How to Do Meaningful Work: Become a Mental Health Occupational Therapist

A day in the life of a mental health occupational therapist.
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You meet him.

He’s young. Twenty years old at most. His large brown eyes, shaded by a baseball cap, don’t meet yours as he reaches out a hand in greeting.

With a smile you sit and gesture for him to do the same. He does, folding his hands on the table in front of him. As always, it surprises you that this shy, seemingly sweet boy could be homeless and jobless, without any idea about how to remedy that.

It’s time to get to work.

For the next hour or so you’ll be chatting with him, working on communication skills, encouraging him to start the job search and maybe showing him how he can do that. It’s your first session together so you won’t push too much—maybe just talk and leave it at that. Still, you can’t wait to learn a little more about this young man and start the process of helping him change his life.

Wish this could be a day in your life?

Sarah Hui was a Psychology major at Santa Clara University. She’d always been fascinated by the way the human mind worked and was drawn to helping underprivileged children/communities. During her senior year, she randomly took a class that explored career options for the sciences (kind of like we do with our posts here on AfterCollege).

Many of the students in the class were on the med school track, without realizing that they had other career options. Speakers came in to introduce the students to other jobs available to them.

One of the speakers was an Occupational Therapist (OT) and after hearing the theory behind their work, Sarah realized that this was the career for her.

Not sure what an OT does? No problem! Sarah tells us what, exactly, a mental health occupational therapist does and what it takes to become one.

What, exactly, does an OT do?

The theory behind occupational therapy is that the things we do every day are what make up our lives and that the small things we do make up our health.

There are three main focuses of occupational therapy that put this theory into practice:

Mental health. This type of occupational therapy blends in with social work and “talk therapies” like marriage/family therapy.

Physical disabilities. For the most part, this type of occupational therapy takes place in a hospital. It can get confused with physical therapy. The difference is that while physical therapists are more focused on muscle growth and rehabilitation of those muscles, OTs are more focused on how to make the body functional.

So for example, OTs will do things like teach a client to use adaptable equipment or work with them to do things like stand in a kitchen and cook when they get discharged from the hospital. So a lot is actually being in the hospital’s kitchen or bedroom and practicing standing or making breakfast independently. Or, if the client is not really going to be able to do those things when they’re released, the families will come in and whoever is going to be taking care of the client will learn to assist without taking over all independence.

School-based therapy. OTs focused on pediatrics and school-based therapy work with developmental disabilities like autism and cerebral palsy. You’re normally hired through the school or sometimes another agency but your work will be in the school and sometimes in outside clinics.

What is the education for this profession like?

Sarah majored in Psychology at Santa Clara university with a minor in Philosophy. She finished her undergrad in three years and went on to Colorado State to do her prerequisite classes for graduate occupational therapy school. She completed both her Master’s in Occupational Therapy as well as her doctorate at USC. Though you do not need to complete a doctorate to become an occupational therapist, this degree is becoming more and more common.

Psychology in undergrad was a really useful major to have for this career. A lot of the credits went into the prerequisites she needed for graduate school. Still, she had a lot of requirements in regards to physiology and anatomy and those types of classes. Other majors that will prepare you for this career are Biology, Anatomy, Sociology, or Anthropology.

Once Sarah got into OT school, the coursework was divided into the three categories of physical disabilities, mental health, and pediatrics/school-based therapy.

In the physical disabilities category, you learn a lot about the body, anatomy, and muscle groups. In the mental health category, you learn about the brain and putting things in a social context. Then in pediatric/school-based therapy classes you learn about sensory integration and developmental disabilities.

Those are the three main educational components and classes that you’ll need to take.

What about internships?

Internships are definitely required. You’ll learn a lot in school, but it’s not until you’re actually working with a population that you’ll understand what the work is really like.

Sarah recommends doing at least one internship in each of the three categories of occupational therapy. It’s not a requirement, though most programs will encourage you to try out different types.

It really helped Sarah figure out which population fit her best. After working with all sorts of age groups she discovered that what really spoke to her were older teens. She absolutely loved one of her internships working with a boys’ detention camp.

“They were really eager to be engaged in any occupation,” she tells me when I ask why she enjoyed it so much, “It was really interesting. It was almost like once they were removed from their gang setting, they were just back to being boys and didn’t feel like they had to act tough.”

But her favorite internship out of all was at the non-profit she’s currently working at. It’s a non-profit that works with the lower income population in LA to help them stay on track. After completing her internship there, she chose to return when it was time to do her residency and then stayed on after it was completed.

What is it like working in the mental health category of occupational therapy?

Sarah admits that the results of your efforts as a mental health OT are a lot less visible and immediate than they are for physical disability OTs.

“With physical disabilities, you get to see your clients get better faster,” she explains, “In a hospital, you’ll see someone unable to bathe themselves one day and the next, they’re totally independent and walking around. With mental health, it’s a much slower process and it’s not as tangible.”

But that doesn’t mean that the results of mental health occupational therapy aren’t just as rewarding. You just may have to wait longer and be more aware to see them.

The focus of Sarah’s work is helping clients to gain the life skills they need to live day to day. Her clients also see a psychotherapist who works at the same non-profit. It’s a team effort. Working with both a psychotherapist and an occupational therapist allows clients to have the talk therapy they need—reflection time discussing any traumas or deep-seated problems—as well as guidance with the life skills that will help them in everyday life.

“As an OT, you need clients to be able to concentrate on the task at hand. It’s easier to re-direct if you can say, ‘How about you talk with your psychotherapist about that and let’s get back to this.’ The people we see need more than just talk therapy to get back on their feet. Just coming into an office and talking about their problems alone isn’t going to solve the things that are going on in their lives. So, like, if they have that [the talk therapy] and us helping them do things like find a job, it makes a big difference.”

Sarah gives us a couple of examples of the work she does. Some of these details have been changed to protect the confidentiality of the clients.

Example 1:

One of the things Sarah might help a client with is gaining independent living skills. This would involve teaching job search skills and actually searching for those jobs, exploring education options, looking for housing together, and practicing communication skills.

For example there might be a client who was having trouble connecting socially and thus couldn’t keep any personal connections. Sarah would work with this client on his communication skills as well as help him to find a job.

Example 2:

Another more typical case would be working with kids who are acting up in school. A teacher will refer a child who is having behavior problems and an occupational therapist will work with these children to improve these behaviors.

Normally, the OT will go to the school and work with either groups or individual children on their social communication skills—helping them identify when they’re angry and then teaching them what they can do when they feel that anger instead of throwing chairs, yelling, etc.

Example 3:

There are also adults that come into the non-profit for help. Sarah is working with an older woman on staying positive and letting go of things. Her sessions consist of teaching her how to use eBay to sell some of the things she’s collected over the years.

What sort of setting does a mental health OT work in?

Sarah’s non-profit is community based. Even though they do have an office where clients can come and do their sessions, a lot of the time Sarah will go out into the community to meet them. A large portion of the population that she works with does not have access to transportation.

“It would be a huge barrier to service if we said they had to come and meet us,” she explains, “I go to their schools or I’ll meet a lot of clients at Starbucks, parks, wherever.”

These meetings are usually for about an hour once a week. The actual length of time she works with a client can vary. Sometimes her work with a client can last a year.

What is the best part of this job?

You get to be creative. Every client is different and it’s up to you to figure out what is going to help them. Yes, you are trying to use evidence as much as possible, but you have a lot of freedom with your schedule and the activities you do.

What is the biggest challenge?

As with any non-profit, working within the budget and living on the salary is not going to be easy. But the bigger challenge has nothing to do with money. It’s making sure that you can get into contact with clients.

With the population that Sarah is working with, there are times when phones are turned off or the kids won’t be going to school and it’s very difficult to reach them. When these situations occur, the only thing you can do is keep trying. It’s also important to figure out the reason behind the lack of connection.

Do they not want to see you or is it just that they don’t want to go to school? If so, why don’t they want to go to school? Is there somewhere else you can meet them?

It takes some persistence, but that’s how it is when you work with the at-risk population.

What advice does Sarah have for students and recent graduates interested in a career in this field?

You probably won’t be able to get positions volunteering as an actual occupational therapist since internships are required during OT school and most places already have a lot of students working there. That’s okay. Volunteering while you’re an undergraduate or right after is a great way to get a better idea of what’s out there and what it’s like in different settings.

Because Sarah was interested in the mental health focus of OT, she volunteered at homeless shelters, Alzheimer’s centers, and tutored at-risk kids. That really helped her to figure out what age she liked as well as what it would be like working with these types of populations. It also allowed her to explore her options and to make sure that she was choosing the path that fit her best.

“While I was in school I thought that I might want to be a psychologist. But after I saw what a psychologist did every day, working in one office and having 20-minute sessions with clients, I realized that it wasn’t the right direction for me. You don’t really know that until you see it in real life.”

Homework time! Sarah got her undergraduate degree in Psychology. Take a moment to check out some other career options for this major. Then, if you’re pretty sure that occupational therapy is the path for you, take a moment to explore the different focuses of this profession. If you can get the chance, see if you can volunteer at some different places. Also, Sarah talks about working at a non-profit. Take a closer look at this work environment to see if it’s right for you.

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