Recovering addicts, asylum-seekers and the homeless may not be seen as typical clients for occupational therapists, but as the public health agenda continues to expand into new areas, the stereotype of the occupational therapist (OT) teaching basket weaving or flower arranging on a quiet hospital ward couldn't be further from the truth.
The aim of occupational therapy is to help people of all ages and backgrounds enjoy meaningful and independent lives, regardless of any physical, mental or social problems they may have. Although for many clients this will involve work and career issues, OTs are equally concerned with leisure pursuits and hobbies as well as day-to-day issues such as getting around or even personal care.
As Christine Taylor, occupational therapy lecturer at the University of Plymouth, puts it: "We're often confused with occupational health, but OT is concerned with much more than how people earn a living."
While the profession's role has tended to revolve around the needs of the NHS, social services and the voluntary sector provide new models, says Anne Lawson-Porter, head of education and learning at the College of Occupational Therapists, who believes the scope of the work in terms of clients and settings has never been wider.
"We're an interesting profession because our skills involve not only physiology and psychology, but social anthropology and societal changes too," she says.
"Helping people cope with the after-effects of an accident, a prison sentence, being thrown out of their home or suddenly finding themselves out of work offers practitioners enormous variety in terms of the types of people they treat and where.
"As more OTs choose to work in what we call 'role-emerging areas' such as specialist care homes, the voluntary sector or perhaps in private practice, the NHS may find itself competing for our talent in the future," she adds.
Jan Jensen is professional lead in occupational therapy at the Department of Allied Health Professions at Canterbury Christ Church University, which teaches the subject to BSc level and beyond.
Many of her students are in their thirties or forties – career-changers who have worked in education, health or perhaps had caring responsibilities. She believes while the work of OTs isn't as well understood as that of doctors or nurses, the chance to maximise the life potential of clients is very rewarding.
"You may be helping a child access the curriculum or supporting a manager suffering from severe workplace stress, but no two cases will be the same," she says.
"Whether it's a case of suggesting new ways of enjoying a previously loved hobby or helping an employee with musculoskeletal disorders adapt their work environment with a new keyboard, you will be putting your problem-solving skills to lasting and meaningful effect."
The NHS pays the tuition fees for OT undergraduates and there is usually the opportunity to apply for a means-tested bursary. While the employment prospects for successful graduates are good, the necessary registration with the Health Professions Council after graduation is not automatic.
A typical BSc course includes anatomy, physiology, psychology and ergonomics as well as more than 1,000 hours of professional practice education, usually split into five separate placements. In preparation for multi-disciplinary practice, learning is often shared with other health and social care students.
OT still has a white, female bias – around 10 per cent of the profession is male and fewer than 3 per cent of the student population is of black-and-minority-ethnic origin – but ageism isn't a problem, says Lawson-Porter.
"A large cohort of the students coming into OT education are between 35 and 43, reflecting the fact that occupational therapy is something you often discover slightly later in life. But, given that the work is so often born out of your own life experience, this isn't necessarily a bad thing."
In their efforts to help people to lead full and active lives, the UK's 28,000 registered OTs must be practical and hands-on; concentrating on what clients can do, rather than on what they cannot. While the skills of the profession are in demand among all age groups, from neonatal to palliative care, it is the area of vocational rehabilitation and the management of long-term sickness absence – a major focus for Government and employers – that will remain a popular specialism for many practitioners.
Alison Biggs completed a BSc in occupational therapy at Oxford Brookes in 1993, and five years later was involved in a Government initiative to get people with back and neck pain back into work. In 2001, she set up her own consultancy, Healthywork Ltd.
"I always knew I wanted to work with people in a way that would benefit their lives and offer practical solutions to their problems," she says.
"Although we tend to be called in by employers, perhaps concerned at a loss of productivity, we tend to find it's the individual worker who is very grateful when we suggest ways to help them manage their workload better and ultimately enjoy their lives far more." In terms of salaries, OT is better rewarded than many imagine. One of the new breed of consultant occupational therapists can earn as much as £80,000, and nowadays it is possible to work your way from a junior OT post in the NHS up to chief executive level.
For those who do not enjoy management or leadership roles, there are many openings in academia or advanced research.
"We want all our students to be ambassadors for OT," says Jensen. "We really shouldn't be the best-kept secret in the health profession any longer."
'I realised I wanted to work with people rather than machinery'
Emily Baxter is a final-year student on the three-year BSc occupational therapy course at Canterbury Christ Church University, and hopes to qualify next February. Now 32, her career history includes education and welfare posts and four years as a propulsion mechanic in the Royal Air Force.
"I decided I wanted to become an OT many years ago, but discovered that the GVNQ in health and social care that I'd taken after leaving school was at that stage not the best route to a university place.
I took the Air Force job as a stopgap, but ended staying for longer than I expected. Although the problem-solving and engineering parts of the job were quite relevant to what I'm doing now, I realised I wanted to work with people rather than machinery.
My placements began with the Headley Court Rehabilitation Centre for military personnel, where I worked with amputees. The oncology ward at Maidstone Hospital was next, followed by a spell at a vocational rehab charity dealing with mental health problems and, most recently, an NHS unit for adolescent psychiatric disorders such as anorexia, self-harming and obsessive-compulsive disorder.
Although the university has been fantastically supportive and has taught me how to reason clinically, it's been a life change, particularly being forced to go home to mum and be dependent on her again.
But nowadays I'm focused on a career with, perhaps, amputees or young people – preferably something outdoors and adventurous – and I'm really glad I got my break in occupational therapy."
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