Discipline of Occupational Therapy, Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
Aust Occup Ther J. 2024 Feb;71(1):88-101. doi: 10.1111/1440-1630.12913. Epub 2023 Oct 20.
Self-determination is a core component of mental health recovery and a predictor of positive outcomes. The literature calls for occupational therapists to lead practice change to greater recovery-orientation, including facilitating people's self-determination. However, systemic challenges thwart translation of policy into practice and therapists report a lack of confidence in implementing recovery-oriented principles. This study aimed to understand the strategies that mental health occupational therapists employ to support people's self-determination.
Data were collected through an international on-line questionnaire principally comprising two open-ended questions designed to elicit deep reflective personal accounts. Participants were asked about an experience in which they supported a person's self-determination and the factors that either facilitated or hindered this experience. Qualitative data were analysed using inductive thematic analysis, guided by constant comparative methods.
Thirty-four therapists, predominantly from Australia (n = 30), participated. Therapists described supporting self-determination as a multifaceted process that involved: (1) working on myself, (2) working with the person, and (3) working with others. They emphasised that the combined use of various strategies across these three areas of work was important to support people's self-determination. Further, awareness of and addressing issues of power in their practice was key.
This study supports the translation of recovery-oriented principles into practice by revealing the nuanced strategies implemented by occupational therapists striving to support self-determination. Participants employed diverse strategies to empower people to take the 'driver's seat' in their mental health recovery journey. Insights from this study will support other occupational therapists to actualise recovery-oriented principles and better support self-determination in their practice. To effectively implement self-determination strategies, therapists must reflect on and address existing power differentials within mental health services, particularly between themselves and the people they support.
自主决定是精神健康康复的核心组成部分，也是积极结果的预测因素。文献呼吁职业治疗师引领实践变革，更加注重康复，包括促进人们的自主决定。然而，系统性挑战阻碍了政策向实践的转化，治疗师报告说他们在实施以康复为导向的原则方面缺乏信心。本研究旨在了解精神健康职业治疗师支持人们自主决定的策略。
数据通过国际在线问卷收集，主要包括两个开放式问题，旨在引出深刻的反思性个人陈述。参与者被要求描述一次他们支持一个人自主决定的经历，以及促进或阻碍这种经历的因素。定性数据采用归纳主题分析进行分析，以恒定性比较方法为指导。
34 名治疗师参加了研究，主要来自澳大利亚（n=30）。治疗师将支持自主决定描述为一个多方面的过程，包括：（1）自我工作，（2）与个人合作，以及（3）与他人合作。他们强调，在这三个工作领域中综合使用各种策略对于支持人们的自主决定非常重要。此外，意识到并解决实践中的权力问题是关键。
本研究通过揭示职业治疗师为支持自主决定而实施的细致入微的策略，支持了以康复为导向的原则向实践的转化。参与者采用了各种策略来赋予人们权力，让他们在精神健康康复之旅中担任“驾驶员”的角色。本研究的见解将支持其他职业治疗师实现以康复为导向的原则，并在实践中更好地支持自主决定。为了有效实施自主决定策略，治疗师必须反思并解决精神健康服务中现有的权力差异，特别是在他们自己和他们所支持的人之间。
