Philippa Willitts asks whether disabled people are being held back from pursuing careers in occupational therapy – and if so, what should be done…
Occupational therapists (OTs) work with ill and disabled people, assisting them to live independently and carry out day-to-day tasks. The work they do might include recommending equipment and adaptations for people with various health conditions and physical impairments, providing mental health support or helping people with learning disabilities. As well as household tasks, their advice focus may also focus self-care, employment or community participation.
OTs may be based at hospitals or local community teams, or else work within vocational rehabilitation services. Many work for the NHS, others for private or third-sector organisations and some are self-employed. According to The NHS Careers website, the skills required to be an effective OT are “Patience, ingenuity, determination, common sense, a sound knowledge base and enthusiasm.”
‘Patience, ingenuity, determination and common sense’ are also traits that could apply to many disabled people. Getting through a world full of barriers requires all the above and more – so surely, given this close overlap, occupational therapy would be the perfect career for people with health problems or impairments?
Leia Stevens is a senior occupational therapist – and regular Access contributor – based at Medway Maritime Hospital in Kent. She works on short-stay wards, carrying out assessments and identifying what patients need in order for them to be safely discharged back to their homes or rehab units.
Leia has Crohn’s disease and systemic rheumatoid arthritis, both of which affect her on a daily basis. Leia’s own experiences of hospital care in her early childhood were what first gave her a passion for later working in healthcare.
In one of her regular columns for Access, Leia recently described her realisation that she could make a difference – “I can point out the moment when I knew I would work in healthcare, and look back on it now as a happy moment in what was a difficult time. If I could do something similar for any of my patients, if just one decides ‘I want to be like her’, then I’ll be happy with that.”
Initially wanting to become a nurse, she discovered occupational therapy later on, seeing it as “A profession that taught people to fix themselves” – something that appealed her own independent nature. In an email, she jokingly says, “I could help other stubborn people like myself stay independent.”
Leia’s Crohn’s disease means that she needs to take frequent bathroom breaks and is often in pain, while her systemic rheumatoid arthritis simultaneously causes her joint discomfort. Taken together, they can create stretches of fatigue and pain that require long periods of time spent in bed and naps after work to recover from.
Leia feels that her own experience of health problems has given her an empathy that really helps her in her OT career. “I know what it is to be in a hospital bed for weeks, to embarrass myself, to need help to wash and dress or make a meal,” she says. “I understand the grief this can cause an individual, so maybe I have a better understanding of the processes, and the ways to discuss and implement them.”
When asked whether she would recommend occupational therapy as a career for disabled people, Leia is encouraging. “I think OT is all about enabling the unable – so we are the perfect people to support and engage others.” She goes on describe how occupational therapy helped her to learn about herself as well as others, and believes that personal experience of ill health or disability can give the therapist a “unique perspective”.
Leia also credits OT teams for being more understanding of health problems in therapists than others – though this is unfortunately not a view that’s held universally.
Assumptions and stereotypes
A 2012 study carried out by Brenda Beagan and Aneta Chacala, titled Culture and diversity among occupational therapists in Ireland: when the therapist is the ‘diverse’ one, found that disabled OT students felt “Marginalised and excluded”, and that some disabled OT professionals had experienced “Discrimination, exclusion, undermining and bullying”. The researchers also heard that colleagues and clients had questioned whether Deaf and disabled OTs could do their job adequately, and from student and qualified OTs who reported struggling to get reasonable accommodations for placements and work, such as sign language interpreters and buildings without stairs.
As in the wider world, some disabled OTs were reported by Beagan and Chacala to have faced assumptions and stereotypes about their conditions and their capabilities. One participant in the research was quoted as saying, “Not all my other managers were Deaf-sensitive. I’ve been called a fire hazard, I’ve been stopped going on courses. Just horrific, some of the comments. I’ve been bullied.”
In another study carried out by Julie Bevan in 2014 published in the journal Disability and Society (available here via paywall access), Bevan herself recalls being asked to give a tutorial about her epilepsy to her colleagues. Other people she spoke reported downplaying their own needs in order to be accepted by their colleagues.
One former OT explained that the career had been unable to accommodate her needs after she became disabled. Physical accessibility, as well as the stress of the work, meant eventually leaving the job, as it became untenable.
I spoke to Louise (not her real name), who found that after becoming disabled she was unable to find a suitable OT role within the NHS. As her health deteriorated, Louise felt there to be structural barriers in place that prevented her from fully participating in her career – and is keen to warn other disabled people the difficulties she faced.
“I think OT is a good choice if you have physical impairments but aren’t sick”, she explains, “but it’s very hard for those of us who have symptoms that severely affect our day-to-day cognitive function.”
Louise also believes that the paucity of part-time OT jobs has a detrimental effect on inclusion within the sector – particularly with regards to disabled people unable to manage full-time work. The stress of the job can additionally cause problems for people with mental health conditions, and varying levels of accessibility within workplaces and clients’ homes can be limiting to people with physical impairments.
In Louise’s case, moving from an NHS role to being self-employed brought about the flexibility and accommodations she needed – though she acknowledges that this is a difficult path for newly qualified OTs and those wanting a more secure career, who she recommends should seek supportive employers, assistance from Access to Work and peer support.
The picture’s not entirely negative. One Deaf participant in Beagan and Chacala’s study felt that she possessed “A distinct advantage [when] working with Deaf clients”, thanks to a shared understanding of a mutual culture and ability to communicate in sign language with ease. Another participant reported that her own experiences of ‘disablism’ had “Enhanced [her] understanding of multiple forms of oppression”, enabling her to work more effectively with clients who had experienced other forms of prejudice and discrimination themselves.
Some participants in Bevan’s research reported that their impairments gave them “A different perspective”; an ability to look at situations from alternative points of view, increased awareness of the importance of not making assumptions, and greater empathy with clients.
OT may not be a straightforward career choice for disabled and ill people – but for those who are successfully supported and able to manage their jobs, their own experiences can go towards empowering clients and improving outcomes. Attitudinal, social and physical barriers do exist, however, and as long as they go unaddressed, disabled people with much to offer will continue to be excluded from what could otherwise be a rewarding career.
0345 60 60 655 www.nhscareers.nhs.uk
British Association of Occupational Therapists and College of Occupational Therapists
BAOT/COT is the professional body for OT staff throughout the UK
020 7357 6480 www.cot.co.uk