The First Two-Years of Mental Health Practice

I am coming up on my second anniversary working in adult mental health and the time has simply flown by! The anniversary has reminded me to pause and reflect on all that has happened in those 24 months. A lot has changed and I have certainly changed too.

Some victories?

• I was part of creating an OT program at my place of work. Previously our employer had only part-time and intermittent OT involvement; there hadn't been an established OT program in a few years. When I started, there were two of us who were hired around the same time (my partner started 3 months before I did) and we built the role of OT within the institution from the ground up. There was a lot of leg-work in developing the programming and a LOT of education provided to staff and clients about what Occupational Therapy is. We've come a long way!
• I developed two of the four psychoeducational groups that are offered by OTs. My first program is called Building On Strengths; it is a program that facilitates self-discovery of personal strengths, values, and priorities and then uses that information to help clients create a personal mission statement and set SMART goals. It's all about how to build a life of meaningful occupational engagement; I love it and the clients I've delivered it to have loved it too. My second program is the Supporting Healthy Interactions Program (SHIP) and I cannot take credit for the foundations of this program! There was a pre-existing SHIP program at our facility that was an anti-bullying program for people who tended to be aggressive. It was a pretty short program and, in my opinion, only covered one end of the spectrum of problematic interpersonal styles that I typically see in my client population. But it was a strong place to start; what I did was build on what was already there. Now, the SHIP program teaches about aggressive and passive interpersonal styles as being on different ends of a spectrum, with assertiveness being the balanced middle ground. The program helps participants to understand their own style, how to set interpersonal boundaries, the benefits of assertiveness, and how to communicate assertively in a variety of different situations. There is a lot of role-play in this group, but while the skills-practice is serious we try to keep the scenarios on the humorous side. 
• I've been lucky enough to have two OT partners at work in the time that I've been there and both have been the most amazing women a girl could ask to work with!! I really can't overstate how grateful I am to each of these women. The first developed an Empowerment Program that we use to this day; it's fantastic for working with women who struggle with self-esteeem and/or feeling disempowered/marginalized in our society (which really, isn't that most women who have serious struggles with mental health?). The second (and my current partner) developed our Mindfulness Program, which teaches about mindfulness, observing, non-judgement, and a variety of different mindful and meditative practices. It's been a great foundation tool for all our clients.
• OT is now involved in some of the tasks on our mental health team that were historically assigned only to psychologists. I think that was more a function of the team being historically made up of only psychologists; but still, there were some people who were not sure OTs were capable of contributing in this way. Those tasks are: risk assessment related to suicide and self-harm, and triage of mental health referrals. Not glamorous stuff, but an important contribution to our team as a whole.
• I introduced a sensory modulation intervention to our environment for clients were were under observation due to self-harming or suicidal gestures. It's no snoezelen room! But given that we had no resources before, were given the tiniest budget imaginable, our clients had a real need, and we also had to consider safety issues (i.e. that the items in the intervention could not be adapted for purposes of harm to self or others) I think we did pretty well. Our intervention includes an assessment of the various stimuli available to determine which will be helpful to the client and then, based on the assessment, a "comfort kit" is put together and given to the client to facilitate self-soothing through interaction with the sensory stimuli. Now... if only we could get more funding to restock our missing items and create a larger inventory of stimuli! A girl can dream.
• I've received specialized training in Cognitive Behavioural Therapy, and engaged in peer-supervision with a psychologist friend of mine who also took the training. I've had mixed success in implementation, as I'll probably discuss in a future post, but the training has certainly informed my practice in a lot of ways.
• I've just recently received specialized training in Dialectical Behavioural Therapy!! I'm excited about this particular intervention, but my training is very recent and I do not yet have any clients who are involved with DBT.
• This past July (2013) I began supervising para-professionals! They are not OTAs, as our mental health team has not historically had OTs, but they serve a similar role and the supervisory relationship is the same as you would see between an OT/OTA. The folks I work with coach our clients on their behaviours and assist them with working on behavioural goals.  This clinical supervision was previously always done by a psychologist, but the transition has gone really well. Currently I have six people that I'm supervising in this way (four full-time and two part-time) and it has been great. The people I work with are amazing and passionate about their work; they make my job as the supervisor really easy! And it's been great to work closely with others as part of a team with a common goal.
• This past December (2013) I had my first OT students!!! I had two students, each of them came to my workplace to join me for one day of job-shadowing. They were on a role-emerging mental health placement in the community and their day with me was just to give them a chance to connect with an OT who works in mental health. They were both wonderful and had a lot of great questions. It was a fantastic way for me to start giving back to my profession. I hope to be able to offer a full student placement opportunity in the future, but challenges at my workplace make it difficult to see how I'll find the time.

The challenges?

• As noted... time is a big problem. With funding cut-backs, our mental health team has been trimmed and trimmed and trimmed again. We have a number of people on parental leaves of absence and our employer does not fill the position while the person is absent; we simply do without. Because of this we're spread pretty thin... to be honest, I'm not sure how sustainable this model is. I see my teammates getting burnt out; I feel burn-out creeping up in myself. I recognize that this is the situation for many of us right now; it's a sign of the times. But I'd be curious to hear feedback from others about how they manage their time or their burn-out. email me at otsweetpea@gmail.com if you have some ideas/strategies that work well for you. This is the biggest pressing issue that I'm dealing with right now.
• Maintaining a core sense of your professional identity on an interprofessional team is something that you have to work at regularly!! For a while, when I was new, I struggled to see the niche within my practice context that OT fit into. I looked for where there was an unmet need and then set about filling it. But as time goes on and you start to have a better understanding of your role in the environment, you also come to better see the overlap with other professions. I find that taking time to debrief with my OT partner at work is really helpful for this. We compare notes and consult on complex cases; in doing so we anchor each other to the core values of our profession.
• It's also worth mentioning that the work environment I am in is stressful all on its own, even without the extra challenge of limited human resources. When you work for a large organization and need to coordinate client care with a variety of different stakeholder groups it can sometimes feel like not everyone is on the same page. Additionally, working with other human beings... who have moods and struggles and priorities of their own... can be tough and I've noticed that the most difficult thing of all (for me) is not letting the negativity or low-morale of others affect how I feel about my work. I do my best to support the people I work closest with, to insulate us from the worst of the negativity in others, but you can only do so much. I find I'm always having to remind myself just how much I love the work I do with my clients, because it's not the clients that are causing the stress. But that's the nature of the beast in a large organization; it's not unique to my workplace, I'm certain.

What's on the horizon?

• The situation on my team, with regard to staffing levels, is going to get worse before it gets better. So seriously, if anyone has any tips for managing your time in this kind of environment, or managing your burn-out, I am all ears!!! I will likely be putting together future posts about both these topics.
• It's been a whirl-wind of training and development for me these last two years. I think year three is going to be about consolidation! I need some time to fully absorb and implement all that I've learned thus far. Plus, I have to take the time to care for myself in all of this... so, my themes for 2014 are about finding balance and consolidating the development I've achieved thus far.