Occupational reconstruction of persons in mental health care in a clinical setting : a qualitative exploration of perceptions of performing

Introduction: The increasing numbers of mental illness during the last years cause a call for effective treatment and lasting rehabilitation. Since occupational therapy is a crucial treatment in this domain, it is necessary to understand the occupational needs of persons suffering from mental illness to provide effective treatment. Objectives: To explore the meanings that persons suffering from an acute mental illness attribute to occupations during their stay at a clinic. Method: The data for this study was taken from two in-depth interviews, conducted with each of the six participants. The analysis was guided by hermeneutic principles. The first interview was conducted during the clinical stay to gain "pre-understanding" through structural analysis. The second interview took place three months after discharge to deepen the understanding of participants' perceptions. To comply with trustworthiness the study was peer-reviewed and the emerging themes were member-checked. Results: The findings focus on three themes: "Meaninglessness", "Joining in" and "Finding oneself". "Meaninglessness" describes the condition of not being involved in meaningful occupation. "Joining in" demonstrates to be engaged in an occupation, but without an individual motivation. "Finding oneself" illustrate the performance of occupation to reconstruct the own personality. Conclusion: The findings can be interpreted as a process to reconstruct occupational identity. The incipient theme "Meaninlessness" can be interpreted as a state of occupational dysfunction. To gain occupational identity again, participants of this study experienced their own abilities through "Joining in" any activities. Bottom-up on the rebuilt self-perception a new perspective for the future can actively be searched through occupations described in the theme "Finding oneself". This process can be compared to Hammells synthesis of "doing, belonging, being and becoming". Contribution to the practice / evidence base of occupational therapy: The findings of the study were applied to an occupational therapy program in mental health care in Switzerland. The constructs of "Meaninglessness", "Joining in" and "Finding oneself" guided clients in their recovery of being active and experiencing occupational identity during their occupational therapy process