Clarifying the Scope of Occupational Therapy

To the Editor: The article by Kopelowicz and associates in the October 1998 issue raises some important questions about the changes occurring in behavioral health care, but I believe it casts an unwarranted negative light on occupational therapy.

Over the past 75 years, occupational therapists have been dedicated practitioners in the mental health service delivery system, continuously promoting clients' overall function and their specific acquisition of knowledge and skills for community living while other practitioners have focused on illness and symptoms. In fact, many of the current psychiatric rehabilitation practice models incorporate occupational therapy theory and practice. The profession's overall commitment and accomplishments in maximizing social functioning and mental and physical well-being in the community is reflected in a recent outcome study by Clark and associates (1).

The research by Dr. Kopelowicz and his colleagues purports to compare two treatment strategies, but it falls to provide any meaningful information about one of them. The community re-entry program is described extensively, while the occupational therapy sessions are briefly mentioned as including "the full range of customary … activities." Occupational therapy is not all of a piece! Our practitioners use a variety of brief, focused strategies to promote particular, individualized ends that may target personal goal setting, attention and concentration, problem solving, stress management, emotion management, communication skills, and other critical coping capacities.

The lack of information about the occupational therapy sessions leaves readers without any data to appraise the study's outcome. Did the occupational therapy regimen in question even focus on community re-entry and the importance of treatment compliance? Or, was it addressing complementary areas that help to contain or manage acute symptoms and encourage more effective self-management in daily living?

Although occupational therapy services may have been selected as a standard treatment with which to compare the targeted strategy, the authors' generalizations serve to undeservedly challenge the credibility of the profession. In fact, the American Occupational Therapy Association has published Practice Guidelines for Adults With Schizophrenia that stress skills for community reintegration (2).

I commend Dr. Kopelowicz's commitment to making brief inpatient hospitalization as purposeful as time constraints permit. Facilitating treatment compliance and sustaining patients in the community is a high priority for all disciplines. However, I urge him and his colleagues to pursue this objective by using the relevant knowledge and skills of occupational therapy instead of dismissing their value for the evolving behavioral health care system.

Ms. Bair is executive director of the American Occupational Therapy Association in Bethesda, Maryland.