occupational therapy in mental health1

Occupational Therapy in Mental Health: An Overview of 6 Typical Settings

Unless you have a background in addressing mental illness, it’s common for occupational therapists to find the mental health field to be an intimidating realm of treatment, especially for US-based OTs.

Those with a lack of familiarity with mental health as a whole tend to immediately concentrate only on the abnormally aggressive behaviors, while ignoring the wider range of dysfunction that plagues a large portion of the adult population worldwide.

It is important to acknowledge that there appears to be an aversion to working with mental health patients. One particular study (Tsan et. al) showed that the majority of 108 occupational therapy students surveyed preferred to work with patients who were “gainfully employed, middle-aged female clients with physical disabilities and no history of aggressive behavior.”

A separate but more encouraging study (Beltran et. al) showed that OT students’ attitudes change for the better with more efficient tutorials and exposure to mental illness via fieldwork experience. When OT’s attitudes shifted, they were able to focus on interventions and help their patients with mental illness.

So for this article, we will provide you with the occupational therapy mental health setting basics, including exploring six settings where OTs provide mental health treatment and can gain experience in this important population. 

The Top Settings for Mental Health Treatment

While there are indeed many misconceptions and stigmas related to mental illness, we will explore this topic in terms of OT treatments by setting type. By having a basic understanding of interventions in each setting, you may be able to reduce your own reservations about working with patients with complex mental illnesses.

1. Acute Care Setting

Acute care in a hospital setting addresses critical or life-threatening medical conditions. Individuals with a history of mental illness often are admitted to the hospital as a direct result of reduced mental capacity. Examples include malnutrition, dehydration, prescription or illicit drug overdose, falls, exposure injuries, failure to adhere to medications (i.e. diabetes management).

Aside from stabilizing the patient, occupational therapists assist patients in daily functional activities. AOTA states that OTs working in the acute care setting specifically addressing psychiatric factors will probably address self-care (including medication management), home management, and community/social participation.

Other interventions include “stress management and coping skills, community re-entry strategies, sleep hygiene, pre-vocational skills, body image issues, and money management” (Occupational Therapy in Acute Care, AOTA). Functional tasks can become more advanced as the patient stabilizes through inpatient care.

2. State Hospital Setting

This is probably the most controversial setting because of occupation therapy’s promotion of de-institutionalization and development of mental health community centers. It also scares a lot of new clinicians away based on the severity of the patients.

For those who are up for the challenge, OTs in state hospital settings create care plans based on intensive evaluations with the goal in mind that the patient can re-enter the community without being a danger to themselves and to others.

Such approaches are quite similar to those in the acute care setting including ADLs, community re-integration, social participation, and pre-vocational skills. For settings that address the pediatric population, family therapy and involvement is intensely added to the multi-disciplinary mix (Utah Department of Human Services).


3. Skilled Nursing/Transitional Care

Skilled nursing facilities and transitional care units are designed to be a stepping stone between “medically stable” and “prior level of function.” Occupational therapy has a huge role in assisting and determining the patient’s ability to safely return home.

This is essential for patient’s passing through with secondary mental illnesses including schizophrenia, bipolar disorder, chemically-induced disorders, etc. The OT works on everything similar to that in an inpatient setting, but with more vigor and a longer duration as tolerated by the patient.

Patients with mental illnesses often need emphasis on carry-over in order to safely and independently conduct daily living tasks at home in order to prevent readmission to the hospital.

4. Assisted Living Facilities

It is assumed that residents who are in assisted living settings are high-functioning enough to do so, but may require some minimal assist for meals, medication management, and community activities. OTs are less focused on discharge to a different home and more concentrated on fine-tuning the resident’s current function in order to promote a higher quality of life.

Examples include establishing a community outing routine while integrating stress management techniques in order to reduce behavioral incidences in public. Others include establishing a therapeutic exercise program in order for the patient to continue with safe mobility.


5. Home Health

The home environment can impact the patient’s mental health for better or for worse depending on what kind of living situation they reside in. Persons living with dedicated caregivers in a clean home can often succeed in completing daily living tasks and mobility with very little safety concerns.

For others who live at home alone and have an out-of-control living space, they can be subject to all sorts of safety hazards. OT’s roles in home health for clients with mental illness include home and environmental modifications to reduce functional barriers and fall risks, medication management, education in emergency access, family and caregiver education in therapy strategies, and cognitive/problem-solving strategies to increase carryover of learned tasks.

6. Community Centers

Although the community setting encompasses the home, this area refers to other centers including group homes, club houses, after-school programs, vocational programs, senior centers, correctional facilities, homeless shelters, and outpatient group therapy. Therapists have a vast influence in theses settings and come well-equipped with methods for community reintegration.


Rather than focus on a staunch medical model, occupational therapy in mental health promotes the active recovery model by enabling people with mental illness to participate in their community through employment, volunteer work, social and educational programs, etc.

OTs can introduce therapeutic treatments to curb disruptive symptoms and behaviors including coping skills, sensory processing techniques, and cognitive remediation/adaptation (Occupational Therapy’s Role in Community Mental Health, AOTA). This can help aid in the person’s quality of life and help them truly live their lives to the fullest potential.


We hope this post gave you some new perspective on the most common occupational therapy mental health settings! Did we miss any? Did any of these surprise you? Let us know your thoughts in the comments below!



Beltran, R.O., Scanlan, J. N., Hancock, N., and Luckett, T. (2006). The effect of first year mental health fieldwork on attitudes of occupational therapy students towards people with mental illness. Australian Occupational Therapy Journal. 54 (1). DOI: 10.1111/j.1440-1630.2006.00619.x

Hector W. H. Tsang; Fong Chan, and Chetwyn C. H. Chan (2004). Factors influencing occupational therapy student’s attitudes toward persons with disabilities: A conjoint analysis. American Journal of Occupational Therapy. July/Aug. Vol. 58, 426-434.

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  • brittany November 1, 2017   Reply →

    I am curious how much OTs make in each of these settings. I have heard that OTs in mental health make far less than OTs in other settings.

    • Sarah Stromsdorfer, OTR/L November 2, 2017   Reply →

      Hi Brittany, I personally don’t have individual salary information for these settings but would love to hear from any OTs in the mental health setting that can chime in!

  • Joel Desotelle December 6, 2017   Reply →

    Working in pediatrics, the growing trend of children living with ASD seems to be bringing in some of our OT roots back to the forefront. A decade ago, caseloads were filled with CP, Spina Bifida, Down’s Syndrome, etc. While these are still around, the number of ASD cases have grown substantially and the issues related often involve compensatory behaviors, neurological deficits, dependencies, etc. similar to those in mental health. Articles like this one and other mental health resources have a lot of helpful information to complement ASD treatment. Interested in your thoughts on the subject. Thank you in advance!

  • What OT assessments are those of you working in mental health using for adults and children? What EMR? I’m beginning a new outpatient program for non-profit organization in Northeastern Oklahoma and wanting to see what others are finding useful. I am wanting to embed evaluations into the EMR that we choose if that is possible. I would appreciate info on what is working in other settings!

  • Deborah February 13, 2020   Reply →

    Thank you so much for writing such an informative article. I have personally recently graduated as a COTA. I wish I had been told of the enormous value placed on productivity. I LOVE my patient time and take a great personal investment into their treatments; the whole productivity issue now measures of course the quantity not quality of patient interaction; this is where I have issues. I am presently in search of a setting that lets me concentrate more on the person and getting them better than numbers. It is quite disheartening. My professor also mentioned to me that OT is the only discipline with such requirements, is this true?

    • Sarah Stromsdorfer, OTR/L February 16, 2020   Reply →

      Productivity requirements are my least favorite aspect of the therapy world, and unfortunately a lot of other disciplines deal with it, including PTs, SLPs and doctors, just to name a few. There are definitely settings that don’t place as much as a point to enforce it (and some don’t have it at all!) Look into non-profit settings/companies that might be less inclined to have or enforce productivity. I always recommend asking about productivity during job interviews to make sure you aren’t stuck with unrealistic/unethical expectations.

  • katie rathers June 25, 2022   Reply →

    Hi! I’m curious how OTs can apply to mental healthcare settings given we are (sadly) not considered Certified Mental Health Practitioners (CMHP) in most states. I see many new positions to address the current MH crisis however nearly all require LSW, RN, or CMHP credentialing.

  • Viviana August 8, 2022   Reply →

    Im very curious as to know if OTs with an interest in the mental health field; specifically in pediatric and adolescent psychotherapy, DBT group work, and coping mechanisms etc., can have and work through a private practice? Or in other words, start their own practice with this type of setting/service in mind.


    • Sarah Stromsdorfer, OTR/L August 22, 2022   Reply →

      If you have the training and are qualified, then definitely!

  • Melissa October 21, 2023   Reply →

    I was in a video about OT’s role in mental health, substance use, and trauma. It’s here https://rvntelevision.com/episode/hands-off-with-melissa-marris/

    • Sarah Stromsdorfer, OTR/L October 26, 2023   Reply →

      Thanks for sharing, Melissa! This is really helpful.

      • Melissa January 4, 2024   Reply →

        Sorry, I just saw this response but no problem! I’m happy to talk with anyone who wants to know more about OT in mental health. I currently work running therapy groups and doing private practice. My email is melissa@innerreachtherapeutics.com

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