ANXIETY AND DEPRESSION
Sidney is 62 years old with a first episode of agitated depression. He recently retired from work as a mechanic as he felt that he could not keep up with the pace of work. He lives with his wife in their own property and has four grown up children and two grandchildren. Sidney’s wife continues to work and as a consequence Sidney spent much of the day at home with little structure to his day. He did not know what to do with his time and felt hopeless about the future. Sidney had been depressed for about 18 months prior to his retirement although he had not sought medical help until after he retired.
Reason For Referral
Sidney was referred to occupational therapy by his Psychiatrist to try and ascertain the reason for his decline in functional skills. It was felt that occupational therapy intervention would help aid his recovery.
Occupational Therapy Assessment
Sidney’s occupational therapy assessment was undertaken using a variety of standardised and non-standardised tools. These included formal assessments such as the Assessment of Motor and Processing Skills (AMPS) and more informal interviews with both Sidney and his wife.
This assessment identified that:-
- Sidney’s depression and anxiety were having a significant impact on his processing skills – his process scores on the AMPS were significantly below the level expected for someone of Sidney’s age;
- As Sidney’s depression was largely untreated towards the end of his career it was likely that his process skills deficits were impacting on his role as a mechanic leading to his decision to retire. Sidney described feeling that he had lost his role in life and wished he had not retired so early;
- Sidney’s previous difficulties in his work environment had led him to doubt his abilities in all tasks so he had stopped engaging in activities he previously enjoyed for fear he would make a mistake. He had also begun to question the safety of work he had undertaken in the past and catastrophise about the consequences of his “poor workmanship" - for example he got a plumber to come and check the safety and quality of some plumbing he had installed a few years previously;
- Sidney’s wife would try and prompt Sidney to engage in tasks by writing a long list before she went out but he would feel overwhelmed and unable to engage and she in turn would become frustrated on her return home;
- Sidney’s lack of occupation was having a significant impact on his recovery and levels of hopelessness.
Occupational Therapy Treatment Plan
Sidney was offered an Occupational Therapy programme consisting of 12 weekly sessions focussing on:-
- Completing an interest checklist – identifying past interests and identifying activities he had considered but never tried;
- Introducing Sidney to the function of goal setting and the purpose of setting achievable realistic goals;
- Acceptance of his current situation and commitment to trying new roles/experiences;
- Agreeing a structured plan for his week with a balance of work, self care and leisure tasks;
- Working alongside his wife to identify ways for her to help Sidney in his recovery by introducing the idea of only focusing on one task at the time and setting realistic goals;
- Working on a relapse prevention plan to enhance his recovery and wellness in the future.
On completion of his occupational therapy programme Sidney was able to:-
- Significantly increase his activities of daily living in a purposeful, structured and graded way - he had arranged saxophone lessons to regain his confidence as this was an instrument he had been very accomplished at playing in the past and this in turn led him to rejoin the band he had left the year before. He has also started swimming twice a week;
- Improve his motor and process skills through his engagement in more activities and the consequent improvement in his mood and motivation. A reassessment with the AMPS at the end of his programme showed a marked improvement in his attention and sequencing process skills;
- Redefine himself in the role of grandparent/homemaker taking more responsibility in tasks around the house and rediscovering his love of cooking;
- Understand the principle of goal setting and able to set himself ongoing goals;
- Identify and successfully interview for a voluntary work opportunity where he could put his skills to use in helping others;
- Acknowledge that he had hope and goals for the future.