solutions that empower clients to engage in meaningful daily tasks, referred to as “occupations.” Within the field of OT, these occupations are categorized into ten distinct areas:
- Activities of Daily Living (ADLs)
- Instrumental Activities of Daily Living (IADLs)
- Work
- Education
- Play
- Leisure
- Sleep
- Rest
- Health management
- Social participation1
OT is a broad and versatile field. You can find OTPs working in settings such as pediatric clinics, schools, hospitals, hand therapy, dementia care, and neuro-rehabilitation centers. Although only a small percentage of OTPs specialize in mental health today, the roots of the profession are deeply grounded in psychiatric care, making OT an essential part of recovery for many individuals2.
A Brief History of Occupational Therapy in Mental Health
While some aspects of the profession can be traced back to the 1800s, OT as we know it today didn’t emerge until the early 20th century3. The profession was founded on the belief that meaningful engagement in daily activities could promote recovery and well-being for individuals with mental illness. The idea that participation in purposeful activities could help improve mental health was groundbreaking and laid the foundation for the profession2 which remains, to this day, the heart of what we do as OTPs.
In the early years of the profession, OTPs worked primarily with individuals who were institutionalized3, using activities to help patients develop a sense of purpose and reduce boredom. However, as medical and behavioral health care evolved, the role of OT expanded beyond psychiatric practice. Due to this expansion and other challenges, OT’s presence in mental health settings has decreased over the years2. Only about 2% of OTPs work in mental health4, which makes it challenging for people to access OT.
Occupational Therapy’s Role in Mental Health
OT in mental health focuses on helping individuals participate in activities that give their lives meaning and structure. For individuals experiencing mental illness and/or substance use disorders, it can be challenging to maintain daily routines or manage the demands of work, school, and relationships. OTPs help clients identify activities that are important to them and develop strategies to overcome barriers that prevent participation5.
Before working with a client an occupational therapist will evaluate a client’s current abilities to perform a variety of daily activities and work with them to set realistic and achievable goals. These goals often focus on improving self-care, building coping strategies, addressing sensory processing challenges, developing executive function, enhancing social skills, and establishing routines. For example, a client struggling with depression may find it difficult to get out of bed in the morning or prepare meals. An OTP can help by working with the client2 to develop a morning routine, break tasks into smaller steps, and use strategies to overcome fatigue or lack of motivation.
OTPs also focus on helping clients develop coping mechanisms to manage symptoms related to mental illness. For individuals with anxiety, this may involve teaching relaxation techniques or helping them use sensory-based strategies to reduce stress and dysregulation. For people with ADHD, it may include creating structure and organizational strategies to help them stay on track with tasks.
It’s important to know that OT doesn’t stop at skill building; one of the core focuses of the profession is ensuring integration of learned skills into daily life. It’s not just about teaching and having clients practice skills in therapy; it’s about helping them take the skills and apply them in real time. The ultimate goal of OT is to help clients build and implement the skills they need to lead fulfilling, balanced lives.
Working with Clients in Substance Use Settings
Substance use disorders often co-occur with other mental health conditions such as trauma, anxiety, depression, and ADHD. OT can play a vital role in helping individuals with substance use disorders rebuild their lives5 by focusing on establishing healthy routines, improving self-care, and finding new ways to experience joy and fulfillment without the use of substances.
One of the key ways in which OTPs help individuals in substance use treatment is through exploration and development of leisure skills5. Clients with substance use disorder often lose the ability to engage in healthy, fulfilling leisure activities. Additionally, boredom is frequently reported as a significant trigger for relapse6 as it can lead to feelings of restlessness, isolation, and frustration. These are feelings that many people seek to reduce through the use of substances.
Additionally, OTPs help clients in substance use recovery develop practical skills5 for daily life in recovery. This includes managing finances, preparing meals, finding and maintaining employment, and self-care. For many people in recovery, these are areas that are often neglected during substance use, and relearning how to manage them can be overwhelming. OTPs work with clients to break these tasks into manageable steps, build confidence, and develop the skills needed to maintain independence.
In substance use recovery, OT empowers clients to explore new hobbies, interests, and activities that bring joy and meaning to their lives. By nurturing independent living skills and establishing structured routines, OT not only promotes a journey of healing but also lays a foundation for long-term recovery.
A Brief Overview of Mental Health Occupational Therapy Interventions
OT interventions vary depending on the specific mental health condition a person is experiencing. For individuals with anxiety disorders or those who have experienced trauma, interventions might include developing coping strategies to manage symptoms7, such as deep breathing, progressive muscle relaxation, or sensory modulation techniques. If a client were experiencing depression and struggled to engage in self-care tasks, an OT would likely focus on establishing a daily routine2, setting small, achievable goals, and finding ways to increase motivation and energy. Clients with ADHD require an approach that focuses on creating organizational systems, such as using a planner, breaking tasks down into manageable steps, and using visual supports, like a timer, to stay on track.
Additionally, OTPs are specially trained to assess and address sensory processing challenges, which are common among people with mental health conditions like anxiety, ADHD, OCD, bipolar disorder, SUD, and trauma. This is one of the most unique aspects of the profession. Sensory processing refers to how the nervous system receives and organizes sensory information8 from the environment so that individuals can respond appropriately.
Dunn’s Sensory Processing Model helps occupational therapists understand a person’s unique sensory preferences by categorizing these preferences into four patterns: Sensory Sensitivity, Sensation Avoiding, Sensation Seeking, and Low Registration. Someone with sensory sensitivity patterns will likely become more easily overwhelmed with stimuli9 such as bright lights or loud sounds, which can lead to feelings of anxiety or agitation. In contrast, someone who has sensation seeking patterns will crave more intense input, such as jumping, pushing, or spinning, to feel calm and focused.
By identifying a client’s sensory profile, occupational therapists can tailor interventions to support their nervous system needs so that they are more regulated and able to engage in their daily life (Pfeiffer et al., 2018).
Summary
OT plays an essential role in the recovery journey for those with mental health disorders and substance use issues. While the profession may not be as well-known in mental health settings as other types of therapy, its unique focus on helping people engage in daily life makes it an essential part of the recovery process. Whether working on establishing a morning routine, building coping strategies, or developing new leisure skills, OTPs help clients regain a sense of purpose, independence, and fulfillment in their daily lives.