By Danielle Hitch
27th November, 2016
Most mental health OT’s get into the field for the best of reasons – to improve quality of life, address occupational justice and generally make life better for people with mental illness. And we think this is enough – but it isn’t …
We can talk ‘till the cows come home about how we support people to engage in meaningful occupations, and enable them to participate to their optimal level in the community … and often do.
But we operate in a system that values other outcomes that are easier to measure and more clearly defined, one of which is cost effectiveness. Money does indeed make the health world spin, particularly in the public sector where everything we do is funded by the hard earned of our fellow citizens.
So, why are there so few studies into the cost effectiveness of OT in mental health? Studies such as these have been conducted in physical health, and invariably found that the presence of OT reduces burden on the public health system and saves money. The most recent of these from Scotland found that OTs can make efficiency saving while also experiencing patient experience.
A 2008 study found that the provision of OT could save €1748 per patient with dementia (Graff et al., 2008), while a 2013 study found an OT led lifestyle intervention for people with panic disorder proved to provide value for money over 10 months. A review by Mary Morley and Genevieve Smith (2013) also found two further studies that showed OT to be a cost effective intervention for people with enduring psychotic conditions (Cook & Howe, 2003) and work related major depression (Schene et al., 2007).
All of this evidence has been generated in Europe – where is the evidence from Australia? We need to partner with health economists to prove, in concrete terms, the ‘worth’ of occupational therapy in mental health. It is only be putting a dollar figure on what we save the community through out work that it will be valued and appropriately funded. While this might seem quite mercenary, the economic analysis of the impact of mental health occupational therapy will provide far greater security and support for the profession than any number of small scale studies into the subjective experience of being a provider or consumer of OT.
So, does this mean that qualitative studies are redundant? – Of course not! As with all aspects of life, there needs to be a balanced approach to the evidence we utilise to support our work in mental health occupational therapist. Economic analyses are tricky to get going, but they are essential to the ongoing sustainability of mental health occupational therapy. So, get in touch with your local health economist …. They could become your best friend.
Cook, S., & Howe, A. (2003) Engaging people with enduring psychotic conditions in primary mental health care and occupational therapy. British Journal of Occupational Therapy, 66(6), 236–46.
Graff, M.J., Adang, E.M., Vernooij-Dassen, M.J. et al. (2008). Community occupational therapy for older patients with dementia and their care givers: Cost effectiveness study. BMJ, 336, 154-158.
Lambert, R.A., Longelly, P., Harvey, I. & Poland, F. (2010). Cost-effectiveness analysis of an occupational therapy-led lifestyle approach and routine general practitioner’s care for panic disorder. Social Psychiatry and Psychiatric Epidemiology, 45(7), 741-750.
Morley, M., & Smyth, G. (2013) Are occupational therapy interventions for service users with mental health problems cost-effective? British Journal of Occupational Therapy, 76(10), 470–473.
Schene AH, Koeter MWJ, Kikkert MJ, Swinkels JA, McCrone P (2007) Adjuvant occupational therapy for work-related major depression works: randomised trial including economic evaluation. Psychological Medicine, 37(3), 351–62.