Vol. 24 Issue 3
AOTA's Plan for Mental Health Practice
What's happenedand what hasn'tin the past 10 months
Here's the latest statistic: the number of OTs and OTAs practicing in the mental health arena is now a meager 2 percent nationally.
And that's down from a little less than 10 percent at the end of the 1980s. The field has bled so dry that occupational therapy actually lost its status as a mental health profession in many states during the 1990s because educationally and practice-wise, its practitioners did not meet the requirements for the designation of "qualified mental health practitioner" (QMHP) there.
With today's emphasis on cost-cutting, and almost a century of practice evidence that blends psychosocial and physical dysfunction treatment, AOTA believes that the future success of occupational therapy demands that it re-enter the mental health arena as a recognized player.
In a 2003 study, AOTA's State Affairs Group found that all of the professions that are listed as QMHPs require extensive coursework and clinical education in psychology, which OT does not have.
AOTA has been working for several years to draw up a plan that will lay the groundwork for the profession's re-emergence as qualified mental health practitioners across the country. Motions passed by the Representative Assembly (RA) last April at the annual conference in St. Louis aimed to pave the way toward a more unified plan, but the effort is moving slowly.
Despite several years of work in many facets of mental health advocacy, AOTA public affairs director Christina Metzler feels much still needs to be examined in the area of mental health. In an upcoming report to the 2008 RA, "we will tell the board what we have doneparticularly in developing relationships with other organizationsbut there is a lot to do; this is a big issue," Metzler told ADVANCE recently.
Last April, based upon specific recommendations made by the Qualified Mental Health Practitioner (QMHP) ad hoc committee studying how to get occupational therapy back into the mental health arena, the RA passed a multi-pronged effort to get that ball rolling.
It charged President Penny Moyers with having executive director Fred Somers implement specific steps toward the goal. In November 2007, Moyers reported back to the fall online RA the progress that had been made on each goal:
Present a summary of the recent mental health reports to Affiliated State Association Presidents (ASAP) at the next available ASAP meeting.
Metzler confirmed to ADVANCE that ASAP has agreed to hold a session on mental health during the conference with Moyers and national office staff, who will "give the state presidents an overview of the situation and what they may need to address in their states regarding qualified mental health practitioner status."
Metzler added that the meeting's agenda will also include discussion of alternatives designed to get occupational therapists recognized in the mental health system of states that do not have QMHP or Licensed Practitioner in the Healing Arts (LPHA) standards.
Identify at least three state associations that have a large cohort of occupational therapists practicing in mental health, have an interest in promoting mental health practice, and QMHP or LPHA statues or regulations in which occupational therapy would benefit from inclusion.
Moyers assured in her report that "each state's interest, resources and current statutory and regulatory status related to occupational therapy in mental health will be used to determine the three most appropriate states in which to pilot the program."
The RA would like to have these states pursue amendments to their QMHP/LPHA statues or regulations to include OTs. To do that, the state associations are going to need help from AOTA.
Advocate with the Congress at the federal level and assist state associations in selected states to educate them about the role of OT in mental health in preparation for specific legislative initiatives.
AOTA has begun a coordinated effort to educate key members of Congress regarding the role of occupational therapy in mental health in support of these planned initiatives.
"Federal affairs staff engaged in direct lobbying of leaders of the Mental Health Caucus including representatives Tim Murphy (R-PA), Grace Napolitano (D-CA), Patrick Kennedy (D-RI), psychologist Brian Baird (D-WA) and Jim Ramstad (R-MN)," Moyers noted in her report.
In addition, AOTA has put forth AOTPAC funds in support of members of Congress with interests and influence in the area of mental health, including Sen. Pete Domenici (R-NM) and reps. Kennedy and Murphy.
"Several members of AOTA's board of directors, including me, addressed mental health issues during their time on Capitol Hill that was part of new board member orientation," said Moyers in her report. In response to AOTA's support, Murphy attended the student conclave in Pittsburgh, held in November, to talk with OTs, Metzler told ADVANCE.
Identify existing occupational therapists practicing in mental health with dual degrees that include QMHP related professions, and evaluate the value such dual degree status has provided these practitioners.
A Zoomerang survey is currently being developed to identify occupational therapists with dual degrees and to examine the extent to which that has impacted their mental health practice from a policy perspective, according to Moyers' report.
Identify other organizations, including providers and consumers, that may be allies in occupational therapy's efforts to secure CMHP/QMHP status.
AOTA has been working to increase its collaboration with key consumer and provider groups.
In addition, AOTA has initiated contact with two new coalitions to discuss formalizing AOTA's participation, beginning with the Campaign for Mental Health Reform, which represents a core of provider and consumer organizations in the area of mental health. "The group previously wasn't open to membership," Metzler told ADVANCE. "But we have been working with them, and apparently our request for membership is going to the board."
AOTA has also formed a partnership with the National Council on the Behavioral Health Workforce, the federally funded centers that provide direct mental health services in communities. Metzler, along with AOTA legislative affairs representative Tim Nanof, will be presenting at the National Council's annual conference this May in Boston on the role of OT in mental health.
AOTA has also recently become an outreach partner of the National Institute of Mental Health (NIMH) while working to improve its relationship and engagement with the Substance Abuse and Mental Health Services Administration (SAMHSA). "All of this is in addition to AOTA's ongoing participation with the Mental Health Liaison group and support of long-term legislative initiatives such as mental health parity," noted Moyers.
Metzler is confident about the aid these partnerships will bring in AOTA's efforts to better promote OT in the field of mental health. "We will need a lot of allies in the mental health care community to make this work," she said.
Explore strategies for improving opportunities for fieldwork experiences in mental health in consultation with the Education Special Interest Section (EDSIS), Mental Health Special Interest Section (MHSIS), Commission on Education (COE), and Accreditation Council for Occupational Therapy Education (ACOTE).
National office staff has reached out to liaisons from EDSIS, MHSIS, COE and ACOTE to determine the most appropriate way to coordinate their participation in improving fieldwork opportunities.
Moyers stated that progress on these items will be used to guide development of a comprehensive, multiyear plan to address the long-term initiatives needed to advance the role of occupational therapy in mental health services. "This plan will be presented to the 2008 Representative Assembly as required by 2007 Charge 112," she concluded.
In keeping with the QMHP ad hoc committee recommendations for advocacy at the federal level and in selected states, Metzler told ADVANCE that AOTA has been working to prevent the government from excessively limiting some of the Medicaid benefits that help people with mental illness.
In December, the Centers for Medicaid and Medicaid Services (CMS) published interim final rules governing case management services provided by state Medicaid programs.
"Targeted case management and rehab really have an impact on people with mental illness and services for people with mental illness," said Metzler.
Currently, states may provide case management to help beneficiaries transition from institutional settings to the community. However, the new rules would prohibit payment until beneficiaries are fully living within the community, and also prohibit states from making fee-for-service payments for case management services in increments that exceed 15 minutes of a given service. That makes it difficult for states to provide case management as part of Assertive Community Treatment (ACT), a program for people with mental illness.
This past fall, AOTA worked in a coalition to get Congress to recognize the inherent problems with these regulations. "We were able to get a six-month delay on using any federal money to implement those regulations," Metzler said of those efforts. But the threat is still out there.
AOTA also has been working to better implement an understanding by Veterans Affairs on the role of OT in the prevention and treatment of PTSD and traumatic brain injuries related both to physical rehabilitation and mental services. On Jan. 25, occupational therapy in mental health got a leg up from National Public Radio when it aired a segment on Tammy Phipps, an OT mom from South Dakota who heads a combat stress team in Iraq to try to help the soldiers deal with the deaths all around them.
Mental Health Education
Considering that OT students have no core curriculum, and programs are free to design curricula as they see fit (as long as students meet particular competencies), students do not complete extensive coursework in mental health. In 2003, the RA charged three groupsthe Commission on Practice (COP), the Commission on Education (COE) and the Mental Health SISto explore exactly what is in the curricula of OT programs that prepares students for mental health practice, and to set those competencies in a framework that will be understood by external audiences.
By late 2004, the three groups had developed a survey to be completed by every OT program in the nation in order to determine what students are actually learning. The status of the survey at this point is not known, but ADVANCE sources say the response rate has been very slow and may have held up the project. In an informal ADVANCE survey done of 107 professional-level OT programs in 2002, students received, on average, nine to 12 credit hours of identifiable psychology training, usually including, at the very least, intro to psych, abnormal psychology and group process.
Until its program survey is available, AOTA has little fodder that would encourage the Accreditation Council for Occupational Therapy Education (ACOTE) to change the ratio of psychosocial coursework in occupational therapy programs.
Last April, COE and ACOTE were asked to explore strategies for improving fieldwork experiences in mental health. When asked how plans are coming for the two groups, Metzler would only say that both are "still considering it and still working on it," adding, "that will be reported to the RA [at the next RA meeting] in April."
She told therapists to watch for the RA to be advised "that the effort to address [the mental health] issue needs to be long-term and needs to be coordinated. If it is going to be successful, it needs to have a lot of direct attention."
Jessica LaGrossa is ADVANCE associate/online editor. Editor E.J. Brown contributed to this story.