Why occupational therapy matters in mental health claims

By Ms Antonette Owen, Team Lead Occupational Therapist, Benchmark ASSESS

In complex matters involving psychiatric injury, the challenge for legal decision-makers is rarely diagnosis alone; it is understanding how psychological symptoms translate into real-world functional impact, capacity and risk. This is often where matters become uncertain or difficult to resolve.

Occupational therapy offers a practical way to understand and clarify this impact.

While psychiatrists and psychologists appropriately address diagnosis and causation, an experienced medico-legal Occupational Therapist provides an independent, structured analysis of how psychiatric injury affects day-to-day function, work capacity, self-care and sustainable participation in ordinary life.

This functional lens equips lawyers, tribunals, and courts with practical, observable evidence that bridges the gap between clinical opinion and real-world implications, supporting clearer liability assessment, more accurate quantum evaluation, and earlier, more confident resolution of matters.

Origins and evolution of occupational therapy in mental health

Source: https://www.myotspot.com/history-of-occupational-therapy/

The profession of occupational therapy originated in the early 20th-century as a ‘work cure’, emphasising daily activity as a treatment for psychiatric disorders. This approach was strongly supported by early leaders such as William Rush Dunton Jr., (often referred to as the ‘father of occupational therapy’), and George Edward Barton. Its foundations can be traced back to the Moral Treatment movement of the late 18th and early 19th centuries, which used purposeful activity rather than restraints for mental health illness.[1]

This movement was a transformative and human approach to psychiatric care, encouraging patients to engage in arts, crafts and daily routines to support recovery and wellbeing. George Edward Barton later coined the term ‘occupational therapy’ after experiencing the therapeutic benefits of meaningful activity in his own recovery. These principles continue to underpin modern occupational therapy practice, including in inpatient psychiatric care.

The focus of the profession shifted toward physical rehabilitation during WWI and WWII (1920s–1940s) to support injured soldiers. Eleanor Clarke Slagle pioneered ‘habit training’, a structured routine of activity for patients in state hospitals to restore a balance between work, rest and leisure.

By the 1960s and 1970s the profession of occupational therapy had evolved further with a growing emphasis on supporting patients transitioning from institutional care into community settings. At its core, occupational therapy has always been grounded in the belief that engagement in meaningful and purposeful activity has a stabilising and restorative effect on mental health.

The strategic role of occupational therapy in medico-legal matters

With this context, instructing an Occupational Therapist in matters involving predominantly mental health presentations should not be viewed as discretionary, but as a strategic evidentiary decision. Occupational therapy evidence moves beyond symptom description to objectively assess how psychiatric injury translates into functional impairment, capacity, risk and rehabilitation potential.

Importantly, well-constructed letters of instruction should extend beyond standard functional questions to address rehabilitation pathways, identifying evidence-based and goal-directed interventions that support sustainable participation and long-term quality of life. This enables courts and decision-makers to move beyond generic care recommendations toward practical, future-focused outcomes that support clear reasoning and more confident resolution.

Future care, treatment approaches and holistic impact

Recommendations for future care extend beyond traditional personal and domestic assistance. The role of Occupational Therapists in this cohort is broader and more comprehensive, focusing on participation in meaningful activity and the use of everyday ‘occupations’, such as social engagement, play and self-care, to foster physical and mental wellbeing.

This approach is grounded in trauma-informed care and may include the involvement of a mental health case manager and support worker. It prioritises creating environments that promote safety, competence and connection, all of which are key elements in recovery and quality of life. Treatment may also focus on self-regulation strategies, helping individuals manage emotional responses and stress through the development of healthy coping mechanisms.

Interventions are often led by a sensory-based approach, particularly where trauma has impacted sensory development. In these cases, Occupational Therapists support individuals to process and regulate sensory input more effectively.

A holistic, client-centred approach underpins all interventions, with therapy tailored to an individual’s unique needs, goals and lived experience. A key focus is restoring roles and enabling engagement in meaningful occupations, while also reducing social isolation through participation in group or community activities.

In addition, Occupational Therapists provide education to clients and families around mental health, self-management strategies and available supports. They may also act as advocates, addressing barriers such as stigma and discrimination and promoting broader understanding within the community.

Working as part of a multidisciplinary team, they coordinate care and contribute to a comprehensive support framework, particularly in cases involving complex or historical trauma.

Occupational therapy’s growing value in complex claims

In summary, occupational therapy has evolved from its early 20th-century roots as a ‘work cure’ for mental illness into a modern, recovery-oriented practice focused on empowering individuals to meaningful participation in daily life. While often associated with physical rehabilitation, Occupational Therapists are increasingly recognised in personal injury contexts for their ability to assess the functional impact of psychiatric injury.

Their contribution provides valuable insight into capacity, participation and future care needs, supporting more informed decision-making and better outcomes in complex claims.

[1] https://caot.ca/