Occupational Therapy in Mental Health: Assessment, Approaches and Activities
How OT helps people with mental illness: problem areas, assessments, goals, approaches from CBT to recovery, group levels and activities.
Occupational therapists have worked with people with mental illness since the beginning of the occupational therapy profession. Occupational therapy and mental health have a long relationship.
There is a big difference between the role of occupational therapy in physical and mental health settings. The outcome of physical rehabilitation is often faster than mental health rehabilitation, and the time needed in mental health varies, partly because illness can affect a person’s motivation and engagement.
Mental disorders are common. The World Health Organization estimates that nearly 1 in 7 people worldwide, about 1.2 billion, were living with a mental disorder in 2023, including 470 million with anxiety disorders and 322 million with depression. Many people with a psychiatric disorder, such as schizophrenia, have a poor quality of life, residual symptoms and long-term disability.
Although early recognition and treatment are the cornerstone of preventing long-term disability, many people need rehabilitation. Methods used in psychiatric rehabilitation include housing support (for example halfway homes and supervised housing), vocational training (such as sheltered workshops, vocational guidance and supported employment) and therapy (activities, social skills training and cognitive remediation).
Areas of concern
The concern of occupational therapy is with the things people do in their daily lives, the meaning people give to what they do, and the impact of those things on their health.
The purpose of occupational therapy in mental health is to help people cope with the challenges of everyday living imposed by mental and emotional illness. The occupational therapist finds the problem areas and plans activities accordingly.
| Area | Examples | How it shows in daily life |
|---|---|---|
| Motor | Psychomotor slowing or agitation, side effects of medication | Moving slowly, restlessness, tremor making tasks harder |
| Sensory and perceptual | Hallucinations, delusions | Distraction, fear or confusion during tasks |
| Cognitive | Decision making, problem solving, attention, memory | Missing appointments, difficulty following a recipe |
| Intrapersonal | Self-concept, feelings, self-esteem | "I can't do anything right"; avoiding new tasks |
| Interpersonal | Socialisation, communication | Withdrawing from friends, conflict at work |
| Self-care | Basic and instrumental activities of daily living | Neglected hygiene, irregular meals, unpaid bills |
| Productivity | Work, study, homemaking | Losing a job, dropping out of college |
| Leisure | Interests, enjoyable activities | No longer doing hobbies; long empty days |
The role of occupational therapy in mental health
- Make the person independent in daily living skills
- Improve social interaction and participation
- Help improve behaviour and coping
- Use occupation and activities to promote wellness and quality of life
- Engage people in activities that help them overcome limitations in self-care, homemaking, work, study, leisure and social participation
- Build capacity, so the person can make choices about their own desired goals and outcomes
Who OTs work with
Occupational therapists in mental health see people of all ages, most often from teenagers to older adults. Common diagnoses include:
- Mood (affective) disorders, such as depression and bipolar disorder
- Schizophrenia and other psychotic disorders
- Anxiety disorders, OCD and PTSD
- Alcohol and substance use disorders
- Personality disorders
- Mental health needs in people with intellectual disability
- Dementia and other cognitive disorders in older adults
Practice settings
Psychiatric units of general hospitals, residential facilities, quarterway and halfway homes, community mental health centres, outpatient departments of mental hospitals, forensic units, addiction services and supported employment programs.
Occupational therapy assessment in mental health
Occupational therapists use different evaluation and assessment tools to identify problem areas and behaviour. A comprehensive OT evaluation, through interviews with the patient and caregiver, includes:
| Area | What the OT notes |
|---|---|
| History | Personal, educational, occupational, social and family history |
| Appearance and attitude | Grooming, dress, attitude towards the examiner |
| Mood and affect | Depressed, anxious, euphoric, flat |
| Thought | Relevant or not; any delusions |
| Perception | Any hallucinations |
| Speech | Rate, volume, appropriateness |
| Orientation | Time, place and person |
| Memory | Immediate, recent and remote |
| Insight and judgement | Understanding of the illness; problem solving |
| Behaviour | Psychomotor activity, engagement in tasks |
| Daily living | Independent or dependent in self-care and household tasks |
| Interests and roles | Hobbies, valued roles, routines |
Occupational therapists may also use projective techniques, such as the Azima Battery and Goodman Battery, to explore a person’s inner thoughts and conflicts (see the psychodynamic frame of reference). Results from psychological tests such as the Thematic Apperception Test or the Minnesota Multiphasic Personality Inventory, usually administered by psychologists, can add to the picture.
Standardised OT assessments include:
- Allen Cognitive Level Screen (ACLS)
- Bay Area Functional Performance Evaluation (BaFPE)
- Assessment of Motor and Process Skills (AMPS)
- Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS)
- Canadian Occupational Performance Measure (COPM)
- Model of Human Occupation Screening Tool (MOHOST)
- Kohlman Evaluation of Living Skills (KELS)
Occupational therapy intervention in mental health
A person usually needs occupational therapy because they are unable to meet the demands of their physical and social environment and are not coping adequately.
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Engage
Build rapport and trust in a safe, calm setting.
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Assess
Interview, observe and use standardised tools to find problem areas and strengths.
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Set goals together
Short-term, intermediate and long-term goals within the person's capacity.
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Intervene
Graded activities, groups and strategies chosen with the person.
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Review
Measure progress and adjust as the person recovers.
Occupational therapy goals
Goals are the targets the person hopes to reach through occupational therapy. They must be within the person’s capacity, and are usually set at two or three levels: short-term, intermediate and long-term. Typical goals include:
- Improve reality orientation
- Improve self-awareness and self-knowledge
- Improve self-acceptance and self-esteem
- Improve the ability to form close relationships
- Pursue productive, goal-directed activity
- Build a balanced daily routine of self-care, productivity and leisure
Intervention planning
Occupational therapy interventions are individualised, and a program is planned for each person. It is a collaborative process between the therapist, the person and the caregiver, designing a unique solution to that person’s problems. After setting goals, the occupational therapist chooses the approach for treatment.
Frames of reference and models used by OTs in mental health:
- Behavioural frame of reference
- Developmental frame of reference
- Psychodynamic frame of reference
- Occupational adaptation
- Model of Human Occupation (MOHO)
- Acquisitional frame of reference
- Cognitive disability (Allen) frame of reference
An OT program may combine these frames of reference in a tailored way. Historically, the psychodynamic frame of reference was the one most used in psychiatry; today, MOHO, recovery-oriented, cognitive and behavioural approaches are also widely used.
Occupational therapists in mental health prefer the functional view of disability, in which the emphasis is on what the person can and cannot do, rather than on the illness they have (World Federation of Occupational Therapists).
Approaches in mental health occupational therapy
1. Humanistic approach
The humanistic approach is one of the most common approaches used by mental health occupational therapists. The therapist tries to understand what the person feels, what problems they have and what is causing them.
How to approach the person: start interviews and sessions in a calm, confident and warm manner. Sessions should take place in a safe, uncluttered environment to avoid distraction. The primary goal is a healthy relationship and good rapport.
2. Client-centred and recovery-oriented approach
A person’s beliefs and attitudes may be different from the therapist’s. They may want to live alone, may not be ready to take medication, or may not be interested in groups. A client-centred approach plans activities around the person’s preferences, engaging them in the whole process of change and allowing them more control over their lives. This partnership helps the OT be extremely creative in finding solutions to the most difficult problems.
The recovery model goes further: recovery means living a satisfying, hopeful life, even with ongoing symptoms. Research on personal recovery describes five processes, known as CHIME: Connectedness, Hope, Identity, Meaning and Empowerment (Leamy and colleagues, 2011). Occupation supports all five.
3. Cognitive approaches
Cognitive behavioural therapy (CBT) is a popular, evidence-based psychotherapeutic approach that looks at five connected areas. Change in any one can lead to improvement, or worsening, in the others.
Thoughts
"Everyone will stare at me."
Mood
Nervous, low
Body
Sweating, racing heart
Behaviour
Avoiding the party
If we exercise (behaviour), we feel better (mood); if we feel nervous (mood), we may sweat more (body); if we find large gatherings difficult (environment), we may avoid them (behaviour).
Occupational therapists use CBT strategies within real activities: practising a feared task step by step, scheduling enjoyable activities, or testing a thought (“I’ll fail”) by trying the task and reviewing what actually happened.
4. Group therapy
Groups are a core tool in mental health OT. Mosey described five developmental levels of group interaction, and the OT matches the group to the person’s level.
Most advanced ↑
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Mature group
Members take on all roles needed for the task and for each other's needs.
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Cooperative group
Members share feelings and support each other; the task matters less.
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Egocentric-cooperative group
Members work on a longer joint task and begin to meet each other's needs, with leader support.
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Project group
Short shared tasks that need some cooperation, e.g. making a poster together.
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Parallel group
Members work on their own task alongside others, with little interaction.
Most basic
Most groups also fall into two broad types:
| Supportive groups | Explorative groups | |
|---|---|---|
| Aim | Strengthen the ego, use healthy defences, cope with long-term problems | Change attitudes, promote insight, resolve conflicts |
| Format | Often open, structured | Usually closed, less structured |
| Good for | Chronic anxiety and depression, serious mental illness | People who are more stable and want deeper change |
5. Physical activity
According to national consensus statements (Grant, 2000), physical activity positively influences depression, anxiety, emotion and mood, self-esteem and cognitive function. Physical activity and exercise are also recommended alongside treatment for serious illnesses such as schizophrenia and substance dependence, where physical health risks are high. Rhythmic aerobic exercise such as brisk walking, jogging, swimming, cycling or dancing is especially helpful for overall health.
6. Anxiety management
Anxiety has many causes across age groups. Anxiety management and relaxation techniques, such as slow breathing, progressive muscle relaxation and grounding, help people with many mental health conditions. Read more: occupational therapy for anxiety.
7. Reminiscence
Reminiscence is the process of remembering, especially recovering past memories by mental effort. The OT can focus on past positive experiences to help with current problems, resolve conflicts or maintain self-esteem, and to improve social participation. Videos, music, audio clips and photos can trigger reminiscence. It is widely used with older adults and people with dementia.
8. Reality orientation
Reality orientation aims to help people relearn basic facts about themselves and their environment. The person is always addressed by their preferred name, and cues such as clocks, notice boards and calendars are provided.
9. Environmental adaptation
The occupational therapist adapts the person’s environment to promote function at the best possible level. For people with problems of orientation, mood or thought, the OT can use colour, plants or familiar objects as environmental cues, reduce noise and clutter, and set up visual schedules.
10. Assistive technology
The OT may recommend assistive devices to improve function, from very simple tools such as memory aids and easy-to-use telephones to medication reminder apps and digital calendars.
11. Supported employment and life skills
Work is a powerful part of recovery. Individual Placement and Support (IPS), a form of supported employment that helps people find and keep regular jobs with ongoing support, has strong evidence for people with serious mental illness. OTs also run life-skills programs for cooking, budgeting, shopping and using transport.
Occupational therapy activities in mental health
Activity is at the core of occupational therapy. The occupational therapist uses a wide range of activities, including personal care, everyday tasks, work-related activities and creative activities.
Everyday activities as part of therapy allow the person to develop or regain skills to the level they need. Learning a new skill can change the way a person sees themselves, build confidence and strengthen personal and social identity. For example, learning to use a computer can help a young person find work and raise their self-esteem.
Characteristics of OT activities in psychiatric settings
- Structured activities are preferred over unstructured ones
- Short-term activities
- Simplified activities
- Covert activities that provide a safe outlet for hostility, such as hammering or kneading clay
- Familiar activities first; familiar activities bridge to new situations
- Goal-directed activities
- Activities graded to match clinical change
- Activities include crafts, art and pottery, creative writing, cooking, gardening and table games
| Need | Activities |
|---|---|
| Intrapersonal issues | Projective activities to explore inner conflicts; non-personal projects (e.g. making envelopes for a department); role play and psychodrama to express hostile feelings safely |
| Interpersonal issues | One-to-one interaction first; unfamiliar activities with step-by-step instruction; trust and motivation building; group therapy |
| Self-esteem | Respect and encouragement for expressing feelings; gradually giving the person decisions; weight training and resistive exercise, which can improve physical self-perception and body image |
| Self-concept and identity | Body movement (dance, circle games to sound and rhythm, spot marching); ball games and group activities; tracing a body outline or drawing human figures; clay modelling |
| Self-discipline | Keeping attendance records; games with rules such as bingo or chess |
| Daily living | Cooking a simple meal, budgeting for a shopping trip, laundry, using public transport |
Summary
Occupational therapy activities help people return to their own occupations and environments with full participation. Mental health occupational therapists assess problem areas across daily life, set goals together with the person, and use different frames of reference and approaches, from CBT and groups to physical activity and supported employment. Read more:
- Occupational therapy for depression
- Occupational therapy for schizophrenia
- Occupational therapy for anxiety disorders
- Occupational therapy for OCD
- Occupational therapy for PTSD
Related guides: OT activities for dementia.
Theory behind this: the OT approaches in this guide draw on MOHO, psychodynamic, cognitive-behavioural and Allen’s cognitive levels, plus the Kawa model.
References
- World Health Organization. Mental disorders: fact sheet. 2026.
- Creek J, Lougher L, eds. Occupational Therapy and Mental Health. 4th ed. Elsevier; 2011.
- Crouch R, Alers V, eds. Occupational Therapy in Psychiatry and Mental Health. 5th ed. Wiley; 2014.
- Scheinholtz MK, ed. Occupational Therapy in Mental Health: Considerations for Advanced Practice. AOTA Press; 2010.
- Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. Conceptual framework for personal recovery in mental health. British Journal of Psychiatry. 2011;199(6):445–452.
- Mosey AC. Psychosocial Components of Occupational Therapy. Raven Press.
Frequently asked questions
What does an occupational therapist do in mental health?
Where do mental health occupational therapists work?
What conditions do mental health OTs treat?
What assessments do occupational therapists use in mental health?
What is the difference between occupational therapy and psychotherapy in mental health?
Is occupational therapy effective for mental illness?
Written by
Payal Mehta, OT
Payal Mehta is a practising occupational therapist and co-founder of Occupational Therapy OT. She writes on pediatrics, sensory integration, and mental-health practice.
All articles by Payal →This article is for general education and is not a substitute for individualized assessment or treatment by a licensed occupational therapist. Always seek the guidance of a qualified professional for specific concerns.
