Making QMHP Status in OT

By E.J. Brown

By far the most important goal for making the Centennial Vision a reality lies in AOTA's concerted drive to make occupational therapy a primary player once more in mental health settings.

The effort has been going on for more than five years, but it will take years' more work to make this goal. Currently only about 2 percent of OT practitioners are working in what they consider mental health settings. That's down from almost 10 percent at the end of the 1980s. Deinstitutionalization during the late 1970s and early '80s is responsible for some of the loss. Many mental hospitals across the country closed, and as mental health workers re-grouped into community centers, drop-in centers and halfway house models, many OTs and OTAs switched their practice to nursing homes and other places that were considered more physical-dysfunction settings.

Mental health fieldwork suffered. Many fewer students were doing it, at least in hospital settings. The money was in physical rehab.

As a result of all this, OT was left off the "team" of professionals considered mental health specialists. When states began to certify various professionals in that field, OT didn't make the cut. And there were hardly any OTs there to protest. Many state OT associations were surprised when they discovered that their members were no longer considered "qualified" mental health practitioners (QHMPs).

In 1999, AOTA funded a partnership project with the National Mental Health Association and the National Association for the Mentally Ill to identify best practices in OT mental health and develop training modules for others to use. Twenty-eight states participated in the training, which led to the development of advocacy networks across the country linking mental health OTs with mental health organizations.

When the Centennial Vision was initiated several years later, it became clear that a much more in-depth study of OT practice in mental health would be necessary. The national association began researching what kind of laws various states have regarding their mental health practitioners.

The Commission on Education (COE) set out a few years ago to see how much psychosocial study OT students were getting, and in which courses, since many of them do not fall under "psychology" labels. According to ADVANCE sources close to the issue, the study has not been publicly released because a good number of program directors have not returned it to AOTA.

But it has been alluded to. Researchers have said that it is not classroom education in psych that we lack. Academic preparation there, as compared to that of other mental health disciplines, may be somewhat behind, but not significantly.

Fieldwork II is the biggest problem. At last count, only 13 percent of schools require mental health affiliations.

Following the national conference in Long Beach this year, three states were targeted to set up demonstration projects in mental health practice geared to gaining "qualified" status in their states, eventually. AOTA sources admit privately that the day is still a long way off. Psychologists in particular are not going to let OTs get back into the picture without making sure their scopes of practice do not overlap.

AOTA is continuing its partnerships with mental health associations in advocacy projects.

ADVANCE will continue to update information on mental health initiatives as we learn of them. Meanwhile, if you are dually credentialed in OT and a mental health discipline, AOTA would like to hear from you. You may contact Laurel Radley (lradley@aota.org) or Tim Nanof (tnanof@aota.org) with that information.

E.J. Brown is ADVANCE editor.