Mental health: An endangered occupational therapy specialty?

M any writers have made us aware of the critical decline in occupational therapy prac­ titioners specializing in mental health practice (Cottrell, 1990; Friedland & Renwick, 1993). Before World War II, the majoriry of occupational therapists and therapy assistants practiced in men­ tal health, but by 1990, the percentage decreased to 11.8% (American Occupational Therapy Association [AOTAJ, 1991). Several factors may have contributed to this decline, such as low pay (Wittman & Gibson, 1990), ambiguiry of the occupational thera­ pist's role in mental health (Ebb & Haiman, 1990), lack of research con­ cerning the practice of psychosocial occupational therapy (Bonder, 1987), lack of third-parry reimbursement (Wittman, Swinehart, Cahill, & St. Michel, 1989), and limited work opportunities outside conventional mental health settings, such as home care and contract work (McFadden, 1987). Negative experiences also may have contributed to the decline. Two studies found that because of poor psy­ chosocial Level II fieldwork experiences, less than 20% of occupational therapy students were likely to choose mental health practice (Atwater & Davis, 1990; Christie, Joyce, & Moeller, 1985). However, the biggest hindrance to the growth of mental health occupa­ tional therapy may be the stigma of mental illness. The public generally believes that prognoses are poor for psy­ chiatric diagnoses and that persons with psychiatric problems are somewhat infe­ rior in their competence (Hargrove, Fox, & Goldman, 1991).