All in a day’s work
Sue Bright describes how offering occupational support can bolster an individual’s recovery journey
How many activities have you already carried out today?
If you take a moment and think of perhaps some of the activities you were involved in during the first couple of hours of your morning, it gives a sense of how occupation is essential in our lives and how we are programmed to ‘do’.
Occupations are all of the things we do day-to-day, which can include domestic and personal care, socialising, hobbies, work or voluntary activities. They can include things we are expected to do, need to do and want to do.
Occupation is a natural means of restoring function and is particularly important in recovery. The World Health Organization ‘no longer looks at health in terms of impairment, disability and handicap but a person’s ability to engage in activities and thereby participate in daily life’.
As an occupational therapist (OT), my aim is to help individuals develop or maintain a satisfying routine of meaningful everyday activities that can give a sense of direction and purpose.
In my role within Unity as a recovery occupational therapist specialising in education, training and employment (ETE), I work with individuals who are ready to address their occupational functioning; in short, ready to do things – the ultimate goal being to move towards education, training and employment.
Research shows that being unemployed or not meaningfully engaged in occupation can have an impact on health. This includes reduced life satisfaction and wellbeing, increased risk of mental illness and suicide, decreased self-esteem and feelings of guilt, diminished social status, disturbed roles and routines as well as the more obvious financial impact.
Spending most of the time engaged in passive, home-based activities such as watching television, ‘doing nothing’ or sleeping is often simply a means of filling the perceived ‘endless free time’ resulting from unemployment. These activities are not often actively chosen, nor may they hold any particular significance for the individual or thought of as purposeful by them.
As Aristotle says, the quality of life is determined by its activities.
One of my daily activities is to facilitate employability clinics in our local Unity bases. Initially I will ask someone to chat about what a typical day looks like for them, from getting up in the morning to going to bed at night, as this creates a picture of their occupations, roles and routines.
For example, Robin told me he didn’t get out of bed until lunchtime unless he had appointments – ‘what’s the point? There’s only mind-numbing telly. I’ve no money to do things and need to keep away from other users. I go to bed at two in the morning as I’m not tired; I’ve not done anything in the day!’
I focus on the will, drill and skill of the individual – motivation, routines and assets.
For instance, when I met Malcolm, I discovered he was motivated to go out on a daily basis to buy his newspaper, but was not interested in cooking – living on snacks. He would regularly go out walking but always the same route. He would get frustrated and bored with the sameness of his days, acknowledging that it would often be a trigger for him to return to drinking. He lacked confidence being with people but was accomplished on the computer, having done book keeping.
Using the Model of Human Occupation to underpin my work provides a basis to then look at occupational goal-setting. Activity grading is important – breaking down an activity into stages that become increasingly more difficult. This enables an individual to become more confident with an activity before they progress to the next stage. This is also true of an occupational journey – breaking it into manageable chunks.
Phil embarked on such a journey. He’d been abstinent from alcohol and had stopped smoking, making many positive changes to his life – such as regular contact with his family, decorating his flat, cycling, engaging in peer support, resolving his debts and managing his mental health. He began volunteering for several organisations, with varied occupations from re-building bicycles to answering telephones.
He had not been in employment for three years, having worked in IT, but was unsure if this was a career he wanted to re-pursue. Phil became a volunteer for us, facilitating our cyber café. As his confidence grew, he felt ready to move towards employment.
He completed a four-week employability course and attended a job club. This helped prepare him to get back into the jobs market. Phil remained unsure if he wanted to go back into an office environment, so I arranged an eight-week office work placement at a large company that maintains social housing throughout Cumbria. This allowed him to re-experience office life, regain skills and gain new ones, as well as establishing a regular work routine. Phil is now searching for IT jobs, having the belief that this is what he wants to do and is able to do.
Support is an integral part of the process. Conversations around occupation in early recovery are valuable in instilling a sense of hope and belief of a positive future as there are many fears that individuals raise – lack of confidence and self-belief, fear of relapse if they take on new occupations, concern about criminal records and not knowing what direction to take.
Jonny had mentioned several of these issues in our discussions but gradually changed his outlook.
‘Life wasn’t going anywhere anytime soon for me and I thought that I had nothing to offer or anything of value to others.
‘All that changed for me in February 2014.
‘I hesitantly started an NVQ level 2 course in adult social care – slightly overwhelming at first. All the staff and service users made me feel welcome and smoothed the transition into Heathlands Project (Learn to Care project, Carlisle).
‘The NVQ is catered for the pace of the individual and run at a relaxed pace, mixed with practical work supporting adults with learning disabilities on two days of the week.
‘I quickly realised that even a small gesture of goodwill, or an ear to offer to listen and a bit of advice, can make someone’s day better. This made me realise I had so much to offer.
‘The six-month course flew by so quickly for me and I was amazed to be offered a relief contract of two days a week working with and supporting the service users. I had a job and soon after it went to three, then four and now five days a week at Heathlands.
‘I feel a sense of worth now I’m doing a job I really enjoy. I have a different circle of friends and colleagues, and have been told I’m a trusted valued member of staff. My social life is good; I have taken up old interests and started some new.
‘I still learn everyday. I enjoy the challenges. I now intend to work my way up and become a group leader and beyond. Who knows?’
In working with individuals, I try to encourage a ‘give it a go’ attitude, focusing on positive coping strategies including a plan b. Linda had always wanted to go on a barbering course at college but was scared she would not cope with it and return to drinking. She had previously started hairdressing, but dropped out due to her addiction. We worked on activities to build her confidence and Linda was encouraged to give her dream a go, with some safety plans in place just in case. She has now almost completed her first year at college.
I work with everyone as an individual, making use of each person’s unique qualities and not taking a one size fits all approach. Occupation for those not work ready may perhaps be volunteering or structured activity as meaningful productivity.
Malcolm, whom I mentioned earlier, was dissatisfied with his routine but very gradually by using goal-setting, started to change his productivity using small steps over a period of time. He started to attend a peer support group, began walking slightly different routes and had an occasional game of golf or coffee with someone he became friends with at the group.
I encouraged him to think about volunteering, but at that time he felt this was ‘trivial’ and ‘not utilising his potential’. We discussed occupation not just as a means to succeeding but all the other positives it could bring to his life. He gradually started to warm to the idea, initially thinking about helping with dogs at an animal refuge to accompany his interest in walking.
I suggested we explored volunteering opportunities to make use of his computing and book-keeping skills. He now regularly updates a website and carries out book-keeping for a mindfulness project. He has meetings with the co-ordinators on a regular basis. Malcolm readily says, ‘It’s given me something to do which also carries quite a lot of responsibility which I needed. It also got me out of a rut.’
Little would be achievable without the Unity staff, who help stabilise and lay the foundation for ETE with individuals or the partnership agencies I work with. The Unity Asset Building Fund has helped support placements around the county as part of the wider Cumbrian commitment to recovery (Jonny has seen the real benefits of this). The Lawrie Brewis Trust in Carlisle (part of Heathlands) creates opportunities for those who may wish to find work in the care sector, to gain experience and qualifications working alongside staff and volunteers in their Learn to Care programme. Participants spend one day a week studying for an NVQ in health and social care and two days working with people with physical and learning disabilities.
Growing Well is a farm-based mental health social enterprise near Kendal. Volunteer placements there enable the recovery of people whose lives have been disrupted by mental distress. Participants spend one day a week involved in organic growing. There is an opportunity to gain a level 1 award in horticulture. Learning Fields is a community interest company near Appleby, offering educational and environmental opportunities for people of all ages and abilities. It provides a range of countryside activities in grass and woodland settings. Participants develop practical work skills to help them reconnect to their community. Connection with projects like these and others is fundamental to providing opportunities for people to develop work-based skills.
My regular attendance at an education, training and employment (ETE) North West Regional Forum, organised by Public Health England, provides information on current practice and enables networking opportunities which I find invaluable – we are able to both give and receive practical and up to the minute ideas.
I consider myself incredibly fortunate within my role as it encompasses two of my passions – people and productivity. My own meaningful occupation is the privilege of accompanying an individual on their journey of occupation.
I would be really interested in hearing from other occupational therapists working within the field of recovery from addiction, and can be contacted at sue.bright@gmw.nhs.uk
Sue Bright is a recovery occupational therapist working for Unity alcohol and drug recovery service