Community Occupational Therapy with Mentally Handicapped Adults

286 Pages·1990·6.51 MB·English

by  Debbie Isaac (auth.)

COMMUNITY OCCUPATIONAL
THERAPY WITH MENTALLY
HANDICAPPED ADULT S
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THERAPY IN PRACTICE SERIES
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This series of books is aimed at 'therapists' concerned with rehabilitation
in a very broad sense. The intended audience partieularly includes occupa
tional therapists, physiotherapists and speech therapists, but many titles will
also be of interest to nurses, psychologists, medical staff, social workers,
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are aimed at one particular profession. All titles will be comprehensive but
concise, and practical but with due reference to relevant theory and
evidence. They are not research monographs but focus on professional
practice, and will be of value to both students and qualified personnel.
1. Occupational Therapy for Children with Disabilities
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2. Living Skills for Mentally Handieapped People
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3. Rehabilitation of the Older Patient
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4. Physiotherapy and the Elderly Patient
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5. Rehabilitation of the Severely Brain-Injured Adult
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6. Communication Problems in Elderly People
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7. Occupational Therapy Practice in Psychiatry
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8. Working with Bilingual Language Disability
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9. Counselling Skills for Health Professionals
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10. Teaching Interpersonal Skills
A handbook of experiential leaming for health professionals
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11. Occupational Therapy for Stroke Rehabilitation
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12. Assessing Physieally Disabled Peop1e at Home
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13. Acute Head Injury
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14. Practical Physiotherapy with Older People
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15. Keyboard, Graphie and Handwriting Skills
Helping people with motor disabilities
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16. Community Occupational Therapy with Mentally Handieapped
Adults
Debbie Isaac
Community
Occupational
Therapy with
Mentally
Handicapped
Adults
DEBBIE ISAAC
Springer-Science+Business Media, B.V.
First edition 1990
© 1990 Debbie Isaac
Originally published by Chapman and Hall in 1990.
Typeset in 10112pt Times by Mayhew Typesetting, Bristol
ISBN 978-0-412-32720-9 ISBN 978-1-4899-3344-7 (eBook)
DOI 10.1007/978-1-4899-3344-7
All rights reserved. No part of this publication may be reproduced
or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, or stored in any
retrieval system of any nature, without the written permission of
the copyright holder and the publisher, application for which shall
be made to the publisher.
British Library Cataloguing in Publication Data
Isaac, Debbie
Community occupational therapy with mentally handicapped
adults. - (Therapy in practice).
1. Mentally handicapped persons. Rehabilitation
I. Title 11. Series
362.38
Library of Congress Cataloging-in-Publication Data
Isaac, Debbie, 1959-
Community occupational therapy with mentally handicapped
adults / Debbie Isaac. - 1st ed.
p. cm. - (Therapy in practice series: 16)
Inc1udes bibliographical references.
1. Occupational therapy. 2. Mentally il1 - Rehabilitation.
3. Mentally handicapped - Rehabilitation. 4. Community mental
health services. I. Title. 11. Series.
[DNLM: 1. Community Mental Health Services. 2. Mental
Disorders - rehabilitation. 3. Mental Retardation - rehabilitation.
4. Occupational Therapy. WM 450.4.02 173cl
RC487.18 1990
362.2'2 - dc20
DNLM/DLC 90-1456
for Library of Congress CIP
Contents
Acknowledgements ix
Preface x
U seful addresses xii
1 Community occupational therapy with the
multidisciplinary team 1
2 Institution to community 17
3 Assessment 44
4 Living skills and training 55
5 Housing 91
6 Preparation and work with people with profound mental
handicap, behaviour problems and mental illness 116
7 Individual and group work 143
8 Integration into the community 179
9 Working with families 200
Appendix 1 219
Appendix 2 233
Appendix 3 240
References 242
Index 266
Acknowledgements
I was lucky enough to be spotted by J 0 Campling at the Annual
BAOT Conference in Newcastle-on-Tyne in 1986 whilst doing a
presentation with Anne Lodge, which is how the idea to write a
book came about. The source of inspiration was my 2V2-year
experience in the North Southward Community Mental Handicap
Team (CMHT). The job itself was enormously satisfying, but very
stressful at times. I was enabled to stay there because of the tremen
dous support and guidance I received from my District Therapist,
Stephanie Correia, and the Head OT at Grove Park Hospital, Wendy
Close. Without them this book would never have been written.
Many people contributed indirectly by way of discussion and
experiences at work - colleagues at North Southwark CMHT, from
community groups and other occupational therapists. These inc1ude
Nick Bouras, Nan Carle, Barbara Chambers, Janet Chambers, Linda
Clarke, Sharon Collins, Lillian Davis, Win Fleming, Beverly
Harker, Rita Hartington, Theresa Heggarty, Geraldine Holt, Val
Huffington, Anne Lodge, Chandra McGowen, Dee Napier, Barley
Oliver, Sarah Organ, Sally Pennington, Lindy Pogue, Julie Rivers,
Nadia Simpson, Howard Slater, Claire Tester, Smithy Thiru and
Chris Vicerman, the team of support workers at North Southwark
CMHT, and occupational therapy staff at Guy's Hospital, New
Cross Hospital and Southwark Social Services.
Of practical contributions to the book, Janet Chambers was
responsible for compiling the original Day Services Questionnaire
(see Appendix 2) for the North Southwark team, and additions have
since been made with the help of Chris Mackie. The guidelines for
architects (Table 5.1) were based on a document written with
Theresa Heggarty, Beverly Harker and Katrina Cooper. The outline
for operational policies (Chapter 5) is based on the operational policy
format used by Sharon Collins and her staff at the Southwark Mental
Handicap Consortium. Thanks go to Hyde and Southbank and
Habinteg Housing Associations and Peter Mischcon and Associates,
for allowing the reproduction of architects' plans.
My husband, David Tofler, has been encouraging and supportive
throughout the writing process and contributed to the content and
layout of Chapters 7 and 9. My mother, Golda Isaac, has helped
with her unstinting domestic support.
For assistance with the computer, thanks go to Gideon Gild and
Harold Zwier, and for typing, to Geeiong Mobile, Sheila Gray and
Ruth Tofler.
Preface
The philosophy of normalization and promotion of the plight of
children and adults with mental handicaps has drawn more public
attention in recent years. Governments in a number of countries have
embarked upon policies involving the dosure of institutions, move
ment of people with mental handicaps back into the community, and
development of community-orientated programmes, although their
reasons for this may be economically, rather than ideologically,
motivated. Occupational therapists have moved into the community,
along with other health professionals, in order to set up community
services for people with mental handicaps.
My own experience of working in a multidisciplinary team in
Central London for 2V2 years, helping adults with mental handicaps
to move out of an institution, has been a source of motivation to
write this book. The amount of written material available on the
occupational therapy approach to re settlement and de
institutionalization is limited, in comparison with the massive amount
of information written by, and for, other practitioners. Additionally,
the number of texts written by and for occupational therapists with
this dient group are few. Despite excellent support from OT
colleagues, I experienced considerable frustration trying to define
and perform my role, not helped by a shortage of texts to draw on.
The topics induded in the book are varied, and serve to highlight
important issues that OTs working in the community, in general, and
with this dient group particularly, should address. The intention is
that this book be used as a guide, to indicate pertinent issues for
therapists to consider, and indicate useful approaches and resources.
In some instances, a range of opinions are detailed, leaving the
reader to draw his/her own condusions. A large number of papers,
programmes and texts have been cited to support various opinions,
but also in the hope that the interested reader will refer to them for
a more detailed discussion of the topic concerned.
The terminology used to describe the dient group are 'aduIts with
a mental handicap'. There are a variety of terms used in practice -
'intellectual disability' , 'mental retardation', 'learning disorders' ,
and 'developmental disability' , to name a few. As 'mental handicap'
was the term most used whilst I worked in London, and because the
book is based largely on my experience there, I have used it as my
term to describe the dient group.
PREFACE
Some of the references used date back to the 1930s, although the
majority are from recent publications. Early references have been
inc1uded because of their highly relevant and illustrative value.
Where possible, I have attempted to demonstrate the natural develop
ment of practices with people with mental handicaps. (For example,
many of the theories and approaches to group and individual therapy
with people with a mental handicap had their origins in the 1930s
and '40s).
As there are several texts cited that may not be available in the
bookshops, an address list of the organizations that print them has
been inc1uded.
Debbie Isaac