March 15th, 2020|Mental Health

Anna is a 45-year-old lady who experienced her first episode of Psychosis in her late 30s. She lives with her teenage son and husband of 20 years.

Anna held a high-level position in accounting and had had several episodes off sick in recent years. She had been off work for six months with no return date planned.

Reason for Referral

Anna was referred to occupational therapy by her Psychiatrist due to a significant deterioration in her activities of daily living, self-care and mood. She often returned to bed for the rest of the day once she had taken her son to school. She had put on weight, lost interest in her personal appearance (something that was previously of great importance to her) and become less concordant with her medication resulting in an increase in symptoms.

Occupational Therapy Assessment

Anna was assessed at home using a variety of standardised and non-standardised tools including the Assessment of Motor and Processing Skills (AMPS). This was supplemented with an informal conversation with Anna, an environmental assessment and further observation of functional tasks.

The assessment identified that Anna:-

  • Had conflicting feelings about returning to work – she worked in a very high pressure, performance /results-driven company and had found it very difficult to return to work on previous occasions;
  • Did not enjoy her job but as the main earner felt a sense of duty to return;
  • Had previously worked long hours without much balance in the structure to her day focusing mainly on work and then tasks at home which made it difficult to identify activities she was interested in;
  • Experienced significant levels of fatigue concentrating the little energy she had on her son – she had started taking him to school (when previously he had got the bus) finding it hard to say no to his requests as she was not working;
  • Felt overwhelmed by the number of household tasks needing to be done and going back to bed as a means of avoidance.

Occupational Therapy Intervention

Anna was initially offered 12 weekly occupational therapy sessions which focused on:-

  • Encouraging her to add more structure and meaning to her day, identifying a balance of activities and finding ways to challenge the urge to return to bed if things were overwhelming;
  • Identifying tasks she needed to undertake to enhance her wellness and structure these into a weekly plan such as taking medication, getting out of the house every day, washing, listening to music and identifying and breaking down any barriers to achieving these;
  • Identifying ways to set and engage in meaningful goals including a strategy to address her home environment by breaking the tasks down room by room, task by task;
  • Helping her feel more confident in her role as a mother, re-establish some boundaries and have some protected time with her son;
  • Applying the stress vulnerability model of psychosis to highlight what situations increased her stress and reduce her vulnerability to these;
  • Enabling her to look at future career options weighing up the pros and cons of returning to work against retraining/alternative career path etc.


On completion of her occupational therapy treatment sessions Anna was able to:-

  • Develop a daily wellness checklist thus improving her concordance with medication and increasing her personal care;
  • Gain confidence in her role as a mother and improve her relationship/quality of time spent with her son;
  • Make an informed decision that she did not wish to return to her previous job and identify a new career path attending a course on setting up her own business;
  • Improve her home environment and enjoy spending time there;
  • Not return to bed during the day;
  • Create more balance and structure to her day such as participating in a Pilates class, cooking a main meal in the evening and spending time with friends.