Occupational therapy and psychosocial disability

Psychosocial disability is the functional impact of a mental health condition, and it is the area where occupational therapy evidence is most often misread. The difficulty is rarely that someone cannot do a task. It is that they cannot reliably do it.

Variability is the finding

Capacity that changes week to week is a functional impairment in its own right, and describing it accurately is most of the assessment. A report that records only a good day understates the support required; one that records only a bad day is just as unhelpful.

What gets assessed

• Daily routine: sleep, meals, medication, hygiene, and what happens to them when things are difficult.
• Home management: cleaning, laundry, shopping, bills.
• Community participation: appointments, transport, work, study, and what stops them.
• Prompting and initiation: what happens without support, which is usually the question a funder is actually asking.
• Safety, including whether living alone is workable.

Working with the treating team

OT describes function; diagnosis and treatment stay with the psychiatrist, psychologist or GP. The assessment works from their information rather than towards a diagnosis of its own, and usually appears as a functional capacity assessment.