What Occupational Therapists Actually Do In Mental Health

You may have heard that parent say, “It just looks like they’re playing.” Or had a session that felt more like a meaningful conversation than therapy, yet something genuinely shifted.

Occupational therapists have a knack for making skilled, effective therapy feel easy and human. That’s not accidental. Play, connection and a felt sense of safety are foundations of OT work and are powerful drivers of change in the brain and body.

Mental health occupational therapy rarely follows a single script. Sessions draw on multiple evidence-informed approaches, framed within OT models (theoretical frameworks) and are guided by the person’s strengths, nervous system, preferences and goals. That’s all well and good – but what do MH OTs actually do?!

As a profession, OTs love a good model. So I thought I’d use one of my faves - the Model of Human Occupation (MOHO) - to help demystify mental health OT and briefly answer that very question.

MOHO is a model that acknowledges the beautifully complex and multidimensional nature of people’s lives. It is widely researched and used extensively in mental health occupational therapy. To grossly simplify, it explores how motivation (volition), habits (habituation), skills (performance capacity) and environments interact to shape daily life, and how disruptions in these systems can show up when mental health has gone awry.

Let’s take a deeper dive…

Volition: Motivation, Identity and Meaning

Volition is about what drives a person: their values, interests, confidence and sense of self. When someone is living with anxiety, depression, trauma, burnout or prolonged stress, this system is often disrupted. People may lack self trust and feel disconnected from who they are and what matters to them. 

Support in this area may include using talk based therapy techniques from Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), Supportive Counselling (SC), Motivational Interviewing (MI) and structured problem solving to address the following:

• Reconnecting with values, strengths and interests

• Rebuilding motivation, confidence and self-trust

• Exploring identity shifts and role transitions (such as becoming a parent, navigating adolescence, or questioning identity and belonging)

Habituation: Everyday Functioning, Roles and Rhythms

Habituation refers to the habits, routines and roles that organise daily life. When mental health is impacted, these are often the first things to unravel. Sleep becomes inconsistent, self-care drops away, productivity feels harder, and life can start to feel chaotic or overwhelming.

MH OT support here focuses on restoring rhythm and structure through activity and talk based therapy (as above):

• Designing flexible routines that match capacity and align with values

• Breaking tasks down to reduce overwhelm and avoidance

• Supporting energy management, rest and recovery

• Re-establishing meaningful roles and activities that bring fulfilment and purpose. 

Performance Capacity: Regulation, Stress and the Body

Performance capacity refers to the physical, emotional and cognitive abilities that allow a person to meet the demands of daily life. This is a big area that includes nervous system regulation, emotional resilience, executive functioning, quality of movement and, for children, developmental capacities.

When these systems are under strain, people may feel unsafe in their bodies, easily overwhelmed, or unable to access skills they know they have. 

Support in this area often draws on a range of therapeutic approaches to build safety first, then capacity:

• Psychoeducation and nervous system support

• Sensory integration and regulation strategies

• Yoga therapy, mindfulness and body-based practices

• Talk-based therapies stated above as well as trauma-informed approaches like EMDR where appropriate. 

Environment: Relationships, Work, School and broader context 

MOHO recognises that mental health does not exist in isolation. The physical, social, cultural and relational environments around a person can either support or undermine wellbeing and participation in life.

Intervention here may involve collaboration and advocacy through a range of therapeutic techniques including sensory, movement, occupation focussed and talk based therapy, with a focus on:

• Relationships, communication and boundaries.

• Emotional safety and social participation

• Adjusting expectations at home, school or work

• Supporting engagement in learning, employment and community life

• Honouring personal and cultural identity

Bringing It All Together

Mental health OTs aren’t in the ‘fixing’ business, and we don’t just dish out coping strategies to keep you on a hamster wheel to ensure you come back for more. Using models like MOHO allows us to deeply understand how mental ill-health shows up for a person, and what drives them towards change. Through this work, clients and families are empowered to take the reins on their wellbeing, resulting in deep and sustainable positive outcomes. 

To conclude, at Tempo, MH OT supports people to:

• Feel safer and more regulated in their bodies and relationships

• Rebuild routines, roles and daily rhythms that are sustainable

• Navigate work, school, learning and social participation

• Reconnect with identity, meaning and a sense of self

If this way of working resonates with you, mental health occupational therapy may be a supportive next step.

Leave a comment or contact for inquiries and appointments here.

References: Mental health occupational therapy capability framework.