James is 60 years old with Bipolar Disorder and is divorced with two children in their late 20s. His life had undergone a lot of significant changes - he took early retirement on health grounds, his marriage had ended and he had recently had to move from the family home to a one bedroom flat. James had had difficulties with his mental health for much of his life and was diagnosed with Bipolar Disorder 15 years ago.
Reason For Referral
James was referred to occupational therapy by his Mental Health Nurse as he was struggling with his mood and motivation since moving to his new flat six months previously. He had not unpacked many of his belongings and spent his day pacing his flat unable to settle to any activities.
Occupational Therapy Assessment
An initial person-centred Occupational Therapy Assessment was conducted drawing on a number of occupational therapy models and treatment strategies including the Canadian occupational performance measure and a more informal one to one interview.
This assessment identified that:-
- James could not identify with any current roles, only previous roles about which he expressed a great sense of loss such as the role of worker, husband, father, respected member of the community and neighbour;
- James was the oldest person in his block of flats by a number of years. He had lived in his previous house for 15 years, was well-known and several friends of the same age in the local community there;
- Since his move his children had been visiting less frequently;
- James did not identify with his new flat being his home having only unpacked the essentials and leaving the rest in boxes;
- James was spending the majority of his time in his flat as he did not know the local area thus making him feel frustrated and bored;
- Although James was concordant with his medication he did not feel it was beneficial and was very anxious about the potential side effects;
- James felt unable to see any hope for the future or identify any future goals and his levels of motivation appeared particularly low;
- James engaged in what he saw as the most important activities (such as getting his prescription, food shopping) but had stopped any leisure or work activities meaning that his days lacked structure and pleasure.
Occupational Therapy Treatment Plan
James participated in an Occupational Therapy programme consisting of 12 sessions over a 24 week period which focussed on:-
- Helping James re-evaluate and engage with his current roles and identify new roles – for example he still had a role as a father although the role had changed as his children were now adults;
- Helping James identify previous interests that he could reengage with and explore new experiences/opportunities;
- Setting a daily/weekly structured activity plan which reflected a balance of activities in self care, leisure and productivity;
- Enabling James to make his new flat feel like home and understand the impact the environment has on wellness;
- Encouraging James to explore the area near to his flat and find activities he could engage in;
- Developing a relapse prevention plan to help him understand what helps to keep him well, possible triggers for relapse and contingency plans for how to manage should his mood deteriorate.
On completion of his Occupational Therapy programme James was able to:-
- Identify meaningful and mutually enjoyable ways to spend time with his children – watching the football at a local pub every week with one son and having lunch out once a week with the other;
- Make contact with his previous neighbours and arrange a regular game of tennis;
- Increase the range of activities in his week and re-engage with previous interests such as attending the gym, art, football and tennis;
- Join a local social group in order to meet new people;
- Sort out and unpack his belongings and identify ways to make it feel more like home by for example hanging pictures and mirrors, setting up his music and TV equipment, rearranging his furniture and inviting his children for a meal;
- Develop a relapse prevention plan which included requesting a review with his Consultant Psychiatrist in order to learn more about his diagnosis/medication.