An exploration into how occupational
therapists in community mental health
services work with peoples strengths
and resources
Summary of research carried out for MSc Occupational
Therapy dissertation
at Sheffield Hallam University 2016-17.
Laura Heath
Contents
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Background to the research
Research aims
Research design and method
Research participants
Research findings
Discussion points
Research strengths and limitations
Implications
Thanks
References
Background to the research
A focus on peoples strengths and resources in legislation, policy and
strategy relating to health. (Department of Health 2014, Public Health England

2015)
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The recovery approach and peoples strengths and resources (Deegan
1993, Shepherd, Boardman, Rinaldi, and Roberts 2014)
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Recovery principles in:
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Mental health strategy (Department of Health 2011, Mental Health
Taskforce 2016)
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Occupational Therapy and mental health
(COT 2010, 'Creek's' 2014)
Occupational therapy and strengths and resources....(COT 2015, COT
2017)
Background ...established approaches

Strengths based approach
(Saleeby 1996, Rapp 1998, Morgan 2014)
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Solution focused therapy
(De Shazer & Berg 1985, 1988, Gingerich and Peterson 2013)
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Asset based approaches
(Kretzmann & McKnight 1993, Morgan & Ziglio 2007, Foot & Hopkins 2010)
Research Aims
Primary research aim
1) To identify in a community mental health setting, what are the themes and
components of an occupational therapy approach to working with peoples
strengths and resources?
Secondary research aim
1) To identify, in a community mental health setting, what supports Occupational
Therapists to work with peoples strengths and resources?
Research Design and Methodology

Qualitative Research
Principles of constructivist grounded theory (Charmaz 2007, 2014)
semi structured exploratory individual interviews
Interviews transcribed and analysed – to co construct theory
about what people said
Research Sample
Large NHS Trust in England with an occupational therapy strategy that
emphasises working with peoples strengths and resources.
13 occupational therapists work in 4 community mental health teams in the
Trust.
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Participants asked to volunteer if they try to work with peoples
strengths and resources
…..Aiming for 4-6 participants
Research Participants
Random selection used to achieve 6 participants from 3 teams.
Participant
No. of years
qualified as an
OT
No. of years
working as an OT
in community
mental health.
Length of Initial
Interview
Length of follow up
interview
A
11
10
43 mins
22 mins
B
22
19
66 mins
28 mins
C
24
9
53mins
24 mins
D
17
5
35 mins
20 mins
E
15
12
49 mins
22 mins
F
23
14
38 mins
26 mins
6
112 years
69 years
4 hours, 44
2 hours, 22
Ethics
Full consideration was given to research ethics
throughout the research design and
process of carrying out the research.
Research did not commence until all necessary academic
and Trust approvals had been granted.
Research Findings
Strengths (internal)
Resources (external)
Skills and abilities
Economic eg finances, housing, employment
Routines and structures
Cultural
Values and beliefs
Transport
Interests
Social eg family, friendships
Things people have achieved
Community resources e.g. groups, facilities
Things people are good at
Services eg health, education, social services
Things people are proud of
Things people enjoy
Roles eg parent role
Motivation (incl.belief in ability to change)
Future hopes
Category 1: understanding Contextual Factors
An understanding of contextual factors helps participants consider peoples
experiences in and of society, this helps them understand what influences
peoples abilities to identify, use and know their strengths and resources.....
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Social (family, friendships, living environment)
and economic (employment, finances) factors
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Experiences of Mental Health

Traumatic Life Experiences
“You need to work with peoples strengths and resources but its has to be
within the context and the limits of what they have got going on in their
lives as well, you've got to be realistic”.
“Often the people we work with have either been quite damaged historically
through life events or traumatic experiences as well as through their
mental illness. Their confidence in their abilities... in themselves,what
they feel they are able to do is really impaired.”
Category 2: Core Beliefs and Approaches
Beliefs:
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focusing on occupation is synonymous with focusing on strengths and
resources.
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everybody has strengths, which are unique to them.

peoples are able to change (although it can be hard to change).
Approaches:

Therapeutic relationship
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Collaborative and Person Centred

Assertive approaches to engage
“People are very individual and very unique it just takes a lot of
time to learn their stories and where they see themselves
going.”
“Its the belief that everybody can change...even if its just a little
step”
“I look for, I am always looking for, even if its a little chink
somewhere, that somebody is good at something”
Category 3: Identifying strengths and resources
Talking to identify strengths and resources:
Observing to identify strengths and resources:
Moving from identifying to doing....
“People can talk about it, or you might see it but they don't believe it and
I think its only through the process of doing and actually trying
something out and achieving something...I think its a real process for
people, that they have to experience the doing of something to
actually then, start experience using their strengths, and I suppose
recognising and re-identifying with the strengths that they used to
have.”
Category 4: 'Doing' to experience strengths and resources
Direct 'doing' to experience strengths and resources:
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Facilitating experiences that are meaningful, interesting to them
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Facilitating motivating experiences
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Facilitating challenging yet achievable experiences
Indirect 'doing' – creating opportunities to experience strengths and resources:

Finding and using existing resources
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Influencing existing resources
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Developing new resources
“We set some small goals around being at home doing some very basic ADL tasks, cos
he was doing absolutely nothing at all. So he started to do some baking again he'd
not done that for a long time. Then he was helping his mum, his family were out
working all day, so he was doing some meal preparation, getting the dinner, and stuff
ready for when people came in.”
“I think its made him feel actually this is doable, I can achieve this. I am changing and I
am making progress and it doesn’t always have to be this way”.
“We do the one to one bit of getting people well but then we've got to do the other bit to
kind of move people on as well.”
“It's about helping people utilise what is already there as well...partly from a social
inclusion and social integration point of view but also it's about the pressure on
services”.
Category 5: Feedback to support 'knowing'
“..its kind of using the things that you see like evidence, to reflect back to them...so
I always feel I am looking all the time, whatever I am doing with them, where
their strengths are and try to feed that back to them”
Feeding back strengths observed in activities helps develop peoples
awareness of their strengths and resources, this feedback forms a two
way bridge between identifying and experiencing.
“Its about somebody noticing the things that are important to them , that fit with
what they want to be doing”
Category 6: Organisational and professional supports
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Distinguishing occupational therapy from other roles in the mental
health multidisciplinary team.
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Involvement in support worker roles.
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Feeling supported by local and national strategies
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Tools and systems to help structure and evidence work with peoples
strengths and resources.
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Participating in continuing professional development opportunities.
Discussion – key points
 An emerging co constructed theory
 Core values of belief in peoples strengths, hope,
collaboration and the importance of participation in
meaningful occupations align the findings with the values
of a person centred approach, the recovery approach and
a holistic understanding of health.
 Individual agency and social determinants of health are
acknowledged in the findings
Discussion – key points continued..

The findings reflect elements of health behaviour change
theories and adult learning theory.

Findings expand on the three established approaches that
work with peoples strengths and resources adding an
occupation focused approach to the literature.
 The findings add to discussion about occupational therapy
roles in community mental health teams
Strengths and Limitations of the Research
Methodological attention to rigour and trustworthiness e.g.
data analysis method, follow up meetings, researcher
memos and supervision
Findings represent the experience of 6 occupational therapists
who work in one NHS Trust and the interpretations of an
MSc student, as such relevance and generalisability is
limited.
Implications for Practice

A model to inform practice?
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How can outcomes be evidenced?
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Support worker roles?
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Occupational therapy roles in community mental health
teams?
Implications for further research
….. so what ?!
Thank you!
Thank you to the occupational therapists who took the time to
participate in this study and share their practice experiences
Thank you to the lead occupational therapist who collaborated
with me to help this research happen.
Thank you to my supervisors Jude Mitchell and Nick Pollard at
Sheffield Hallam University for their support
References 1
Bryant, W., Fieldhouse, J., Bannigan, K., Creek, J. & Lougher, L. (Eds). (2014) Creek's Occupational
Therapy and Mental Health, 5th Edition . London: Elsevier Health Sciences.
Charmaz, K. (2007). Constructing Grounded Theory; A Practical Guide through Qualitative Analysis.
London: Sage Publications Ltd.
Charmaz, K. (2014). Constructing Grounded Theory. California: Sage Publications.
College of Occupational Therapists (2010). Recovering Ordinary Lives: The strategy for occupational
therapy in mental health services 2007–2017, A vision for the next ten years. London: COT.
College of Occupational Therapists (2015). Code of Ethics and Professional Conduct (revised edition).
London:COT.
College of Occupational Therapists (2017). Professional Standards for Occupational Therapy Practice
(revised edition). London: COT.
Deegan, P. (1993) Recovering our sense of value after being labelled mentally ill. Journal of Psychosocial
Nursing. 31(4), 7–11.
Department of Health (2011). No Health Without Mental Health: Delivering better mental health outcomes
for people of all ages. Retrieved from
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215811/dh_124057.pdf
De Shazer, S. (1985). Keys to solution in brief therapy. New York: W.W. Norton.
De Shazer, S. (1988). Investigating Solutions In Brief Therapy. New York: W.W. Norton.
Foot, J. & Hopkins, T. (2010). A glass half full: how an asset approach can improve community health and
wellbeing. London: Improvement and Development Agency.
References 2
Gingerich, W. & Peterson, L. (2013). Effectiveness of Solution-Focused Brief Therapy: A Systematic
Qualitative Review of Controlled Outcome Studies. Research on social work practice, 23 (3), 266-283.
Kretzmann, J. & McKnight, J. (1993). Building communities from the inside out: a path to finding and
mobilising a community's assets. Illinois: ABCD Institute.
Mental Health Taskforce (2016). The Five Year Forward View for Mental Health. Retrieved from
https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf
Morgan, S. (2014). Working with strengths: putting personalisation and recovery into practice. London:
Pavilion Publishing.
Morgan, A. & Ziglio, E. (2007). Revitalising the evidence base for public health: An assets model.
International Journal of Health Promotion and Education, 2, 17-22
Public Health England (2015). A strategy to develop the capacity, impact and profile of allied health
professionals in public health 2015-2018 - Strategy from the Allied Health Professionals Federation
supported by Public Health England. Retrieved from
http://www.ahpf.org.uk/files/AHP%20Public%20Health%20Strategy.pdf
Rapp, C. (1998). The strengths model: case management with people suffering severe and persistent
mental illness. New York, Oxford University Press.
Saleeby, D. (1996). The strengths perspective in social work practice : extensions and cautions. Social
work, 41 (3). 296-305.
Shepherd, G., Boardman, J., Rinaldi, M. & Roberts, G.(2014). Supporting recovery in mental health
services: Quality and Outcomes. Centre for Mental Health and Mental Health Network, NHS
Confederation. Retrieved from http://www.centreformentalhealth.org.uk/recovery-quality-andoutcomes.
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