Occupational Therapy Australia 
                Submission to the Mental Health Select 
                               Committee 
                                     
              Inquiry into the opportunities to 
             improve mental health outcomes 
                       for Queenslanders 
                                     
                                     
                              February 2022 
         
         
        Introduction 
         
        Occupational Therapy Australia 
         
        Occupational Therapy Australia (OTA) welcomes the opportunity to provide a submission to the Mental 
        Health Select Committee’s Inquiry into the opportunities to improve mental health outcomes for 
        Queenslanders. 
         
        OTA is the professional association and peak representative body for occupational therapists in Australia. As 
        of December 2021, there were approximately 26,500 registered occupational therapists working across the 
        government, private and community sectors in Australia. Queensland represents 20% of the Australian 
        occupational therapy workforce (AHPRA, 2021). OTA is a member organisation of Mental Health Australia 
        and Allied Health Professions Australia and is regularly represented by these entities. The association is 
        strongly supportive of Mental Health Australia’s efforts to promote closer collaboration within the sector. 
         
         
        The role of occupational therapy in mental health  
         
        Occupational therapy is a client-centred health profession concerned with promoting health and well-being 
        through occupation. The primary goal of occupational therapy is to enable people to participate in the 
        activities of everyday life. Occupational therapists achieve this outcome by working with people and 
        communities to enhance their ability to engage in the occupations they want to, need to, or are expected to 
        do, or by modifying the occupation or the environment to better support their occupational 
        engagement (World Federation of Occupational Therapy [WFOT], 2019). Occupational therapists work with 
        all age groups and in a wide range of physical and psychosocial areas. Places of employment may include 
        hospitals, clinics, day and rehabilitation centres, home care programmes, special schools, industry and 
        private enterprise (WFOT, 2019). 
           
        Mental health service provision is a longstanding and core area of practice in occupational therapy, dating 
        back to the beginning of the profession more than 100 years ago. Occupational therapists work across the 
        full spectrum of mental health, providing services to people with relatively common conditions, such as 
        anxiety and mood disorders, as well as those which require more targeted interventions, such as psychosis, 
        trauma-related disorders and complex presentations with multiple/chronic conditions involved. Occupational 
        therapists have a specific and well-established role in child and adolescent mental health services, adult 
        services, and aged care services (Hitch et al, 2018; Occupational Therapy Australia 2019).   
         
        Occupational therapists provide strengths-based, goal-directed services to improve mental health and 
        wellbeing, and to help a person access personally relevant and valued roles and occupations. In this way, 
        occupational therapists focus on the client’s function as well as their diagnosis. They recognise that two 
        people with the same illness can have different levels of functioning; just as two people with the same level 
        of functioning can have different health states. By understanding the person’s individual roles, circumstances 
        and environments, occupational therapists support their clients to develop and attain goals relevant to their 
        unique situation. A key strength of occupational therapists is their depth of understanding of the interplay 
        between the bio psychosocial and cognitive issues that typically coexist with people with mental health 
        conditions. This expertise is nationally recognised and well-established.   
         
        In Queensland, occupational therapists have a vital role in transforming the lives of people accessing mental 
        health services, as well as through a range of services that address mental health and mental illness among 
        the homeless, those in prison and justice services, those in mother and baby units, and with children in 
        school settings. Functional outcomes for people with mental ill-health can include areas such as learning and 
        application of knowledge, performance of everyday tasks, communication, mobility, self-care, care for others, 
        interpersonal interactions and relationships – all of which are personally relevant or meaningful to the client.  
         
         
         
         
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          Clients who are referred to an occupational therapist working in mental health are assisted to: 
           
          •  Engage in activities that are personally relevant, such as specific vocational and leisure interests 
            (D'Amico, Jaffe, & Gardner, 2018);  
          •  Find meaningful work and undergo training to improve their career options, particularly where their ability 
            to remain engaged for a sustained period has been affected as a result of their condition (D'Amico, Jaffe, 
            & Gardner, 2018); 
          •  Develop ways to enhance their social connectedness and community engagement (Gibson, D'Amico, 
            Jaffe, & Arbesman, 2011); 
          •  Develop skills and qualities such as assertiveness and self-awareness (Gibson et al., 2011); and, 
          •  Develop or restore skills through focused strategies such as personalised behavioural/ functional goal 
            setting, psychoeducation, graded exposure and skills-based approaches, experiential learning, group and 
            individual work, and adaptive learning strategies (Burson, Barrows, Clark, Geraci & Mahaffey; 2010; 
            D'Amico, et al, 2018). 
           
           
          Training and Standards 
           
          Occupational therapists who work in mental health have extensive training and adhere to rigorous standards 
          to ensure quality of care.  
           
          In Australia, all occupational therapy education programs are accredited to ensure they meet strict national 
          standards. This is performed by the Occupational Therapy Council on behalf of the national regulator, the 
          Australian Health Practitioner Regulation Agency (AHPRA). All Australian occupational therapy courses also 
          meet international standards, as they are accredited by OTA on behalf of the World Federation of 
          Occupational Therapists (WFOT).  
           
          In addition, as is common across all professions working in mental health which include additional training to 
          be competent to do so, suitably trained occupational therapists also provide interventions such as 
          psychotherapy, counselling, and other psychological strategies such as services for eating disorders, 
          through the Better Access scheme (Department of Health [(Australian Government Department of Health 
          [DoH], 2017). There are approximately 1,000 OTA members currently endorsed to provide services under 
          the Commonwealth Government’s Better Access initiative. 
           
           
          Response to consultation terms of reference 
           
          The following terms of reference are addressed in OTA’s response: 
           
               (b) the current needs of and impact on the mental health service system in Queensland; 
               (c) opportunities to improve economic and social participation of people with mental illness through 
               comprehensive, coordinated, and integrated mental health services; and 
               (h) mental health funding models in Australia. 
           
          Item (b) The current needs of and impact on the mental health service system in 
          Queensland 
           
          A fragmented system 
           
          The mental health sector is facing unprecedented demand for services and there are many people with 
          mental illness experiencing occupational deprivation and community disengagement (Gibson, D'Amico., 
          Jaffe, & Arbesman, 2011; RACGP,2019). Only those consumers who are acutely unwell and have potential 
          to harm themselves or others, or have high risk needs and complex presentations, meet the necessary 
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          criteria for tertiary mental health services. Care has become increasingly episodic due to high demand, and 
          little attention is paid to the skills and supports that would maintain the person in the longer term (Vic Health, 
          2019d). 
           
          Care and support for consumers in transition from and to services is variable and inconsistent. A consumer 
          may move from inpatient care back to community living with very little support.  Community based services 
          following discharge from inpatient units that provide shorter term care with outreach-based interventions is 
          essential. Such models of care prevent a revolving door of deterioration and readmission. Once people do 
          seek help, there may be complicated intake processes around eligibility, and delays before being seen, 
          leading to frustration or lack of timely service provision.  
           
          Stressors such as homelessness, domestic violence, lack of employment opportunities, financial hardship, 
          drugs and alcohol dependency, and limited support systems in our communities create a need for 
          therapeutic supports, however the stigma of accessing these remains high.  
           
          It is evident that mental health, primary health, and community health systems require more investment and 
          better integration to address growing demand for services. OTA invites the Committee to consider the extent 
          to which this fragmented service delivery is attributable to the fact that different levels of government have 
          responsibility for different areas of care, often without apparent reason. For example, Primary Health 
          Networks (PHNs) which include among their stated objectives improving coordination of care to ensure 
          patients receive the right care in the right place at the right time are a federal government initiative despite 
          the obviously local nature of their purpose (Australian Government Department of Health [DoH], 2019). While 
          OTA understands that Australia’s federated structure of governance must inevitably involve a role in 
          healthcare for different levels of government, efforts should be redoubled to ensure greater coordination and 
          continuation of care. It is imperative that those experiencing mental health challenges are not discouraged 
          from seeking care or, worse, allowed to go unnoticed, because of fragmented service delivery. 
           
           
          There is an urgent need to invest in mental health services that directly address 
          everyday occupational concerns 
           
          OTA believes there is an urgent need to invest in mental health services that directly address the everyday 
          occupational concerns for people with mental health issues and their families (RCOT, 2018). These 
          concerns are most frequently about the most important determinants of health and life expectancy, such as 
          education, employment and social support (RCOT, 2018).    
           
          Social determinants of health have a significant impact on mental health, so communities experiencing 
          multigenerational difficulties, or with uncertain housing and high levels of unemployment, or farming 
          communities adversely affected by weather, are at greater risk of poorer mental health. These problems are 
          often compounded by limited protective and risk reducing opportunities for engagement and connection, 
          limited access to learning new and different skills, and a lack of meaningful engagement opportunities. To 
          address these challenges there needs to be a clear investment in the factors that are paramount to mental 
          health and wellbeing such as housing, employment, social support, and meaningful occupation (WHO, 
          2001). 
           
          OTA strongly supports the broad adoption of the International Classification of Functioning (ICF) to ensure 
          there is a shared (and destigmatised) language and approaches to mental health care. Such care should 
          directly address the impact of mental health issues on activity and participation, place core emphasis on 
          promoting mental health and wellbeing, and facilitate improved coordination and collaboration of care (WHO, 
          2001). We recommend that this include navigational pathways and support for mental health consumers and 
          their families to ensure seamless support across services and throughout different stages of care, and, most 
          particularly during transition of care from one stage to another (Manderson, McMurray, Piraino & Stolee, 
          2012). 
           
           
          It must be recognised that, to date, the implementation of the National Disability Insurance Scheme (NDIS) 
          has failed those with mental illness. The NDIS as it stands currently operates on a deficit oriented framework 
          whereby clients must constantly prove their disability. This is in direct conflict with the recovery oriented 
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