Crazy for Life

Ok, I admit, this is a shameless plug for an event I'm involved in organizing, but if you can't plug on your own blog, where can you plug?

Check out www.crazyforlifeevent.com for an exciting and entertaining mental health event happening on the 27th August. Victoria Maxwell presents her award-winning play - Crazy For Life. Reserve your seat now!

Also, take a look at Victoria Maxwell's blog in Psychology Today
http://www.psychologytoday.com/blog/crazy-life

Going on with the new media theme, I've been enjoying the podcast 'Ouch!' produced by the BBC. It's a show about disabilities hosted by people with disabilities and the langauge used is a refreshing change from the ultra-P.C. world we life in. Find out what 'biffos' and 'snapbacks' are and listen to the game 'Vegetable, Vegetable or Vegetable'. Search for the podcast in your iTunes player.

Touching The Void

There is not much that gets OT students' excitement levels skyrocketing like word that "The List" is up. What first starts as conversation between a few, soon gets overheard and then spreads like wild-fire. Confirmation of the rumour comes when clusters of students congregate by a bulletin board, eagerly pointing at "The List". "The List" is, of course, the list of upcoming work placement allocations. As students of the Master of OT program, we get five work placements, lasting roughly six week each time, interspersed throughout the program. We are also lucky enough to get a certain amount of choice in the location of the placement and the area of specialism. Despite the choices we get, places with willing and available clinicians in the community are not plentiful, so the competition for highly desired placement opportunities is reasonably intense. Even the most altruistic OT students must get a pang of envy on seeing someone else lined up with the placement they really wanted.

I am currently in the second half of my fifth and final placement. At the beginning of the program, we were introduced to a diagram which depicted a series of upwardly progressing steps with accompanying ascending numbers. This represented our journey as OT students progressing up the competency ladder as our knowledge and clinical skills increased. I suppose the second year OT students are now on that final step ready to enter the big bad world of employment and reality. What concerns me somewhat is that thinking back to the diagram, nothing seemed to come after that final step. In fact, rather worryingly, there seemed to be a big drop into nothingness after that final step! Is that what the future holds? Maybe before blindly jumping into this abyss, I should take a moment to reflect on my work placement experiences and see if I'm ready to take the plunge.

I can safely say, with a high degree of confidence, that my work placement experiences have been invaluable. After a few months of school, just when students are beginning to get a little jaded by PowerPoint presentations and group projects, the next placement seems to be just around the corner. Placements are an opportunity to be with clients which is why everyone signed up for the program in the first place. This is extremely motivating. They are a chance to experience a new medical setting and learn some important clinical skills. However, more important than consolidating OT skills, the placements have been useful for opening our eyes to the real world: institutional (dis)organization and the associated politics; budget restrictions and the lack of resources; the challenge of supporting people with disabilities in an able-bodied world; the all-imposing "bottom line" that pervades both public and private health care. This is a pretty depressing list, but I would definitely like to know these things before beginning my career, rather than unintentionally wearing rose-tinted glasses and then getting my bubble sadly burst.

It's not all bad though. From my work placements, I have garnered several reasons to be optimistic: all my preceptors have be first-rate, dedicated professionals - they have been great teachers and skilled clinicians; the "system", despite its faults, is often efficient and provides a high quality of care - judging from my experiences as both a consumer of health services and from the perspective of a prospective health care professional, we are privileged to have a health care system of this high standard. I'm sure many would disagree, but when you look around the world, it could be a lot worse; we are also fortunate to live in an era of research and implementation of evidenced-based practice - advancement in health care is being made all the time and it's an exciting prospect to be jumping into this employment sector; and maybe the best reason to be optimistic is that despite talk of economic downturns and global belt tightening, employment prospects in health care and especially OT seem promising (particularly when compared to other work sectors).

So maybe my evolution from a fledgling OT student to someone nearly ready to drop the M in my current MOT designation, has entailed the removal of the type of blinkers used on racehorses to keep them running straight. Do I feel ready to enter the workforce? No. But I do feel ready to enter a profession which I know will support my learning and professional development and judging from OT's out there in the field, when people ask me in the future, "do you enjoy your job?", I will be able to smile, give a satisfied head nod and say yes. Knowing this, I'm happy to take the plunge...I think.

Peer Support Workshop

Just imagine walking into a room of complete strangers, most of whom are younger than you, and divulging your most personal life details and allowing open questioning in response. How comfortable would you feel? How comfortable would they feel? Now imagine talking candidly from personal experience about one of society's most stigmatized afflictions: mental illness. Now how comfortable would you and your audience feel?

The considerable contributions of Peer Support Workers have been recognised for a number of decades but only recently has financial backing begun to viably support this movement. From a generalized perspective, the principles of peer support make perfect sense. In life generally, we gravitate towards people who we feel understand us and can share our life experiences. This is particularly the case if you have been through a traumatic life experience. In such situations, even the people that really want to understand what you have been through or are going through (which is probably the minority), struggle to comprehend in a tangible way. Whether an individual has experienced cancer, spinal cord injury or mental illness, connecting with someone who has undergone a similar experience is likely to be, in most cases, a comforting and spirit-boosting experience. Peer support workers are further along in their rehabilitation or recovery and offer tangible signs of coping's most powerful ingredient: hope.

Some of the most meaningful and instructive sessions during the OT program so far have been when we have interacted with 'real' potential clients (as opposed to written case studies). Part of the OT's skill set is the way in which we interact with people. You can read all the books and research papers dedicated to exposing the 'lived experience' of having a life changing illness or injury, but hearing it straight from someone's mouth is so much more powerful. Attending the Richmond Mental Health Consumers and Friends Society workshop was one of these powerful learning experiences. Students from different health care disciplines were invited to attend and the format was like the scenario described above. The peer support workers took turns to tell their story - their experience of living with mental illness and their road to recovery. The stories were touching and they showed great humility and insight. Yet the overriding tone that threaded through the stories was one of recovery and hope - a sense that no matter how low someone had felt during the worst times, there was a way back. Often the route was not a direct highway back to the same place they were before, but rather a winding country road to a different place, sometimes a more settling place. Either way, the fact that there is a route and it had been found is what's important. We discussed the stigma associated with mental illness, the non-linear recovery path, aspects of spirituality and the importance of occupation in facilitating recovery. All of the peer support workers are currently employed by Vancouver Coastal Health and in many cases this was their first paid position after experiencing mental illness. In life, you have got to love win-win situations and this is one of those situations. The peers provide an invaluable service by representing a beacon of hope and offering support and practical advice from a unique empathetic perspective to their clients. The peers in turn have meaningful employment and some financial renumeration - huge stepping stones in the recovery process. They are skilled employees with rights and responsibilities. Empowerment. They help to foster positive change in their clients and gain great satisfaction from their work. How many people can say that about their respective professions?

I felt very privileged to have been involved in this experience. I have so much respect for the peers for telling their illness and recovery stories for the benefit of our learning. By speaking up, the peer support workers are on the front line in the battle against societal stigma associated with mental illness. Throughout the session, I was reassured to hear the messages we are taught at school resonate in the peer's stories: the small steps towards recovery, the need for a mix of medication and occupation, family involvement, hope, spirituality, empowerment and the list goes on. Hearing these themes being discussed helped me to realise that I am on the right track in my learning. Phew! In ten month's time, when I graduate, I'm not sure I'll feel fully competent to help people along the rehabilitation path. However, I will feel, thanks in part to this experience, that I have a better idea of my approach to supporting recovery.

Who is Stationed on the Front Line?

A woman in her early forties hurries into a medical clinic. She is relieved to be out of the rain and does not notice the sign above the door of the newly opened facility. She is directly by the receptionist down a bright hallway into Room 2. Inside the room, sitting behind a tidy desk is a man with a pleasant smile and approachable looking face. The man waits for the newcomer to sit down and asks, "What brings you to the integrated health clinic today?" The woman is taken aback. She is surprised to be in front of a doctor without having to wait and falteringly begins to express her problems, not knowing how or where to start. "I've been working so hard recently...I haven't been getting much sleep - I have young children and it's only me to look after them. I've felt very down...quite depressed". "I am not a doctor" says the man, directing his eyes to the sign on the desk which reads "Integrated Triage", "but I can give you an appointment with an occupational therapist in five minutes". The woman thinks there has been a mistake - she is not having troubles with her job, although she has been struggling a bit recently. The man goes on to explain that an occupational therapist can help her to identify where she is having difficulties in different areas of her life and provide her with strategies for resolving her problems. The woman feels relieved that someone can see her so quickly and gladly accepts the appointment.

Ok, I've snapped out of my fictitious world, but as a student, I feel I have an obligation to conjecture with a dose of idealism. Entering into the second year of a Master of Occupational Therapy program, I feel that my eyes are being opened to the potential of this health discipline. Occupational therapists work with people who have a range of disabilities within a variety of settings: hospitals, rehabilitation centres, schools, long-term residential care and in people's homes for clients living in the community. The focus of the profession is on supporting people to engage in meaningful activities following disabling physical impairment - whether this means dressing, shopping in the community or fulfilling parental obligations - it all comes within the discipline's scope. Most occupational therapists work with people who have health issues. The dream scenario described above projects forward to a time in which occupational therapists and other health care professions can work in a more preventative manner; i.e. seeing clients prior to serious health problems occurring. I believe that occupational therapists and other health care disciplines can play a vital role on the front line of health care service provision as part of an interdisciplinary team.

Health Canada and the BC Medical Association recognise the importance of shifting the health care focus towards an emphasis on greater primary care. There is also recognition that primary care needs to be more interdisciplinary in order to operate efficiently. Having a unified team available at the first port of call seems not only to make sense - it seems blindingly obvious. As patients, we are conditioned to visiting the doctor when we have health concerns. Sometimes, it may be more appropriate to see another health professional, but we do not have that option readily available. How can GP’s be expected to work effectively when they have an unrelenting stream of patients listlessly flipping through glossy magazines in the waiting area? If other health care professionals can ease the burden of the GP's by providing discipline-specific expert advice, this has got to be a preferable situation.
Despite the good intentions of educators to push the interdisciplinary agenda, from my experience there is scant evidence of health care students getting together to carve out a model that could translate into 'the real world'. The two opportunities I have had to collaborate with my future colleagues in nursing, physical therapy, pharmacy, medicine etc. have been inspiring and enlightening experiences. As representatives of our respective professions, we sat around a table explaining to each other exactly how we would approach the treatment of a fictitious patient. Misconceptions, of which there were many, were dispelled. We felt empowered, unified and emboldened as we contemplated the prospect of entering into the often maligned health care system – together as a team. There are also emerging frameworks that have the potential to foster greater collaboration between disciplines. The World Health Organization (WHO) has changed the way in which ‘health’ and ‘disability’ are conceptualized. It is recognizes that all humans experience variability in health condition over a lifetime. Therefore, disability is not seen as something occurring to the minority, but something that everyone is subject to. Viewed this way, health and disability can be measured on the same continuum rather than the more traditional view of distinct ‘healthy’ and ‘disabled’ populations. WHO’s International Classification of Functioning model depicts a holist view of health determinants rather than focusing solely on the physical body and symptoms. This biopsychosocial model provides a blueprint for health care professionals to work from, where everyone can identify their area of expertise and see the continuity between scopes of practice. Importantly, it provides a means of communicating in a common language, allowing for improved interdisciplinary understanding.

The initiatives to change the emphasis of primary health care and foster greater interdisciplinary collaboration are in place (e.g. Enhancing Interdisciplinary Collaboration in Health Care), but the momentum is slow. There are various interdisciplinary primary health care units around the country and reports show improved satisfaction from all stakeholders, including patients. When I qualify as an Occupational Therapist, I want the option of working within a primary health care setting to provide vital services to all people in the health continuum. Ultimately, change is an economic issue, but it is also a philosophical and ethical one. We have the ideas for developing a more efficient and inclusive medical system. Now is the time to make it a practical reality. It is either that or a less rosy outcome to the above scenario: the woman is discouraged when she is told she must wait at least 45 minutes to see a doctor so she decides to go home. Her problems are unresolved. What happens next?

Inspired again!

I have a confession to make: I love maps. I would like to put it down to being male but maybe it's not as simple as that. When heading into unfamiliar territory, I can't resist buying a map of the region and planning out the best route to each destination. The touristy maps with the little illustations of noteworthy buildings are especially juicy. I feel sorry for people who travel with me because of my reluctance to venture far without my map (or maps) in hand. They also have to deal with my frustration when the map doesn't seem to match up with the surroundings and of course, similarly to following Ikea instructions, it is always the map's fault! Of course, maps are so 20th century. The trusty map is underthreat by GPS and maybe one day, like when I reluctantly converted from buying tapes to buying CD's, I will have to bow to modern technology once again and buy a little machine that speaks to me in a reassuring, yet slightly pompous robotic voice, and in theory, I'll never get lost again. But what's the fun of that? Some of the best experiences come from getting lost - meeting the friendly local who is more than happy to put you back on track or meeting the suspiciously too friendly local who is more than happy to take adavantage of the clueless tourist vibe given off in such situations. For a map geek such as myself, there is nothing more satisfying than getting lost and then finding your way out of the labyrinth without even using a ball of wool. Who needs GPS? (Well, probably me, but I refuse to admit it at the moment!).

Towards the end of my first year of OT school, I got lost. Whatsmore, my map seemed to be lost too. Somewhere between placements, online courses and neuroanatomy, I practically forgot what program I was taking. My OT flame was not burning quite as brightly and I lost track of why I entered into the course to begin with. However, I'm happy to say, I'm inspired once again and excited to be beginning my second and final year. How did this turnaround occur? Well the three weeks of summer holiday might have had something to do with it as it allowed me to step back and reflect. I realised that over the course of the first year, I had developed many questions about the occupational therapy profession but not really found many answers. In discussions with peers, we realised that we had become good at trotting out standard theoretical responses but we were not taking the time to get to the real nitty gritty of issues. It seemed like a raised toilet seat and energy conservation strategies were the answer to everything no matter what the client needs or the diagnosis (of course, when 'meeting the client' consists of reading a case study, it's hard to replicate real life client-centeredness). They say that if you recognise a problem, you are well on the way to resolving it and now that we've chatted about this, I think we can move to the next level and start to become real experts rather than superficial ones. Also, I'm not too detered by this educational confusion as I used to preach to my students that confusion is ok and a necessary part of learning; however, it's one thing to smuggly say this as a teacher - another to accept this with total coolness, calmness and collectedness as a student.

The main reason for the rekindling of my inspiration has been having the good fortunate to listen to a number of preeminent OT gurus in the past week. I heard the first two during the Capstone Conference during which this year's graduates presented their research projects. The two keynote speakers were contrasting in style, but both were equally effective in translating their knowledge. Sue Baptiste talked about aspects of professionalism and Pam Andrews spoke about resilience. I had been watching the Democratic Party's National Convention the night before the conference and had been amused to see the rapturous applause and standing ovations that met every other sentence Hillary uttered. Listening to these two OT champions, I felt like I needed to get on my feet and cheer, wave my OT flag and pump my fist in the air in a victorious manner - but thankfully I controlled myself. The third wave of inspiration came in the form of a former head of our OT department. Having been out of formal teaching for a while, Margaret McCuaig played a cameo role, returning as a guest lecturer at the end of our 'get your minds back into gear after the summer' week. She offered many pearls of wisdom, but one of her parting expressions resonated particularly. Reflecting on her career in OT she said (in full sincerity), "I am just as passionate about this profession now that I'm leaving it as I was when I entered it". This statement definitely marks highly on the inspiration scale as I bet not too many people could genuinely say that about their respective professions. Thanks to these people, I've found my map. I just hope I can hold on to it until around this time next year.

A New Line of Work for OT's?

Occupational Therapy’s Identity Crisis

"So what do you do?" is a handy question to ask when meeting people for the first time at social gatherings. The answer gives an insight into who that person is and provides us with avenues for further conversation depending on whether the response is considered interesting or worthy of follow up. My reply used to be "I'm an elementary school teacher". Some people found this interesting and pursued their line of questioning; to others, this answer maybe seemed too 'normal' a profession to warrant further comment. Whether people are interested or not, everyone has a strong conception of teaching as a profession. Most people don't have to think too hard to conjure up images of their favourite or most detested teachers in days gone past. Stories of chalk board erasers flying across the classroom aimed at disruptive pupils' heads or the teacher that could make learning seem interesting and dare I say it, fun, are fondly recounted at reunions of school friends. So like it or not, telling someone you're a teacher immediately provides people with conceptions and probably also misconceptions of who you are, what you're like, what you stand for etc.

Responding to the 'so what do you do?' question with the answer 'occupational therapist' probably makes some people wish they had never asked. When it comes to knowing what OT's do, people seem to divide into three groups: the majority have no idea at all of what an OT is or does - these people are then faced with the awkward decision of whether to pretend they know and then divert the conversation without being discovered or admitting that they don't have a clue what an OT is (I fell into the first category before beginning my OT training); the second group try to posit a definition of what being an OT entails - "so is that like helping people to find jobs or helping people when they are having difficulty doing their jobs" - which is a reasonable attempt considering the words of the job title; the minority of people break into a knowing smile and usually express some favourable comment about the work of OT's - these people, or maybe someone in their family or a friend, have usually experienced OT first hand.

For most people, the word occupation means 'job' so why wouldn't people think OT's are job counselors or career advisers? We don't have any popular tv dramas to publicize, or more accurately sensationalize and glamorize, the nature of our work. Lawyers have Ally McBeal and Boston Legal; medics have ER, House and Gray's Anatomy; teachers have Boston Public and Degrassi High (actually, did those kids ever go to school?); The police have CSI Miami, New York, Vegas and also Cagney and Lacey and CHIPS to take it back a few years. Even members of special intelligence agencies that investigate paranormal phenomena and extraterrestrial beings have their own tv show (The X-Files) even though this must be a pretty niche career.

Explaining to people what an OT does is tough. Launching into definitions of "enabling people to maximize their potential in valued activities" is vague. "Helping people to do, be and become" is even vaguer. When it comes down to it, unless a close friend or family member has had a debilitating illness, injury or condition, most people would not really understand why someone would need help with tasks and activities where the skills required for successful completion are normally regarded as second nature or just 'common sense'. OT's are keen to advocate and publicize their profession. On one level, this is out of necessity to compete for funding dollars, but also it stems from a passion for the profession and having first hand experience of its effectiveness. But the most convincing advocates, from my experience so far, are the recipients of OT services, the clients themselves. The experience of living with disability is a unique perspective from which to explain the challenges that everyday life presents. People with disabilities are likely to express the need for a profession that assists in remediation of every day life challenges in a more meaningful way that most OT's could. Maybe the time has come for a television drama based on the lives and work of OT's. After all, haven't Lindsay Lohan, Amy Winehouse - not to mention Britney - made rehab part of popular culture? Watch out for the new series 'Rehab' - coming to your tv screen soon.