Occupational Therapy 

 

The History of the Profession

Occupational Therapy the history of the profession

Occupational therapy is a little-known profession; many Occupational Therapists (OT) will spend their whole career introducing themselves to non-medical people as an OT and will, more often than not, receive a blank response. It is not surprising then that 95% of our clients have little or no idea at initial assessment what OTs can do or how occupational therapy can help them.

Despite this lack of knowledge, OTs themselves remain resolute in the passion they hold for their profession. This commitment to ‘the cause’ can be attributed to the dogged determination held by all OTs that everyone has the right to reach their potential regardless of illness or disability.

All OTs have a unique set of skills; we do what we do because we have seen first-hand the benefits experienced by our clients after a period of occupational therapy intervention.

 

 Our profession is truly holistic; the client centred nature of the role is guided by the aspirations and goals of the clients we serve. 

Jo Throp

 

The question, ‘What is occupational therapy?’ is one we hear often and one I hope to address here. However, in the end, it does not matter if our profession is unknown by the vast majority of people, what matters is, that if you need us, we are here.

Human occupation is defined as the doing of work, play or activities of daily living within temporal, physical and sociocultural context that characterises much of human life

Gary Kielhofner

What does an Occupational Therapist do?

OTs use activities to improve health and wellbeing. They work with all age groups and understand the concept of human occupation and behaviour; they understand activities, human function and the impact of the environment on individual abilities. They are interested in a person’s ability to participate and perform activities and they use activities as therapeutic tools to promote health and wellbeing.

OTs hold a BSc (Hons) degree in occupational therapy or a Diploma of the College of Occupational Therapists (Dip COT) and after a period of clinical practice they usually specialise in a chosen clinical speciality, including, among others, neurogical OT.

The history of the use of activities in healthcare

Occupational therapy and, specifically, the use of activities in healthcare has established roots in history. The earliest use of activities in healthcare goes as far back as Ancient Greek times. Asclepiades of Bithynia (124-40 BCE) was the first physician in Rome who treated patients with a mental illness humanely using a variety of activities, including therapeutic baths, massage, exercise and music.

Having a knowledge of how medical care has evolved throughout the centuries helps us to understand how and why the occupational therapy profession evolved and was established, and the principles that guide the way we work today.

In the 18th Century, management of individuals' mental health needs was poor. Formal descriptions of diagnosis were rare and little was understood about mental health. Care in the asylums was often harsh and people were treated poorly. Examples of poor management included:

 

  • People being chained up in cells

    People being chained up in cells

  • Records of treatment for insanity, which included wrapping patients in wet sheets, obscuring vision and laying them out in neat rows, or restraining people in adult size restraint beds known as cribs

    Records of treatment for insanity, which included wrapping patients in wet sheets, obscuring vision and laying them out in neat rows, or restraining people in adult size restraint beds known as cribs

 

Towards the end of the 18th Century, things started to change with the introduction of the ‘Moral Occupational Treatment Movement’. It was felt that treating people in the examples given, unsurprisingly to us today, does little to help people improve. The Moral Occupational Treatment Movement recognised the connection between mental wellbeing and activity; their views pushed forward change within the mental health services at that time and cemented the professions foundations within the mental health arena.

In the 19th Century a lady called Octavia Hill worked as a social reformer, her life's work focused on trying to address the causes of poverty. Octavia believed in the principle, ‘give a man a fish and he will eat for a day, teach a man to fish and he will eat for a lifetime.’

In the late 19th century she established the ‘Settlement House Movement’ to help people living within the London slums, the focus of which was on self-care and helping people to look after themselves. The settlements were created to move people out of poverty, and would offer care of ‘the whole person’ by supporting general wellbeing, assisting individuals to develop independent living skills, such as managing their lives and affairs and encourage development of new skills by the introduction of recreational activities. The movement, started by Octavia Hill, highlights the importance of independent living skills within the community setting and offers insights into the value that is placed on these skills within the occupational therapy profession today.

It is neither wealth nor splendor, but tranquility and occupation which gives you happiness

Thomas Jefferson

The evolution of occupational therapy, the value of occupation

The First World War created great change within the United Kingdom. The uprising of the women's movement, combined with a reduction in a male dominated work force, with many men fighting overseas, provided ideal opportunities for women to develop skills away from the home. This opportunity lead to women expanding their skills in vocational based activities and within the arts and crafts sector. These new-found skills were then applied to the medical arena and became useful in the treatment of WW1 service men coming back injured from the war. Occupation and activities were used to get men back to the workforce or returned to the front, and ir was atthis time that we saw the development of bedside occupations, primarily arts and crafts and workshop activities, to build strength and stamina.

At the same time as all this social reform, a lady called Elizabeth Casson worked as a Social Housing Officer (like those set up by Octavia Hill) and who subsequently trained as a Doctor working within mental asylums. She realised that occupation was fundamental to an individual’s health and wellbeing and must be a central part to good health and wellbeing. Later in her career she studied in the United States and brought back the ‘Occupational Therapy’ approach. Elizabeth Casson formed her first clinic in 1917 and, subsequently, set up the very first occupational therapy school in Bristol.

Occupational therapy, our role within a modernising health care system

All the social history and change within healthcare has resulted in the profession that we know today. OTs use activity as a medium for treating and managing health and wellbeing; looking back over time this goes some way to explain why the profession is so broad.

OTs work across health and social care and can be found within:

 

  • 1

    Physical health and rehabilitation settings: working with adults and children sits within the acute hospital and community settings

  • 2

    Social care: within statutory services advising on housing, environmental adaptions and equipment

  • 3

    Mental health services within acute and community services

  • 4

    Emerging services, such as charities and voluntary organisations, who see the value and unique skills that an OT can bring to a team or service

        

The fundamental principles of occupational therapy are the same now as they were back then. Having knowledge of the profession and its historical roots can help us to understand the focus of OT in the present day and the intrinsic value of the profession.

A skilled Neuro OT blends the knowledge of a person with an in-depth understanding of the brain and how it functions. They have a curious and enquiring mind regarding the components of activities and where the barriers to independence lie, with a persistent determination to problem-solve and help their client overcome the actual or perceived barriers to independence

Jo Throp, Clinical Director

Further reading

From the history of our profession through to current day practice you can find all you need to know here...

A Guide to  Neuro OT

A Guide to Neuro OT

OTs use activities to improve health and wellbeing, they work with all age groups and understand the concept of human occupation and behaviour, they understand activities, human function and the impact of the environment on individual abilities. Let’s put this theory into some context.
Neuro OT in Context

Neuro OT in Context

OTs use activities to improve health and wellbeing, they work with all age groups and understand the concept of human occupation and behaviour, they understand activities, human function and the impact of the environment on individual abilities. Let’s put this theory into some context.


Neuro OT in Practice

Neuro OT in Practice

Effective rehabilitation and, specifically, Neuro OT are only beneficial if time has been taken to understand the person before commencing rehabilitation. Understanding an individual’s values, motivators and aspirations are an essential foundation to effective outcomes.
Our Blog and News feed

Our Blog and News feed

Our resources pages are full of interesting reads, award winners, competition winners and the latest conference visits. Get yourself a cup of tea, sit back and enjoy all things neuro OT!

 

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