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Origins of Occupational Therapy and Mental Health Practices Within the Profession

The Connecticut Occupational Therapy Association defines occupational therapy (OT) as a scientific, evidence-based “skilled treatment that helps individuals achieve independence in all facets of their lives.” And while occupational therapy is thought of primarily as a profession involving physical engagement, the creative career field has strong roots in the mind-body connection, having originated alongside the mental health movement in the early 20th century.

In 1916, Herbert J. Hall, M.D. described the methods of treatment for nervous disorders in his sanatorium as “handicrafts for the handicapped.” He once advised, “Idleness too long continued is as deadening to the spirit as it is disabling to the body.” And through his work cure theory, the medical doctor used arts and crafts to improve his patients’ self-esteem and employment potential (AOTA, 2017).

Wounds of war form a new field of work

Occupational therapy was established during World War I, and even in its earliest stages, included mental health initiatives. Towards the conclusion of the war, when so many American soldiers were coming home with panicked mindsets (a condition later coined “shell shocked”), the United States War Department employed reconstruction aids (RA) to assist wounded and worrisome soldiers in their recovery.

These RAs were civilian women who served in military hospitals, at home, and abroad to help reconstruct the realities of the lives the soldiers had known before becoming disabled. Occupational therapy RAs taught crafts and vocational skills to distract the injured while increasing their productivity and morale.

Commanding officers were often resistant to having women in military camps assisting in the advancement of anguished soldiers. When an army captain asked RA Ora Ruggles how she would help “wrecks [of soldiers] like these,” she brought to life the lessons of occupational therapy in her response. “Finding and teaching occupations will take their minds off of their misfortunes,” she replied. “It’s not enough to give a patient something to do with their hands, you must reach for the heart as well as the hands. It’s the heart that really does the healing” (AOTA, 2017).

Pioneers that propelled the OT profession

The same year, the National Society for Promotion of Occupational Therapy was founded. Initiated with innovation, the society had six gender-equal members, three men and three women — unheard of at a time when American women did not yet have the right to vote.

Former architect George Edward Barton started the Society. After spending more than a year in a sanatorium, he opened the Consolation House in New York to rehabilitate himself and others. Barton’s secretary Isabel Newton was another founding member.

The third founder was psychiatrist Dr. William Rush Denton, who embraced occupational therapy at the Sheppard and Enoch Pratt Hospital in Baltimore. He was known for intertwining occupational treatment with mental health techniques and was quoted as saying, “Sick minds, sick bodies, and sick souls may be healed through occupation” (AOTA, 2017).

Eleanor Clarke Slagle, the director of the occupational therapy department at Phipps Psychiatric Clinic at Johns Hopkins, was another founder. In Chicago, she established the Henry B. Favill School of Occupations, the first professional training school for occupational therapists. The Eleanor Clarke Slagle Lectureship Award remains one of the highest occupational therapy recognitions.

Thomas B. Kidner, a vocation secretary for the Canadian military hospitals commission, also helped start the Society after developing an occupation program to engage bedridden soldiers.

Susan Cox Johnson was the final founder of the Society. Johnson was an arts and crafts teacher in Manhattan and director of occupations committee for the New York state department of public charities. She went on to teach occupational therapy at Columbia University and advocated for “using crafts to redirect thoughts, strengthen bodies, and regain confidence” (AOTA, 2017).

Significant OT strides that persist in present day

The National Society for Promotion of Occupational Therapy changed its name in 1921 to the American Occupational Therapy Association, Inc. (AOTA). By 1933, AOTA was affiliated with the American Medical Association Council on medical education and hospitals.

Between 1939-1945, during WWII, when military hospitals acknowledged the need for assistance with soldiers who had psychiatric and orthopedic conditions, war efforts yet again expanded the profession. In 1944, the United States Army recognized occupational therapy and created specific training courses for Occupational Therapy Assistants (OTA).

When the 1963 Community Mental Health Act was signed by President Kennedy, occupational therapy services shifted from the hospital into the community. During this time, the service delivery philosophy for individuals changed from a medical model to a recovery one — reinforcing OT care as a long-term process with the ultimate goal of independence and full participation in community activities.

In 1967, during her acceptance of the distinguished Eleanor Slagle Lectureship Award, occupational therapist Wilma “Willie” West reminded colleagues that, “Occupational Therapy is concerned not only with the individual physical abilities but also with his mental, emotional, social, and economic needs” (AOTA, 2017). 

Occupational Therapy makes way for modern mental health initiatives

Present-day occupational therapy practitioners and occupational therapy assistants provide mental health treatment and prevention services across the lifespan with a primary focus on restoring a patient’s daily function and performance, independence, and ability to participate in valued activities and roles.

Several OT skills are still utilized in the mental health field today. Such training and services include:

  • Activity analysis
  • Behavior health
  • Cognition
  • Communication
  • Evaluation
  • Human development
  • Independent living management
  • Interpersonal skills
  • Intervention and identifying barriers to improve
  • Psychology
  • Relaxation and restorative sleep management, and
  • Sociology

Occupational therapists and OTAs provide mental health support to patients of all ages — teaching them everyday life skills. Mental health-focused occupational therapy professionals can work in a variety of settings, such as acute and long-term care psychiatric facilities, employment programs, juvenile justice centers, military institutions, public and private schools, skilled nursing facilities, and more.

Occupational therapists and OTAs also train children with mental health difficulties about social competence — skills needed to get along with others, make and keep friends, cope with frustration and anger, and understand social etiquette.

Additionally, OTs and OTAs help adults enhance attention span, improve intrinsic motivation, memory, problem-solving, and self-esteem. Trained specialists in the field can also help patients build a healthy sense of belonging. Friends and family members of those diagnosed with mental health disorders can likewise benefit from OT instruction by learning stress management methods for caregivers.

For those with sensory processing difficulties like Autism Spectrum Disorder, occupational therapists aim to decrease sensory overload through techniques like creating calming sensory bottles and various small motor skill activities.

For people who struggle with mental health difficulties like depression, addiction, and recovery, occupational therapy helps patients to redefine their identity and restructure their lives with purpose.

Since the profession’s start with reconstruction aides assisting sanatorium patients and mentally shaken soldiers, occupational therapy professionals continue to help and heal those affected by mental health. Occupational therapy professionals actively promote patients’ participation in their recovery, collaboration within their communities, and encourage resiliency, hope, and a holistic lifestyle that sets them up to live a successful and satisfying life.

Are you interested in a career that makes a difference in the daily lives of others?  Check out our OTA program today!

Photo courtesy of the Archive of the American Occupational Therapy Association, Inc.

References

American Occupational Therapy Association. (2015). Occupational Therapy’s Role with Post-Traumatic Stress Disorder. AOTA.org.

American Occupational Therapy Association. (2016). Mental Health in Children and Youth. AOTA.org.

American Occupational Therapy Association. (2016b). Occupational Therapy’s Role with Mental Health Recovery. AOTA.org.

AOTA. (n.d.). History of AOTA Accreditation. AOTA.org. Retrieved May 7, 2021 from AOTA.org.

AOTA. (2017, January 1). Celebrating AOTA’s Centennial: A Historical Look at 100 Years of Occupational Therapy [Video]. YouTube.

The American Occupational Association, Inc. (2013). Occupational Therapy’s Role in Community Mental Health. AOTA.org.