Maintaining occupation-based practice in Australian mental health practice: a critical stance

Introduction: This paper explores the way dominant discourses, and their associated practice knowledge dimensions, shape personal paradigms and occupation-based practice in mental health workplaces. Method: Narrative inquiry methods and narrative thematic analysis was used to explore the career stories of nine occupational therapists who had worked in mental health practice for more than five years. Findings: The main narrative themes to emerge were (i) living with the biomedical practice knowledge discourse, (ii) living with the psychological practice knowledge discourse and (iii) reflection as a strategy for maintaining occupation-based practice. These discourses created the need to reflect on practice and adopt strategies to avoid the marginalisation of occupational perspectives and occupation-based practice. The strategies used to cope with these discourses varied from acceptance and embracing of other discourses to resistance and rejection. Conclusion: This paper demonstrates that in some mental health workplaces there is a danger that occupational perspectives and occupation-based practice can become marginalised. Making visible the different discourses in mental health practice allows occupational therapists to analyse, better understand, and live with the tensions in their professional lives. This requires professional support strategies to be in place to maintain occupation-based practices and retain practitioners in the workforce.