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Special issue: Effectiveness of occupational therapy services in mental health practice.

This special issue on the effectiveness of occupational therapy services in mental health practice was compiled in an attempt to further build the evidence supporting the profession’s contribution to this practice area. How did we lose our footing in mental health practice when the profession was once considered to be one of the most valued services for people with mental health disorders? In the period between World War I and World War II, occupational therapy services were considered to be an essential component of the treatment arsenal for people with psychiatric disorders (Ellsworth, 1983; Gutman, 1995; Wish-Baratz, 1989). Our profession grew out of the Moral Treatment era in the early 19th century—a movement based on the idea that people with psychiatric disorders should be treated humanely and in safe and sanitary environments (Peloquin, 1989; U.S. Department of Health and Human Services, 1999). Providing people with occupations that could engage their minds and interests— and quiet impulsivity and anxiety, even temporarily—was, at that time, considered to be one of the most effective treatments for adults with chronic mental illness (Levine, 1987). Treatment in this period was provided in large state and private institutions where patients were commonly housed for years, often for life (U.S. Department of Health and Human Services, 1999). Discharge was infrequently a consideration. At this time in the profession’s history, most occupational therapists were employed in mental health facilities (Quiroga, 1995). In 1963, Congress passed the Community Mental Health Act, which mandated that treatment of adults with mental illness be provided in the least restrictive setting and supported community integration (Ray & Finley, 1994). This act was the impetus for the deinstitutionalization movement in which large state and private mental health facilities closed, and patients were released to community settings—such as group homes—where people were expected to live and receive supportive services (Sharfstein, 2000). In many instances, however, deinstitutionalization outpaced the development of and funding for needed community services, and many former patients became homeless (Accordino, Porter, & Morse, 2001). As treatment of people with mental illness transitioned from large inpatient institutions to the community, occupational therapy positions, like many other mental health care positions, were lost. In the years in which mental health care services transitioned from institutionbased to community-based provision, certain health care professions (e.g., psychiatry, psychology, nursing, social work) rebounded and became part of policy-making decisions, but occupational therapy did not. Why did occupational therapists not sufficiently advocate for their role inmental health community integration at this time? Society, insurers, and legislators demanded Sharon A. Gutman, PhD, OTR