Psychiatric Rehabilitation Journal Copyright 2009 Trustees of Boston University
2009, Volume 32, No. 3, 155–161 DOI: 10.2975/32.3.2009.155.161
Special Section
Doing Daily Life:
How Occupational Therapy
Can Inform Psychiatric
Rehabilitation Practice
▼
Terry Krupa
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Queen’s University
Kingston, Ontario, Canada
Ellie Fossey
LaTrobe University
Melbourne, Australia
William A. Anthony
Boston University
Catana Brown
Touro University, Nevada
Deborah B. Pitts
University of Southern California
Topic: This paper provides an overview of occupational therapy in the context of
psychiatric rehabilitation and mental health recovery. Purpose: The paper delin-
eates practical aspects of occupational therapy’s involvement in the mental health
field with a discussion of occupation and the elements of conceptual models that
guide the practice of occupational therapy. Sources used: CINAHL, Psych Info,
Medline. Conclusion: Occupational therapy is a key discipline in the field of psy-
chiatric rehabilitation and brings to the field a strong theoretical and knowledge
base along with unique procedures and practices. It is important for the psychiatric
rehabilitation field to learn from all disciplines, including occupational therapy.
Keywords: occupational therapy, psychosocial rehabilitation, recovery,
mental health
O ccupation: The focus of occupation- activities performed to attend to basic
al therapy. needs that both ensure survival and fa-
cilitate participation in other activities
As its name implies, occupational ther-
and daily routines. Personal care,
apy’s central focus is on occupation as
health, and hygiene activities typically
a determinant of health and well-being.
carried out in the home are included,
Occupation is a broad construct that is
as are community activities such as
meant to capture “how people do daily
banking, shopping, and visiting health
life,” and considers three broad cate-
care professionals. Productivity in-
gories to describe the occupations in
cludes the range of activities in which
which people participate: self-care,
people engage to support themselves
productivity, and leisure. Each category
and their families, and to contribute to
of occupation includes a broad range
their communities and society. In addi-
of activities, defined by their central
tion to paid employment, productivity
purpose and the ways in which they
includes education, parenting and
contribute to health. Self-care includes
home maintenance, volunteer work,
155
 P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l
and even the play of children. Finally,
leisure includes a wide range of
nonobligatory activities, motivated pri-
marily by personal interest, enjoyment
and quality of life (Reed, 2005).
The theoretical foundation of occupa-
tional therapy is based on the assump-
tion that humans are occupational
beings in that human beings have a
need to participate in occupations that
are fundamental to survival, health and
the optimization of human potential
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
(Wilcock, 1998; Yerxa, 1998). The
This document is copyrighted by the American Psychological Association or one of its allied publishers.
knowledge base of the profession
draws on a range of basic and social
sciences to explain the relationship be-
tween occupation and well-being and
to understand common occupational
problems. The ultimate goal of occupa-
tional therapy is to enable participation
in personally and socially meaningful
occupations that support health and
well-being.
Understanding Occupation
A strength of the construct of occupa-
tion is that it is easily understood in lay
terms and relevant to most people:
after all, everyone knows something
about what people do in daily life and
why they do it. Yet this simplicity also
masks the complexities of occupation,
which are a central concern of the theo-
retical and practical knowledge base of
occupational therapy.
Motivation, selection, experience, per-
formance and contextual factors under-
lie participation in healthy occupation
across the lifespan. Occupations in
daily life include activities that provide
a means to organize time use, meet
personal goals, provide meaning and
satisfaction, prompt human develop-
ment, develop abilities, capacities and
coping, and change oppressive experi-
ences (CAOT, 2002). The actual “doing”
of occupations is believed to be trans-
formative, promoting adaptation, cre-
ating personal and social identities,
connecting people to their communi-
ties and enabling ongoing personal
growth and development.
Conceptual models of occupation pres-
ent occupational performance, partici-
pation, and experience as resulting
from a transaction between the occu-
pations themselves, as well as person-
level and environment-level factors.
Person-level determinants of occupa-
tion are variously classified but include
the following (McColl et al., 2003;
Baum & Christiansen, 2005):
• Spiritual dimensions refer to the per-
sonal meanings attributed to occupa-
tion as a reflection of identity of the
self, one’s connections to others and
to one’s place in the world. Personal
accounts have described how living
with mental illness can be experi-
enced as a crisis in meaning and pur-
pose that is expressed as profound
occupational disengagement.
• Socio-cultural determinants refer to
the internalized values and beliefs
that underlie a person’s occupational
choice and the social enactment of
occupations. For example, the need
to negotiate complex social situa-
tions is often complicated for individ-
uals with a mental illness because
their coping strategies must include
dealing with features of illness.
• Physical determinants refer to the
movement, strength, endurance and
flexibility demands of occupations.
Physical issues affecting occupation
occur frequently in the context of a
mental illness, emerging, for exam-
ple, as a result of the inactivity asso-
ciated with occupational deprivation,
effects of medical treatments, co-oc-
curring physical conditions and
changes associated with aging.
• Cognitive determinants are mental
functions that support learning, im-
plementation and transference of oc-
article
156
Doing Daily Life
cupational knowledge and behaviors.
For example, the potential impact of
mental illness on attention, memory,
problem solving and other cognitive
processes is well known, and these
can in turn affect the experience and
performance of occupations.
• Neurobehavioral determinants refer
to underlying motor and sensory
processes that support the experi-
ence and performance of occupa-
tions. Although often cited as an
“invisible” disability, people with a
mental illness can experience observ-
able problems in refined motor enact-
ment of task and social demands of
occupations.
• Psychoemotional determinants refer
to internal processes that motivate
and sustain occupational engage-
ment. Negative occupational experi-
ences of persons with a mental
illness frequently contribute to com-
promised self-esteem, self-efficacy
and the loss of self-agency. In addi-
tion, many people with a serious
mental illness describe a decrease in
their capacity to experience pleasure
and interest when engaged in occu-
pations.
Environment-level factors are broadly
viewed as the social, physical, cultural,
and institutional factors external to in-
dividuals that influence occupation,
and are potentially amenable to alter-
ation to enable participation, or alter
performance (CAOT, 2002). Social fac-
tors include attitudes about the poten-
tial for people with mental illness to
engage in meaningful occupations, the
nature and level of support for occupa-
tions received from everyday social in-
teractions, the availability of social
supports focused on occupations, and
the social climate of important occupa-
tional environments, such as work-
place. The physical environment can
include privacy conditions that support
occupation and access to the tools nec-

essary for occupation. Cultural factors
are values and beliefs about occupa-
tion and shared rules for occupational
performance. Institutional factors refer
to broader social structures such as
government social policies, organiza-
tional and economic structures that in-
fluence (and even regulate)
participation in occupations.
Experiencing
Occupational Disruptions
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
Because the organizing structures of
societies are, to a great extent, con-
nected to the occupations of their citi-
zens, occupational disturbances have
broad impacts on communities. Many
health conditions and social situations
can evolve into significant disruptions
to the ability of individuals to partici-
pate in and benefit from daily occupa-
tions. Occupational problems can, for
example, involve family in exceptional
caregiving responsibilities, compro-
mising their participation in other oc-
cupations, their financial resources
and their autonomy. Occupational
problems may also deprive the work-
force of a pool of promising workers
and contribute to the social disorgani-
zation of communities characterized by
poverty. The construct of occupational
justice has recently been developed to
describe the importance of occupation-
al opportunities in ensuring the growth
and development of both individual cit-
izens and of society itself (Townsend,
2003). Given the extent of exceptional
caring responsibilities often undertak-
en by families of people with a mental
illness, and the extent of workforce ex-
clusion and poverty among people with
a mental illness, the notion of occupa-
tional justice seems particularly salient
to this field.
Occupational therapists are concerned
with understanding the factors con-
tributing to people’s patterns of partici-
pation in occupations, as well as the
w i n t e r 2 0 0 9 — V ol u m e 3 2 N u m b e r 3
quality of their performance. The pro-
fession has developed a number of
terms to define how problems in occu-
pation might be experienced, under-
stood and ultimately addressed. An
explanation of the terms and examples
relevant to psychiatric rehabilitation
and recovery are provided below.
• Occupational interruption is the ex-
perience of a temporary disruption in
occupation occurring because of
changes occurring in the personal or
environmental influences on occupa-
tion. Ex: Sam, a married father of two,
takes a short leave from his job as a
production manager when he notes
an increase in the symptoms of his
bipolar mood disorder. He uses the
time to collaborate with service
providers to adjust his medications,
readjust his time use patterns to de-
crease demands and ensure regular
periods of rest, and engage in coun-
seling related to disclosure.
• Occupational imbalance is the experi-
ence of time use patterns which con-
strain the ability to meet the variety
of personal health and well-being
needs provided by occupation. Ex:
Linda’s commitment to be successful
in college with the help of the sup-
ported education program is con-
straining her ability to have fun with
her friends, visit her family and enjoy
her hobbies.
• Occupational disengagement is the
experience of a relative lack of in-
volvement in occupations character-
ized by a lack of investment and
emotional detachment. Ex: Andrew
dropped out of his college studies be-
fore his first episode of psychosis.
Bored and isolated, he wants to go
back to complete studies but no
longer has interest and the emotional
investment needed for his studies,
maintaining friendships and pretty
much all of his former activities.
article
157
• Occupational delay is the experience
of significant deviations in the typical
development of occupation. Ex:
Wendy wants to pursue a job but she
considers herself at a disadvantage
compared to other young women who
did not have their schooling and early
work experiences interrupted by
mental illness.
• Occupational deprivation is the expe-
rience of a remarkable level of disad-
vantage and constraints with respect
to occupational opportunities. Ex:
Selma has been living in a board and
care facility for six months. She
spends most of the day around the
television room. She isn’t involved in
any activities outside of the home
and she lacks the supports she would
need to connect to activities.
• Occupational alienation is the experi-
ence of a lack of involvement in
meaningful occupations emerging
from social and cultural exclusion. Ex:
Kyle would like to return to his col-
lege studies but the school’s disabili-
ty service doesn’t offer the services
he needs to help him negotiate ac-
commodations.
• Occupational apartheid is the experi-
ence of participation in occupations
that are socially trivialized, low sta-
tus, and poorly valued. It is used to
label and represent barriers external
to the person’s strengths, needs,
abilities or preferences. Ex: Despite
their best efforts the supported em-
ployment workers are unable to find
jobs beyond those that are entry-
level, poorly paid and with few career
advancement opportunities for the
people with mental illness.
Disrupted occupation has emerged as
an important concern for people with
persistent mental illnesses. Indeed,
one of the major failings of policy and
service development related to com-
munity-based services for this popula-
 P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l
tion has been the failure to make occu-
pational outcomes a high priority and
subsequently to develop and dissemi-
nate practices and resources address-
ing their occupational needs. Many
fine evidence-based services focusing
on occupation have been developed
(for example, supported employment
and education), yet the majority of peo-
ple with a persistent mental illness liv-
ing in the community still do not have
access to these services. In addition,
particular factors associated with a
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mental illness, such as profound social
stigma, and disrupted affective re-
sponses to occupation, can also under-
mine people’s power to advocate on
behalf of their own occupational
needs.
A particular strength of these concepts
is that they encourage a holistic under-
standing of personal and environmen-
tal factors influencing occupation, and
discourage an overreliance on diagno-
sis, symptoms and impairments of
mental illness to explain and address
occupational disruptions. So, for exam-
ple, using the construct “occupational
disengagement” instead of relying on
the biomedical construct of “negative
symptoms” encourages therapists and
the individuals they serve to focus their
efforts on addressing issues of activity,
social participation and creating envi-
ronments that support engagement.
Occupational Therapy Practice
The major focus of occupational thera-
py is directed to enabling occupation.
but the actual patterns of practice are
shaped by features of the therapist’s
employment, which often creates prac-
tice constraints. For example, thera-
pists employed by insurance
companies may have only a limited
number of visits to offer a return-to-
work program for an individual recover-
ing from major depression; while the
therapist with a case management
service might be asked to focus his or
her expertise in the areas of time use,
occupational balance, and activities of
daily living to complement the contri-
butions of recreation therapists, voca-
tional specialists, and peer support
workers. Occupational therapy practice
can also be aimed at enabling occupa-
tion at multiple levels including person-
level services addressing the needs of
the individual, and environment-level
interventions focused on the program/
service and the community.
Individual-Level Practice
While occupational therapists will
bring an “occupational perspective” to
all aspects of their work, it is not un-
usual for the therapist to be asked to
bring their expertise to work with indi-
viduals with serious and complex occu-
pational problems. Occupational
therapists have available to them sev-
eral process models that define phases
and strategies for collaborating with in-
dividuals to understand their occupa-
tions, define their occupational issues
and strengths and negotiate priorities
and strategies for change (Farhall et
al., 2007; Bland et al., 2007; Sumsion,
2005). The occupational therapist’s
expertise in the analysis of the actions
and skills that underlie occupational
performance can contribute to a de-
tailed understanding of the tasks and
demands experienced by individuals
and their particular strengths, difficul-
ties and potentials.
Occupational therapists use a range of
self-report methods to explore and
learn from individuals’ knowledge and
experience of their own occupations.
For example, the Occupational
Performance History Interview II (OPHI-
II, Kielhofner, Mallinson, Forsyth & Lai,
2001) uses a semi-structured interview
format to build relationships with peo-
ple with mental health issues and their
support networks to develop an under-
standing of the person’s lived experi-
article
158
Doing Daily Life
ences with occupation (Ennals &
Fossey, 2007) .
In addition, occupational therapists
have available a range of standardized
and ecologically valid observational as-
sessments that provide detailed infor-
mation about the quality of an
individual’s performance in real life oc-
cupations, which can be useful in col-
laborative service planning. Two
examples used in mental health are the
Assessment of Motor and Process
Skills, which focuses on how personal-
ly relevant activities of daily living are
impacted by motor and process skills
(Fossey, Harvey, Plant & Pantelis,
2006; Fisher, 2003; McNulty & Fisher,
2001), and the Assessment of
Communication and Interaction Skills
that focuses on how performance in a
range of activity contexts are influ-
enced by underlying social abilities
(Forsyth, Lai & Kielhofner, 1999).
Occupational therapists in the mental
health arena typically use a range of in-
terventions to, as much as possible,
meet occupational goals that are
meaningful to the individual and to col-
laboratively engage individuals in the
intervention process as experts on be-
half of their own lives and well-being.
Engaging people directly in occupa-
tions is a hallmark of occupational
therapy intervention. Individuals with
persistent mental illnesses frequently
experience extreme occupational dis-
turbances, and occupational therapists
will likely use all or a combination of
detailed occupational analyses; activi-
ties graded to meet personal needs;
explicit time use planning to encourage
balanced participation; education to
provide individuals with the informa-
tion about their occupational situa-
tions, with which to empower an
individual to effect change; focused ef-
forts to capitalize on strengths and
build skills; and consultation and envi-
ronmental modification to secure the
 w i n t e r 2 0 0 9 — V ol u m e 3 2 N u m b e r 3

best match between the person and ducing illness (Krupa, McLean, In addition, serving as a “champion”
the occupation in which she or he is Eastabrook, Bonham, & Baksh, 2003). for an occupational perspective on
seeking to participate. These stress models have been a factor health may involve occupational thera-
in the hesitation of service providers in pists in revealing how service struc-
Occupational therapy interventions in
the mental health field to pursue av- tures, such as resource allocation, job
the mental health arena may also be
enues to involve the people they serve descriptions, and program policies
directed to resolving underlying per-
in meaningful occupations, contribut- can compromise occupational enable-
formance problems, with a view to
ing to experiences of occupational dis- ment. For example, it has been noted
building capacity for occupation. This
ruption and deprivation. Consistent that occupational therapists working
can take the form of adaptation or
with contemporary perspectives on re- on Assertive Community Treatment
modification of performance. For exam-
covery, the philosophical and knowl- Teams have found their ability to offer
ple, an occupational therapist might
edge base of occupational therapy occupational interventions con-
use the findings from the Adult
advances a balanced view that pro- strained by the priority given to gener-
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Sensory Profile (Brown, Tollefson,

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motes an active and informed ap- ic duties focusing on illness

Dunn, Cromwell, & Filion, 2001), sug-
gesting issues related to low sensory
registration in the context of activities,
to collaborate with the individual to de-
velop ways to attend to missed sensory
stimuli (Brown et al., 2001; Brown,
2001). Resolving underlying perform-
ance problems can also take the form
of direct remediation. Tryssenaar and
Goldberg (1994), for example, describe
an example of an occupational thera-
pist and psychologist collaborating to
deliver a cognitive remediation pro-
gram for a young man with a mental ill-
ness that linked focused computer
activities directed to improving atten-
tion-focusing with improving activity
and social performance in the class-
room and at work.
There have been calls to develop em-
pirical evidence demonstrating how in-
volvement in occupations can improve
mental health and even alleviate the
symptoms and impairments of mental
illness (Rebeiro, 1998). There is no
doubt that the relationship between
engagement in daily activities and the
experience of a mental illness is com-
plex. This complexity is reflected in the
contradictory assumptions about activ-
ity and health that permeate the men-
tal health field. Popular
vulnerability-stress models suggest
that participation in daily activities can
have harmful effects, overwhelming an
individual’s adaptive capacities and in-
proach, to supporting participation in
meaningful occupations (Krupa,
Radloff-Gabriel, Whippey & Kirsh,
2002). When this support is matched to
individual need and circumstances, the
transformative capacities of “doing
daily life” are released.
Environment-Level Practice
Occupational therapists also use their
environment-level “occupational per-
spective”—the social, physical, cultur-
al, and institutional factors external to
individuals that influence occupa-
tion—to enable program/service de-
velopment. For example, with their
emphasis on enabling occupations,
therapists may attend to the extent to
which the program focuses on, creates
and develops meaningful and real oc-
cupational opportunities for the peo-
ple they serve. They may focus on
particular populations to ensure that
services are meeting their occupation-
al needs. For example, Bassett, Lloyd
and colleagues, Australian occupa-
tional therapists, describe efforts to
prevent the persistent disruption of
the occupational lives of young per-
sons with first episode psychosis
(Lloyd & Waghorn, 2007) and to enable
the parenting skills of women with a
serious mental illness to ensure the
continuation of their involvement in
this important social role (Bassett,
King & Lloyd, 2006; Bassett, Lampe &
Lloyd, 2001).
management (Krupa, Radloff-Gabriel,
Whippey & Kirsh, 2002). Likewise,
Townsend’s (1998) institutional
ethnography of practice in Canadian
Clubhouses found that despite good
intentions to support real occupational
opportunities, the participatory and
empowering elements of such services
can also be easily overruled by other
routine aspects of the organization of
mental health services.
With the growing interest in evidence-
based program development built on
sound evaluation practices, occupa-
tional therapists are increasingly be-
coming involved in working with other
providers to identify or develop ap-
proaches to the evaluation of occupa-
tional changes affected by service
delivery. This may involve assisting
the team with developing program
logic models and outcome evaluations
that include a focus on demonstrating
the quality of service recipients’ occu-
pational lives. Some occupational
therapy measures, such as the
Canadian Occupational Performance
Measure by Law, Baptiste, McColl,
Opzoomer, Polatajko, & Pollock (1994)
have the advantage of being both
client-centered and applicable to both
individual service planning and pro-
gram evaluation, as further illustrated
in Kirsh and Cockburn’s article in this
issue.

article

159
 P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l
Community-Level Practice
Beyond a focus on program develop-
ment, environment-level interventions
include community-level practices
which focus on identifying, under-
standing and addressing how commu-
nities themselves enable or hinder the
occupational patterns of people with
mental illnesses. Occupational thera-
pists will use established community
development techniques, such as com-
munity assessments, community ca-
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pacity building, the development of
This document is copyrighted by the American Psychological Association or one of its allied publishers.
partnerships and peer-support, health
promotion techniques, systems advo-
cacy, community economic develop-
ment and participatory approaches,
but the goal of these will be focused on
occupation and constructing communi-
ties and societies that are occupation-
ally rich and just (Trentham, Cockburn
& Shim, 2007). An example of this type
of effort is the Northern Initiative for
Social Action, a consumer-driven occu-
pational effort that creates, among
other things, economic opportunities
along with a participatory research unit
(Rebeiro, Day, Semeniuk, O’Brien, &
Wilson, 2001).
Summary/Conclusion
Psychiatric rehabilitation is obviously
compatible with the ultimate goal and
values of occupational therapy, with its
focus on “living, working, learning and
social environments” (USPRA, 2008)
lining up well with the notion of “doing
daily life” through occupational thera-
py’s concern with occupations related
to self-care, productivity, and leisure.
Attending to both the person and envi-
ronment levels is common to both psy-
chiatric rehabilitation and occupational
therapy.
The philosophical foundations of occu-
pational therapy also are highly consis-
tent with the elements of recovery
(Anthony, 1993, 2000; Davidson,
O’Connell, Tondora, Staeheli & Evans,
2005; Del Vecchio & Fricks, 2007;
Ralph, 2000; Repper & Perkins, 2003).
Contemporary professional standards
advocate for partnership-centered ap-
proaches that acknowledge individuals
served as experts of their own lives; re-
specting and enabling the personal
control and responsibility as central;
and therapists as bringing their occu-
pation-related expertise to facilitating
meaningful and satisfying forms of par-
ticipation of individuals and communi-
ties served. Renewing hope, moving
beyond illness to construct a new self,
expanding social roles, building social
connections, learning to manage symp-
toms, being a citizen and overcoming
stigma, are all elements of the recovery
process (Davidson, Sells, Sangster &
O’Connell, 2005), and are all seen as
integral to occupational engagement
(Krupa & Clark, 2004).
The development of a truly recovery-
oriented system will depend on innova-
tive cross-disciplinary collaborations
among service providers to effectively
use all of their available resources to
foster recovery.
Consistent with psychiatric rehabilita-
tion, occupational therapy has tended
to focus on assessment processes that
are highly client-centered and attend to
environmental and situational context.
In addition, occupational therapy has
contributed to the development of
standardized assessments that attend
to discrete determinants of perform-
ance in occupation, such as motor,
process and sensory performance com-
ponents.
Occupational therapy is a key disci-
pline in the field of psychiatric rehabili-
tation and brings to the field a strong
theoretical and knowledge base and
some unique procedures and practices.
All kinds of individuals who identify
with the practice of helping people
with mental illnesses recover have
much to offer the still young field of
psychiatric rehabilitation. It is impor-
article
160
Doing Daily Life
tant for the psychiatric rehabilitation
field to learn from all disciplines, in-
cluding occupational therapy.
References
Anthony, W. A. (1993). Recovery from mental
illness: The guiding vision of the mental
health service system in the 1990s.
Psychosocial Rehabilitation Journal, 16,
11–23.
Anthony, W. A. (2000). A recovery oriented
service system: Setting some system level
standards. Psychiatric Rehabilitation
Journal, 24, 159–168.
Bassett, H., King, R., & Lloyd, C. (2006). The
development of an observation tool for
use with parents with psychiatric disabili-
ty and their preschool children.
Psychiatric Rehabilitation Journal, 30,
31–37.
Bassett, H., Lampe, J., & Lloyd, C. (2001).
Living with under-fives: A programme for
parents with a mental illness. British
Journal of Occupational Therapy, 64(1),
23–28.
Baum, C. & Christiansen, C. H. (2005). Person-
environment-occupation-performance: An
occupation-based framework for practice.
In C. H. Christiansen, C. Baum & J. Bass-
Hagen (Eds.), Occupational therapy:
Performance, participation and well-
being. Thorofare, NJ: Slack Inc.
Bland, R., Clarke, M., Elsom, S., Epstein, M.,
Farhall, J., Fielding, J., Fossey, E., Leggatt,
M., Liaw, S. T., Meadows, G., Minas, H.,
Olsen, A., Roper, C., Rosen, A. & Singh, B.
(2007). Active participants in mental
health services. In G. Meadows, B. Singh
& M. Grigg (Eds.), Mental health in
Australia: Collaborative community prac-
tice, 2nd Edition (pp. 190–226). South
Melbourne: Oxford University Press.
Brown, C. (2001). What is the best environ-
ment for me? A sensory processing per-
spective. Occupational Therapy in Mental
Health, 17 (3/4), 115–125.
Brown, C., Tollefson, N., Dunn, W., Cromwell,
R. & Filion, D. (2001). The adult sensory
profile: Measuring patterns of sensory
processing. American Journal of
Occupational Therapy, 55(1), 75–82.
Canadian Association of Occupational
Therapists (CAOT). (2002). Enabling occu-
pation: An occupational therapy perspec-
tive. Ottawa: Canadian Association of
Occupational Therapists.

Davidson, L., O’Connell, M. J., Tondora, J.,
Staeheli, M. & Evans, A. C. (2005).
Recovery in mental illness: Paradigm shift
or shibboleth? In L. Davidson, C. Harding
& L. Spaniol (Eds.), Recovery from severe
mental illnesses: Research evidence and
implications for practice, Volume 1
(pp. 5–26). Boston: Center for Psychiatric
Rehabilitation, Boston University.
Davidson, L., Sells, D., Sangster, S. &
O’Connell, M. J. (2005). Qualitative stud-
ies of recovery: What can we learn from
the person? In R. O. Ralph & P. W.
Corrigan (Eds.), Recovery in mental illness:
Broadening our understanding of well-
ness. Washington, D.C.: American
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Psychological Association.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Del Vecchio, P. & Fricks, L., (2007). Guest edi-
torial: Special section on mental health
recovery and system transformation.
Psychiatric Rehabilitation Journal, 31, 7–8.
Ennals, P. & Fossey, E. (2007). The
Occupational Performance History
Interview (OPHI-II) in adult community
mental health settings: Consumers’ and
occupational therapists’ perspectives.
Australian Occupational Therapy Journal,
54, 11–21.
Farhall, J., Fossey, E., Keble-Devlin, B.,
Meadows, G., Roberts, S. & Singh, B.
(2007) Conceptual models used in mental
health practice. In G. Meadows, B. Singh
& M. Grigg (Eds.), Mental health in
Australia: Collaborative community prac-
tice, 2nd edition, pp. 21–50. South
Melbourne: Oxford University Press.
Fisher, A. (2003). Assessment of motor and
process skills: Development, standardiza-
tion, and administration manual. (5th ed.
Vol. 1). Colorado: Three Star Press Inc.
Forsyth, K., Lai, J. & Kielhofner, G. (1999). The
assessment of communication and inter-
action skills (ACIS): Measurement proper-
ties. British Journal of Occupational
Therapy, 62(2), 69–74.
Fossey, E., Harvey, C. A., Plant, G., & Pantelis,
C. (2006). Occupational performance of
people diagnosed with schizophrenia in
supported housing and outreach pro-
grammes in Australia. British Journal of
Occupational Therapy, 69(9), 409–419.
Kielhofner, G., Mallinson, T., Forsyth, K. & Lai,
J. (2001). Psychometric properties of the
second version of the Occupational
Performance History Interview (OPHI-II).
American Journal of Occupational
Therapy, 55(3), 260–267.
Krupa, T. & Clark, C. (2004). Occupational
therapy in the field of mental health:
Promoting occupational perspectives on
health and well-being. Canadian Journal
of Occupational Therapy, 71(2), 69–74.
w i n t e r 2 0 0 9 — V ol u m e 3 2 N u m b e r 3
Krupa, T., McLean, H., Eastabrook, S.,
Bonham, A., & Baksh, L. (2003). Daily
time use as a measure of community
adjustment for persons served by
assertive community treatment teams.
American Journal of Occupational
Therapy, 57(5), 558–565.
Krupa, T., Radloff-Gabriel, D., Whippey, E., &
Kirsh, B. (2002). Reflections on...
Occupational therapy and assertive com-
munity treatment. Canadian Journal of
Occupational Therapy. 69(3), 153–157.
Law, M., Baptiste, S., McColl, M., Opzoomer,
A., Polatajko, H., & Pollock, N. (1994).
The Canadian Occupational Performance
Measure: An outcome measure for occu-
pational therapy. Ottawa: Canadian
Association of Occupational Therapists.
Lloyd, C. & Waghorn G. (2007). The impor-
tance of vocation in recovery for young
people with psychiatric disabilities.
British Journal of Occupational Therapy,
70(2), 50–59.
McColl, M. A., Law, M., Stewart, D., Doubt, L.,
Pollock, N., & Krupa, T. (2003). Theoretical
basis of occupational therapy. Thorofare,
NJ: Slack, Inc.
McNulty, M. C. & Fisher, A. G. (2001). Validity
of using the Assessment of Motor and
Process Skills to estimate overall home
safety in persons with psychiatric condi-
tions. American Journal of Occupational
Therapy, 55(6), 649–655.
Ralph, R. O. (2000). Review of recovery litera-
ture: A synthesis of a sample of recovery
literature 2000. Alexandria, VA: National
Association of State Mental Health
Program Directors; National Technical
Assistance Center for State Mental Health
Planning.
Rebeiro, K. L. (1998). Occupation-as-means to
mental health: A review of the literature,
and a call for research. Canadian Journal
of Occupational Therapy, 65(1), 12–19.
Rebeiro, K. L., Day, D. G., Semeniuk, B.,
O’Brien, M. C., & Wilson, B. (2001).
Northern initiative for social action: An
occupation-based mental health program.
American Journal of Occupational
Therapy, 55(5), 493–500.
Reed, K. (2005). An annotated history of the
concepts used in occupational therapy. In
C. H. Christiensen, C. M. Baum and J.
Bass-Haugen (Eds.), Occupational thera-
py: Performance, participation and well-
being. Thorofare, NJ: Slack, Inc.
Repper, J. & Perkins, R. (2003). Social inclu-
sion and recovery: A model for mental
health practice. Edinburgh: Bailliere
Tindall.
article
161
Sumsion, T. (2005). Facilitating client-centered
practice: Insights from clients. Canadian
Journal of Occupational Therapy, 72(1),
13–21.
Townsend, E. (1998). Good intentions over-
ruled: A critique of empowerment in the
routine organization of mental health
services. Toronto, ON: University of
Toronto Press.
Trentham, B., Cockburn, L. & Shim, J. (2007).
Health promotion and community devel-
opment: An application of occupational
therapy in primary health care. Canadian
Journal of Community Mental Health,
26(2), 53–69.
Tryssenaar, J. & Goldberg, J. (1994). Improving
attention in a person with schizophrenia.
Canadian Journal of Occupational
Therapy, 61(4), 198–205.
USPRA (n.d.) Definition of psychiatric rehabili-
tation. Retrieved November 7, 2008
http://www.uspra.org/i4a/pages/index.cf
m?pageid=4124
Wilcock, A. (1998). An occupational perspec-
tive of health. Thorofare, NJ: Slack, Inc.
Yerxa, E. J. (1998). Health and the human spirit
for occupation. The American Journal of
Occupational Therapy, 52, 412–418.
Terry Krupa, PhD, OT Reg. (Ont.), Associate
Professor, School of Rehabilitation Therapy,
Queen’s University, Kingston, Ontario.
Ellie Fossey, MSc, AccOT, is a Senior
Lecturer, LaTrobe University, Melbourne,
Australia.
William A. Anthony, PhD, is the Executive
Director of the Center for Psychiatric
Rehabilitation, Sargent College of Health
and Rehabilitation Sciences, Boston
University.
Catana Brown, PhD, OTR, Associate
Professor, School of Occupational Therapy,
Touro University-Nevada, Henderson, Nevada.
Deborah Pitts, MBA, OTR/L, CPRP, BCMH,
Clinical Faculty Division of Occupational
Science and Occupational Therapy, School of
Dentistry, University of Southern California.
Contact:
Terry Krupa, PhD
Associate Professor
School of Rehabilitation Therapy
Queen’s University
Kingston, Ontario K7L 3N6
CANADA
terry.krupa@queensu.ca