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. 2026 Jul 7;73(4):e70103. doi: 10.1111/1440-1630.70103

The occupational therapy role in acute psychiatric inpatient units in Australia: A mixed methods study

Leanne van Diemen 1,✉, Genevieve Pepin 1, Rachel Knight 1
PMCID: PMC13349337  PMID: 42415424

Abstract

Introduction

Occupational therapists are important members of mental health multidisciplinary teams. Despite aligning with mental health reform priorities, including promoting client centredness and participation, the role of occupational therapists in mental health, particularly in acute psychiatric inpatient units, is poorly understood. This study explored the role, function, and scope of practice of occupational therapists in Australian acute psychiatric inpatient units.

Methods

This mixed methods, convergent parallel design study combined in‐depth interviewing and a cross‐sectional survey. Qualitative and quantitative data were analysed using thematic analysis and descriptive statistics, respectively. Both forms of data were analysed separately and then integrated and merged using a contiguous approach. The Occupational Therapy Australia Mental Health Capability Framework guided survey questions and interview guide development. The Model of Human Occupation informed interview guide development, while maintaining an occupational focus across the study.

Consumer Involvement

Consumer involvement was not relevant for this study.

Findings

Fifty‐nine mental health occupational therapists participated in the study. All completed the survey, and 13 also participated in interviews. Participants were mostly females (83%), aged under 30 (58%), from Victoria (70%), with less than 3 years' experience in acute psychiatric inpatient units (77%). Four themes were identified: (1) a day in the life—same same but different, (2) the underutilised potential of occupational therapy, (3) an evolving practice and increasing demand, and (4) practice shaped by and shaping the environment. Key functions of the role included assessment, completed by survey participants either once a day (37%) or more (16%); individual interventions, completed once a day (48%); group work, completed several times a day (43%); and discharge planning.

Conclusion

Occupational therapists working in Australian acute psychiatric inpatient units share common functions, challenges, and experiences. Limited resources and challenges advocating for their role impact occupational therapists' ability to demonstrate their value within multidisciplinary teams.

Keywords: mental health, occupational therapy, professional role, psychiatric unit, scope of practice

PLAIN LANGUAGE SUMMARY

This research explored what occupational therapists who work in acute psychiatric inpatient units do. The researchers surveyed and interviewed occupational therapists from different acute psychiatric inpatient units across Australia. A total of 59 mental health occupational therapists completed the survey, and 13 of them also took part in interviews. Most participants were women aged under 30, from Victoria, with less than 3 years' experience in acute psychiatric inpatient units. Findings showed that occupational therapists in acute psychiatric inpatient units across Australia have similar roles. They commonly conduct assessments, provide interventions, run groups, and assist with discharge planning. Participants faced challenges in their roles due to limited resources and difficulty advocating for the occupational therapy role within the multidisciplinary team. This study is the first to describe the role of occupational therapy in acute psychiatric inpatient units in Australia. Strengths include the inclusion of both interview and survey responses from therapists in different facilities in different states/territories. However, no responses were received from rural areas, and most respondents were from Victoria. Future research should explore the number and experience of occupational therapists in acute psychiatric inpatient units across more diverse locations for broader understanding of the role.

Key Points for Occupational Therapy.

  • Adequate resourcing will support occupational therapists to demonstrate their value within multidisciplinary teams.

  • Occupational therapists and professional organisations must advocate for their unique role in acute psychiatric inpatient units.

  • Occupational therapists in acute psychiatric inpatient units must adapt to increasingly complex, changing environments while maintaining professional identity.

1. INTRODUCTION

Occupational therapy (OT) has long established roots in mental health, with its focus on participation aligning with the national framework for recovery‐oriented mental health services (Australian Health Ministers' Advisory Council, 2013). OT remains a significant and growing component of Australia's mental health workforce (Australian Institute of Health and Welfare, 2024).

Acute psychiatric inpatient units (APIUs) provide intensive, short‐term assessment, treatment, and care during acute phases of mental illness for people unable to be supported in the community (Department of Health, 2015, 2025). Located within public and private hospital facilities, these units represent a critical intervention point in the mental health system. Occupational therapists have the skills and expertise to address functional, leisure, occupational, and recovery‐oriented needs in acute mental health care (Levick et al., 2025; Marshall et al., 2019; Skaltsi et al., 2021). However, the extent to which these needs are addressed and the approaches used by occupational therapists in APIUs remain unclear.

To support and guide practice, Occupational Therapy Australia (OTA, 2025), the professional association for OT in Australia, developed the Mental Health Capability Framework. This framework, developed in collaboration with an Expert Advisory Group and through consultations with occupational therapists, outlines key capabilities required of occupational therapists working in the mental health sector, in areas including assessments, interventions, and collaboration with groups, families, and multidisciplinary teams. While the framework effectively articulates the expectations of occupational therapists at different career stages (foundational, intermediate, and senior) and advocates for the role of mental health OT, it does not align capabilities to specific settings, such as APIUs. The role of occupational therapists in APIUs is absent from the framework, and the existing literature provides a fragmented description of the role and scope of practice. A detailed understanding of this role is critical to understanding the real‐world practice of occupational therapists in this high‐pressure crisis care setting involving short lengths of stay and unclear professional roles and boundaries (Adelle et al., 2025). It is hoped that further exploration of what occupational therapists actually do in acute inpatient settings, the challenges they face, and the factors that support workforce sustainability will generate new knowledge contributing to ensuring that high‐level capability frameworks translate into safe, effective, and sustainable practice in complex work environments.

Recent evidence has begun to map the OT role in APIUs; however, most research is focussed on interventions. A scoping review of 21 studies (including four from Australia) on OT interventions in APIUs by Adelle et al. (2025) identified that occupational therapists commonly provide interventions focussed on activity engagement, functional restoration, and sensory modulation in APIUs. Notably, the review emphasised the unique role occupational therapists have in reducing the use of restrictive practices. For example, occupational therapists can reduce the need for seclusion by safely facilitating participation in meaningful activities. These findings underscore OT's pivotal role in enhancing activity engagement, expanding occupational choice, and fostering recovery of people in APIUs (Adelle et al., 2025). OT interventions can be delivered individually or in groups (Adelle et al., 2025), with evidence supporting the therapeutic benefits of group‐based approaches. Research demonstrates that groups facilitated by occupational therapists in APIUs increase social connection, enhance mental health self‐efficacy, and improve mood (Ngooi et al., 2021, 2022; Plastow et al., 2018; Ramano et al., 2021, 2017). Furthermore, occupational therapists employ therapeutic modalities to promote engagement and support recovery. Leisure has emerged as an important therapeutic modality, with a recent study piloting Levick's Leisure Practice Principles in an APIU to guide practice and encourage meaningful engagement in leisure (Levick et al., 2025). Sensory‐based approaches, including sensory modulation rooms, have been shown to enhance self‐efficacy and provide alternatives to restraint and seclusion (Barbic et al., 2019). In Australia, Wright et al. (2022) emphasised occupational therapists' leadership in implementing sensory‐based interventions and its alignment with state guidelines and with recovery‐oriented practice principles (Australian Health Ministers' Advisory Council, 2013).

Despite the emerging evidence on OT interventions, our understanding of the broader OT role in APIUs remains unclear, and evidence is scarce. An audit conducted by Fitzgerald (2016) in the United Kingdom compared 16 months of data from two APIUs with and without occupational therapist staffing. The study examined the core functions of the OT role, originally identified by Lloyd and Williams (2010), including individual assessment, therapeutic groups, individual treatment, and contribution to discharge planning. These functions were evaluated in relation to key service outcomes such as home leave utilisation, ward occupancy, and admissions of less than 3 days. The audit results indicate that occupational therapists appear to strengthen APIU services by increasing service efficiency, which, in turn, may reduce the duration of acute inpatient care a person requires (Fitzgerald, 2016).

Similarly, García‐Gestal et al. (2024) conducted a scoping review of 24 studies (14 dated between 1986 and 2015) on OT in APIUs. Three Australian studies were included. Included studies were mainly focussed on interventions and assessment. The review featured mostly qualitative studies (45.8%, n = 11) and revealed that research predominantly captures service user experiences (87.5%, n = 21) rather than occupational therapists' perspectives (8.3%, n = 2). While findings confirm that service users benefit from OT in APIUs, particularly through group work, the review emphasised the need for greater recognition of the OT role and its contribution to the quality of care provided in APIUs (Garcia‐Gestal et al., 2024).

The existing literature on the role of OT in APIUs mainly reflects European, African, and Asian contexts with minimal research from Australia. This geographic and conceptual gap is important because of Australia's unique socio‐cultural context, healthcare system, funding models, and policy, which may shape how OT roles function in practice. Critical shortages have been identified in the allied health workforce, more specifically among occupational therapists in mental health (Department of Health, 2021; Department of Health and Aged Care, 2022). An understanding of the OT role in Australian APIUs may assist in identifying factors contributing to this shortage and inform future workforce planning.

In addition, current knowledge predominantly focusses on OT interventions and other individual aspects of the role, such as leading group programs and sensory modulation, rather than the broader role occupational therapists play within APIUs. While past research has explored the role more broadly (Lloyd & Williams, 2010), it is unclear if this continues to reflect the role in the present context and the Australian context. There is also a limited understanding of occupational therapists' own perspective on their role, functions, and impact in these acute settings. Greater role clarity may support more consistent practice across services, strengthening the promotion and justification of OT's value within inpatient mental health care. Given the link between professional identity, job satisfaction, and burnout among mental health occupational therapists (Scanlan & Hazelton, 2019; Yan et al., 2025), a greater understanding of the role may also lead to increased professional fulfilment for occupational therapists working in APIUs.

To address these gaps, this study aimed to explore the OT role within Australian APIUs from the perspective of occupational therapists working in that role. The specific research question for this study was as follows: What is the role of OT in Australian APIUs?

This study also sought to answer these sub‐questions:

  • What are the functions of OT in APIUs?

  • Are there differences and similarities in the OT roles across different APIUs?

  • What is the scope of practice of OT in APIUs?

In this study, role is defined as the description of the position within the multidisciplinary team, function entails tasks occupational therapists perform in their role, and the scope of practice encompasses all aspects of the role and function in line with organisational expectations and relevant legislation (OTA, 2017).

2. METHODS

2.1. Study design

This research project is underpinned by a pragmatist research paradigm. Pragmatism offers a perspective that recognises multiple ways of interpreting the world and conducting research to explore reality. It suggests that combining different approaches can lead to a more comprehensive understanding of the topic being studied (Cresswell & Plano Clark, 2026).

In line with the pragmatism paradigm, this study utilised a mixed method, convergent parallel design, incorporating a quantitative cross‐sectional design and a qualitative descriptive design. Convergent parallel mixed methods research leverages quantitative research strengths, including larger sample size and objective measurements, combining qualitative research strengths such as in‐depth exploration (Cresswell & Plano Clark, 2026).

Qualitative and quantitative data were collected in parallel, and data were analysed separately before being integrated and merged using a contiguous approach as outlined by Fetters et al. (2013). This study received ethical approval from the Deakin University Human Ethics Advisory Group (approval number HEAG‐H 73_2024), was conducted in accordance with all relevant ethical guidelines, and was in line with the Research Data Management Procedure determined by Deakin University.

Cross‐sectional designs examine a phenomenon at a specific time (Schofield & Forrester‐Knauss, 2016), here focussing on the current role of occupational therapists in Australian APIUs. Qualitative descriptive designs examine the perspectives of a select sample of participants (Stanley, 2023), aligning with our research focussing on occupational therapists in Australian APIUs. Quantitative data produced a static picture of the role and current workforce; qualitative data provided occupational therapists' perspectives, giving further depth and insight into the scope of practice and barriers and facilitators to the role.

2.2. Participants and recruitment

Participants were occupational therapists who currently (or in the past 12 months) worked in an Australian APIU. Non‐probability purposive sampling (Carpenter, 2016) was used in this study, targeting the specific workforce relevant to the research question. Snowball sampling (Carpenter, 2016) was then used, as participants were invited to pass details of the study to other potential participants.

Different sample sizes were determined for each part of this mixed method study. For the survey, an alpha of 0.05 and statistical power of 0.8 were used, in line with OT studies (Dickerson, 2024). A medium effect size of 0.3 suggested that the sample size for the quantitative strand of the study should be 84 participants. The sample size for the qualitative strand of this study was based on the concept of information power and associated factors such as the aim of the study, the specificity of the participants and the data analysis strategies as identified by Malterud et al. (2016). No comparable study was found in the literature to inform the sample size. In addition, while 2700 occupational therapists work in Australian mental health settings, data on the proportion of these clinicians who work in APIUs are unavailable. Therefore, the qualitative strand of this study aimed to include between nine and 12 participants.

A flyer with study details and a survey QR code was shared on the OTA website, in the OTA member newsletters (July–August 2024), and with researchers' professional networks and through publicly available social media platforms. Participants could complete the survey only, the interview only or both the survey and interview. The survey's final question asked participants if they wished to participate in an interview. All survey and interview participants provided written informed consent before participating.

2.3. Data collection

2.3.1. Instruments

For this study, a bespoke survey and interview guide were developed as no existing data collection tools aligning with the research questions were located in the literature. The OTA (2025) Mental Health Capability Framework and the Model of Human Occupation (MOHO) (Taylor et al., 2024), a conceptual model of OT practice that explains how occupation is motivated, patterned, and performed informed the development of these tools. For example, specific MOHO concepts such as roles and daily routines linked to habituation were included in the interview guide, while the Framework heavily influenced the development of the survey. Data collection tools were pretested by the research team and two occupational therapists who had worked in APIUs.

The survey featured 26 questions divided into four sections. Section 1 included three questions relating to study inclusion criteria and a link to the Plain Language Statement and Consent Form with a checkbox to provide consent. Section 2 featured nine demographic questions (e.g., age and years of experience). Section 3 included seven multiple choice questions about participants' workplace such as ‘What type of health service do you work in?’ and ‘What best describes the clients in the acute inpatient unit where you work?’ Section 4 contained seven questions about participants' role, functions, and scope of practice. Participants were asked to rate, using Likert scales, the importance of functions commonly performed by clinicians working in acute settings identified in the OTA Mental Health Capability Framework, and time participants spend completing these functions. Then participants answered one multiple‐choice question, selecting interventions they complete in their role. After reviewing the provided OTA Scope of Practice Framework, participants answered the question ‘Do you feel that your functions/role as an occupational therapist working in an APIU align with the OTA scope of practice?’ An optional open text section for justification of their response was included. The final survey question asked if participants wished to participate in an interview. Those who were interested could enter their contact details in a separate survey.

The interview guide included three sections: Sections 1 and 2 included the same demographic and workplace related questions asked in the survey. Section 3 contained open questions where participants were invited to describe their role ‘How would you describe the role of occupational therapists in APIUs?’, describe their routine ‘How would you describe a typical day for you as an occupational therapist in the acute inpatient unit where you work?’, and explore what their views of their ideal role would be ‘If you could redesign your role in this setting what would an ideal occupational therapy role look like in an APIU?’. These questions facilitated a deeper exploration of the participants' experiences and perspectives on the OT role in APIUs.

2.3.2. Procedure

Data were collected in July and August 2024. Quantitative data were collected via an anonymous survey online using the Qualtrics XM software platform (Qualtrics, 2024). Qualitative data were collected through individual interviews, lasting approximately 45 min, conducted by L. vD. via the Zoom software platform (Zoom Video Communications, 2024). Thirteen survey participants expressed interest in participating in an interview; all 13 subsequently completed an interview, meeting the targeted sample size. Verbal consent to record video and audio was received. L. vD. transcribed interviews verbatim and emailed transcripts to participants for member checking; identifying information was then replaced with pseudonyms.

In line with mixed methods studies (Cresswell and Plano Clark, 2026), data triangulation was used through interview and survey data collection methods in this study; investigator triangulation was also used through involving all research team members in data analysis, as well as methodological triangulation using quantitative and qualitative methodologies. This supported minimising bias within the quantitative strand of this study.

2.4. Data analysis

Quantitative and qualitative strands were analysed separately and integrated after analysis. Quantitative data were analysed using descriptive statistics in the form of frequencies and percentages to summarise the data and describe the dataset (Rice et al., 2019).

Qualitative data were analysed using Braun and Clarke's (2022) six‐phase reflexive thematic analysis process; an inductive approach allowed participants' data to drive theme development (Braun & Clarke, 2022). L. vD. conducted and transcribed interviews, reread transcripts, and became familiar with the data before analysis (Phase 1: familiarisation with the data). R. K. and L. vD. independently read and coded three transcripts. The research team collaboratively reviewed the coded transcripts and discussed differences to develop greater understanding and enhance interpretation of the data. L. vD. then independently coded remaining transcripts (Phase 2: coding). Initial themes were developed by L. vD., who reviewed codes and data (Phase 3: generating initial themes) and grouped codes according to their shared meaning and relevance to the research questions (Phase 4: developing and reviewing themes). From initial themes, the research team collectively developed, refined and named key themes (Phase 5). NVivo software (Lumivero, 2024) was used in coding and generating themes.

Quantitative and qualitative data were integrated using primary data analysis integration procedures, using a contiguous approach (Fetters et al., 2013), and presented as a narrative discussion as described by Cresswell and Plano Clark (2026).

2.5. Positionality statement

At the time of this study, L. vD. was an OT honours student. She is currently a graduate occupational therapist working in public mental health. R. K. and G. P. are occupational therapists and researchers with expertise in mental health. Collectively, the research team acknowledges areas of privilege in their lives. Their approach to this research was guided by their motivation to enhance outcomes for people experiencing mental illness. The potential impact for bias is acknowledged, and steps were taken to mitigate this through supervision and reflexive journaling.

3. FINDINGS

3.1. Participants

A total of 59 mental health occupational therapist participated in the study. All completed the survey, and 13 also participated in interviews. As shown in Table 1, participants were mostly females (n = 49, 83.1%), aged under 30 (n = 34, 57.6%), from Victoria (n = 41, 69.5%), working in public health (n = 55, 98.2%), and had worked in APIUs for less than 3 years (n = 44, 77.2%).

TABLE 1.

Participant demographic data.

Variable Interview (n = 13) Survey (n = 59) a
Frequency (n) Percentage (%) Frequency (n) Percentage (%)
Age Under 30 8 61.50% 34 57.60%
30–39 4 30.80% 13 22.00%
40–49 1 7.70% 10 17.00%
50–59 0 0.00% 2 3.40%
60+ 0 0.00% 0 0.00%
Prefer not to say 0 0.00% 0 0.00%
Gender Male 3 2.10% 8 13.60%
Female 8 61.50% 49 83.10%
Other 2 15.40% 2 3.40%
Prefer not to say 0 0.00% 0 0.00%
State Australian Capital Territory 0 0.00% 0 0.00%
New South Wales 1 7.70% 2 3.40%
Northern Territory 0 0.00% 2 3.40%
Queensland 1 7.70% 11 18.60%
South Australia 0 0.00% 1 1.70%
Tasmania 0 0.00% 0 0.00%
Victoria 10 76.90% 41 69.50%
Western Australia 1 7.70% 2 3.40%
Location Metro 12 92.30% 45 79.00%
Regional 1 7.70% 12 21.10%
Rural 0 0.00% 0 0.00%
Qualification Undergraduate 7 53.90% 35 61.40%
Masters 8 46.20% 22 38.60%
Doctorate 0 0.00% 0 0.00%
Length of time as an occupational therapist Less than 3 years 4 30.80% 28 49.10%
3–5 years 8 61.50% 13 22.80%
6–10 years 0 0.00% 3 5.30%
11–20 years 1 7.70% 9 15.80%
20+ years 0 0.00% 4 7.00%
Length of time working in an APIU Less than 3 years 10 76.90% 44 77.20%
3–5 years 3 23.10% 7 12.30%
6–10 years 0 0.00% 2 3.50%
11–20 years 0 0.00% 4 7.00%
20+ years 0 0.00% 0 0.00%
Role type Occupational therapy specific 11 84.60% 52 91.20%
Generic 0 0.00% 5 8.80%
Other b 2 15.40% ‐ ‐
Health service type Private 0 0.00% 1 1.80%
Public 13 100.00% 55 98.20%
Beds 0–5 0 0.00% 1 1.80%
6–10 1 7.70% 4 7.10%
11–15 1 7.70% 6 10.70%
16–20 5 38.50% 9 16.10%
21–25 4 30.80% 10 17.90%
26–30 2 15.40% 13 23.20%
31–35 0 0.00% 4 7.10%
36–40 0 0.00% 0 0.00%
41–45 0 0.00% 2 3.60%
More than 45 0 0.00% 7 12.50%
Beds available for mental health intensive care 0 1 7.70% 4 7.10%
1 0 0.00% 2 3.60%
2 0 0.00% 5 8.90%
3 1 7.70% 3 5.40%
4 1 7.70% 6 10.70%
5 1 7.70% 12 21.40%
6 1 7.70% 5 8.90%
7 0 0.00% 1 1.80%
8 1 7.70% 4 7.10%
9 0 0.00% 1 1.80%
10 0 0.00% 2 3.60%
More than 10 1 7.70% 11 19.60%
Other c 5 38.50% ‐ ‐
Type of clients d Child 2 15.40% 6 10.50%
Youth 2 15.40% 11 19.30%
Adult 10 76.90% 45 79.00%
Older adults 1 7.70% 15 26.30%
Male only 1 7.70% 1 1.80%
Female only 2 15.40% 2 3.50%
Male and female 10 76.90% 29 50.90%
Specialist focus e 2 15.40% 8 14.00%
Number of occupational therapists working in the APIU (including participant) 1 1 7.70% 13 23.20%
2 7 53.90% 19 33.90%
3 3 23.10% 13 23.20%
4 2 15.40% 9 16.00%
5 0 0.00% 1 1.80%
6 0 0.00% 0 0.00%
7 0 0.00% 0 0.00%
8 0 0.00% 1 1.80%
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a

Some survey participants (n = 12) did not answer all questions; therefore, the number of respondents varies throughout the results.

b

‘Other’ data were collected from interview participants only. One participant has a generic role with the title of occupational therapist, while another holds a dual role that is partly occupational therapy specific.

c

‘Other’ data were collected from interview participants only. Some units have flexible or multiple levels of care (e.g., general, medium and intensive), while others have beds that can expand to accommodate different levels of care.

d

Participants could select more than one option.

e

Specialist focuses include forensic, youth justice forensic and neuropsychiatry.

Qualitative findings are presented below, followed by quantitative results.

3.2. Qualitative findings

Four themes were generated: (1) a day in the life—same same but different, (2) the underutilised potential of occupational therapy, (3) an evolving practice and increasing demand, and (4) practice shaped by and shaping the environment.

3.2.1. A day in the life—same same but different

This theme captures the daily routine described by most participants. There were shared tasks and functions across many of the participant's routines, suggesting these were fundamental to the OT role in APIUs. For example, several tasks (such as handover meetings, service improvement projects, and group work) served to improve the unit's environment and milieu. Interviewees cited group work as a major function of the role, as Ashley identified, ‘we are the master of running groups, any groups, we just do them’. Notably, participants had diverse opinions on whether leading a group program is the role of an occupational therapist. In some APIUs, occupational therapists were ‘expected’ to have oversight and coordination of the group program, but this differed between inpatient units.

Another common function that featured in occupational therapists' routines was person‐centred assessment; Bianca states, ‘[…] it is a lot of assessment. I think in the acute setting, you're more so doing assessment as opposed to intervention per se’. Despite typically brief admissions, short‐term interventions that supported the early stages of recovery from an acute episode were delivered and valued. Ashley explained that one‐to‐one, short‐term interventions were important, in order ‘to close that gap and help them find some level of occupational balance’. Interventions varied, with some aligning with applied models of practice (such as the MOHO) and others developed based on a person's unique needs.

Non‐specific OT tasks such as equipment and resource management for the unit were also included in participants daily routines. Some participants felt that this was within their scope of practice while others felt these tasks exceeded scope of practice; Charlie commented, ‘All the groups, everything that's a bit extra, that's a bit “allied health‐y”, or a little bit holistic is usually palmed off to the occupational therapists’.

3.2.2. The underutilised potential of OT

This theme describes occupational therapists' perceptions of their role and their contribution to APIUs. All interview participants felt they were valuable members of the multidisciplinary team and brought a different perspective to supporting people in APIUs. Occupational therapists in this study reported that by taking the time to ‘just listen to them, and validate them, and just be there with them’ (Ashley), they were able to understand more about service users' interests and preferences, compared to other clinicians on the inpatient unit. Quinn further explains:

Yeah, and I think from the outside perspective, it very much looks like we are just hanging out with them, or playing with them, or running activities for them. And so, I think because it does not come across as being this very restrictive intervention, or [ … .] a medical model, that's where we sit very differently, and nothing that we do is kind of as regimented or as prescriptive as I think the other clinicians [are]. We come in [… .] with a very flexible approach. We're really interested in learning what their likes and dislikes are, and using that as an in. Which I do not think necessarily is reflected in other roles

Participants believed taking the time to understand a person's interests and preferences enabled them to facilitate engagement with the service user through occupation, which in turn strengthened rapport. However, the function of using meaningful occupation to engage a service user and as an intervention was often misunderstood by other clinicians, who did not always recognise its therapeutic value.

If I'm playing table tennis with someone, it's for a purpose, and it's part of their engagement and part of their therapy. But to [… .] someone else, that looks like ‘you are playing table tennis, and I can take them for a more important medical review’. (Thomas)

Participants reported that the multidisciplinary team did not always acknowledge the essential contribution of OT; therefore, the input of other professions was sometimes prioritised or deemed more important. As Sarah explained, ‘they [multidisciplinary team] don't really recognise what we can do’, and as Thomas shared, ‘I think, often in my experience, the scope of OT [occupational therapy] has been limited by what others perceive what OT [occupational therapy] does on the unit’. The limited understanding of the role of OT meant that ongoing advocacy was necessary to establish and sustain their OT identity within the multidisciplinary team. As stated by participants, professional identity was well established in inpatient units where the role and value of OT were understood and acknowledged by managers and leaders. Unfortunately, occupational therapists commonly felt their role was undervalued and underutilised within the APIU setting. This contrast was described by Jamie:

“I've been in teams where occupational therapy is not valued, and you are kind of just thrown task after task, and then no one cares about the outcome anyway, so you feel like a tick box. And that makes being an occupational therapist really undermining and kind of undervalued, where here, we feel quite valued. So, the work is relevant to us, it's valued, we get job satisfaction from the clients, we do not get burnt out.”

Almost all interview participants felt that the benefits of working in an OT specific role allowed them to use OT skills, knowledge and frameworks more easily. In turn, this strengthened professional identity. Subsequently, participants agreed that their role and functions aligned with the OTA Scope of Practice Framework. However, there was a mismatch between the described advantages of working in an OT‐specific role because most interviewees also felt they were not operating to their full scope of practice. Some participants described this as feeling like an incomplete occupational therapist.

So, I think, based on everything I learned at Uni and everything that I have capacity to do, I'm definitely not doing everything. But I do think that everything I'm doing is very much OT [occupational therapy], and […] I am using specifically OT [occupational therapy] skills in what I'm doing. (Quinn)

3.2.3. An evolving practice and increasing demand

This theme describes changes affecting participants' roles over time. It recognises that the OT role in APIUs is, at least in part, fluid and changing. This is because occupational therapists are adapting their practice in response to changing environments, legislation and policy, political priorities, and the needs of people admitted on the unit.

Participants reported that there has been an increase in people admitted to APIUs with high levels of complexity and acuity. Jamie noted that ‘the acuity in patients can make it very challenging … the agitated, aggressive, fluctuating presentations can be quite difficult’, highlighting how elevated levels of risk and distress can shape the way occupational therapists engage with and support patients. Despite these challenges, several interviewees mentioned that supporting people admitted to APIUs with complex presentations was an opportunity because occupational therapists can achieve ‘good engagement with complex consumers … we're able to help unpack the problems, and kind of find the missing pieces’, which has ‘cemented our value as a profession’ (Jamie).

Planning and facilitating discharge of people from APIUs was identified as an increasingly important aspect of the OT role. Participants reported that the multidisciplinary team relied on occupational therapists to provide recommendations on the level of support required by service users for safe discharge. As Jordan explained, ‘The main […] thing that we're trying to look at though is[..], how do we actually get this person out of hospital’. Participants also described how changes to funding structures were reshaping models of care, with greater emphasis placed on reducing length of stay and expediting discharge. Consequently, interviewees anticipated that OT practice within APIUs would become increasingly focussed on discharge planning. Sam reflected on this shift, suggesting that there may be ‘a stronger movement towards […] supporting […] that discharge, making sure that discharge goes smoother and maybe [with] less issues. I think [it] will be […] a bit of a change from what we're doing now’.

All participants cited that the introduction of the National Disability Insurance Scheme (NDIS) had resulted in changes to their role(s). Most participants felt that NDIS related administration, such as applications and reviews, detracted from other valuable aspects of their role, such as direct time spent with service users. More specifically, participants identified that occupational therapists on APIUs have had to incorporate functions such as advocacy and liaison with external providers and complete a range of administrative tasks to secure changes or updates to support plans in preparation for discharge from the psychiatric unit. Ashley explains this challenge further:

technically, in public health, we are not funded to do NDIS report writing work. And it's actually, if anything, it's outside of our roles and responsibilities. But unfortunately, […] there's a discrepancy in […] NDIS coming in and […] the work of […] public health OTs [occupational therapists], and […] it has not been integrated that well. So obviously, we see that there is a huge gap and we do that report writing, […]. We do it because we see that there is a benefit to it. But that takes us away from the unit work.

While participants agreed that NDIS is important for service users on APIUs, it was perceived that this role may be better suited to occupational therapists in the community.

Participants recognised multiple influences (such as the NDIS), which meant their role was evolving and thus required a change in practice. However, occupational therapists also described a tension between needing to change their practice and having capacity to do so. Occupational therapists in this study already felt at capacity and stretched, and therefore, changes to practice felt like a burden:

we are having to change the program to meet the needs of our young people. So that comes with its own set of challenges about having the resources and […] capacity to review and do a […] literature review and having all of the space to do that. (April)

3.2.4. Practice shaped by and shaping the environment

This theme describes how the physical, social and occupational environment influences the OT role in APIUs.

Occupational therapists on APIUs are both influenced by and influence the physical environment. Interview participants discussed the impacts of safety restrictions such as limited use of stationery and the unavailability of equipment such as basketball hoops because of ligature risk. Interviewees identified a lack of space to conduct individual therapy and assessments, and several did not have a permanent desk space. Where spaces were well‐designed, this was a facilitator for the participants' role.

Working in a new building that's only […] 2 years old, I think that makes such a difference to your job and having lots of access to heaps of different interview room spaces, lots of courtyards you can chat to people, and I know that sounds quite basic, but other units I've worked on are really old and rundown. (Jordan)

Occupational therapists positively influenced the APIU environment as illustrated by Jamie:

So, we have been able to […], we have done the sensory room. That's […] been my first big focus, the sensory room and our group activity room […] we have been able to ask for new things that do not make it feel […] outdated.

Interview participants also expressed a desire to contribute to cultivating a space that promoted recovery.

The need for adequate resourcing including funding, staffing and material resources was overwhelmingly reported. While some participants described additional support through protected time for training, peer support and supervision in a graduate program role, for one participant, supervision rarely occurred. The lack of resources directly impacted participants' ability to perform their role and fully demonstrate their value in the multidisciplinary team. Because of inadequate budgets for equipment and resources (such as sensory tools and items for groups), fundraising sometimes became a function of the OT role.

And it's a bit of a push and pull. I'm happy to do those things, obviously I care a lot about my job. I'm happy to flip sausages and make that happen. But you know, talking about scope of practice, that is not really what I got my master's degree to do. (Lucy)

Several interviewees who were employed part time were willing to increase their work hours, while others recognised a need for increased OT presence after hours and on weekends. Reportedly, strict budgets prevented these workforce changes.

3.3. Quantitative results

Survey respondents rated the importance of different functions to their role in APIUs (see Figure 1). Sensory modulation assessment and intervention were extremely important to 61.2% of participants. Group work and individual interventions were extremely important to the role according to 59.2% of participants; 53.1% of participants rated assessments as an extremely important function. Providing or receiving clinical supervision was extremely important (55.1%), and completing NDIS related documentation was very (30.6%) or extremely (24.5%) important.

FIGURE 1.

FIGURE 1

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Importance of functions to the occupational therapy role in APIUs. Note: †Some survey participants (n = 12) did not answer all questions; therefore, the number of respondents varies throughout the results.

Participants indicated their time spent on these functions (see Figure 2). Most survey participants worked with groups several times a day (42.9%) or at least once a day (38.8%). Participants conducted individual interventions (36.7%) and assessments (47.9%) at least once a day. Sensory modulation was most commonly performed once a day by 36.7% of participants. Providing or receiving clinical supervision was performed once a month by over half of participants (53.1%). Participants completed NDIS related documentation once a week or more (49.1%). Over half of participants (52.1%) did not perform alcohol‐related and other drug‐related assessments or interventions.

FIGURE 2.

FIGURE 2

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Time spent completing occupational therapy functions. Note: †Some survey participants (n = 12) did not answer all questions; therefore, the number of respondents varies throughout the results. ‡‘Other’ includes the following responses: supervision occurring fortnightly or bimonthly, not currently completing care coordination due to job sharing and rarely conducting individual occupational therapy assessments.

Other functions that were commonly listed (by three or more participants) in an open text response include participation in multidisciplinary team meetings, handovers or clinical reviews, falls risk assessments, training to the multidisciplinary team, supporting students, research and project work, obtaining resources (includes by donation) and discharge co‐ordination and planning.

Survey participants agreed that sensory modulation (100%), psychoeducation (93.8%), working with groups (97.9%), therapeutic use of occupation (91.7%), and activity scheduling (91.7%) were common OT interventions in an APIU (see Table 2). Less common were psychological interventions such as narrative therapy (14.6%) and psychotherapy (14.6%). Two participants listed using the Hearing Voices approach as an intervention commonly used as an open text response for other interventions performed.

TABLE 2.

Interventions completed by occupational therapists in APIUs.

Intervention Percentage (%) Frequency (n) a
Sensory modulation interventions 100.0% 48
Working with groups 97.9% 47
Psychoeducation 93.8% 45
Therapeutic use of occupation 91.7% 44
Activity scheduling 91.7% 44
Therapeutic use of self 85.4% 41
Activity grading and adaptation 77.1% 37
Remotivation process 41.7% 20
Dialectical behaviour therapy (DBT) 27.1% 13
Cognitive behavioural therapy (CBT) 22.9% 11
Acceptance and commitment therapy (ACT) 22.9% 11
Coaching 18.8% 9
Psychotherapy 14.6% 7
Narrative therapy 14.6% 7
Other b 12.5% 6
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a

Some survey participants (n = 12) did not answer all questions; therefore, the number of respondents varies throughout the results.

b

‘Other’ interventions include physical assessments and interventions; NDIS applications; brief interventions based on CBT, DBT and ACT therapy principles; Hearing Voices interventions; neurodevelopmental psychoeducation; family and dyadic group; and child‐focussed play.

Survey participants agreed that their role and functions aligned with the OTA Scope of Practice Framework (91.7%). Several participants provided comments on the discipline‐specific nature of the OT role in APIUs and the focus of their work on occupational participation as justification for how well their role aligns. Additionally, several participants highlighted the difficulties of aligning with the full scope of practice due to limitations of the ward environment.

4. DISCUSSION

This is the first study to provide a comprehensive description of the role of occupational therapists in APIUs and map this description against the OTA Mental Health Capability Framework. In doing so, this study extends the current understanding of the role of occupational therapists within APIUs to provide further detailed knowledge and anchors it in the contemporary Australian context. Specifically, it highlights the influence of different factors such as external pressures, the tension between the role (including the capabilities within the Framework) and the realities of practice, resource limitations and environmental influences. These factors then affect occupational therapists' ability to fulfil their role and maintain an occupation focus, their professional identity and advocacy for the profession.

4.1. The role and functions of OT in APIUs

The main functions described by occupational therapists in this study align with the OTA (2025) Mental Health Capability Framework in areas such as assessment, occupation‐focussed and structured interventions, working with other health professionals, carers and families, and sensory modulation. Functions described by participants, including individual assessment, therapeutic groups and individual treatment, also align with existing literature (Fitzgerald, 2016; Gallagher et al., 2023; Hickey, 2016; Skaltsi et al., 2021). However, discharge planning and support, not currently a Framework component, were identified as a significant function of the role.

Participants agreed on the importance of group work, which aligns with existing literature (Ngooi et al., 2021, 2022; Plastow et al., 2018; Radnitz et al., 2019; Ramano et al., 2021, 2017) and highlights the value of multidisciplinary involvement in group interventions in APIUs (Pownell et al., 2023; Versitano et al., 2024). However, participants in this study disagreed on how much involvement occupational therapists should have in leading groups and what this involvement should consist of.

Unique to this study was the discussion about environmental impacts on participants' role. Negative impacts such as limited available space impacting how and when they conduct sessions, and positive impacts such as operating in newer, purpose‐built environments facilitating flexibility in their role were discussed. Interactions with the multidisciplinary team both negatively and positively impacted professional identity. Shetty et al. (2024) discuss individual physical environment elements such as lighting and architectural design features and their impacts on job satisfaction among healthcare staff, not specific to mental health facilities. Alsabhan et al. (2025) identify how occupational and social environmental impacts such as a lack of resources and lack of support from managers negatively impact healthcare staff job satisfaction in various healthcare facilities. The intersection between the environment, a person and their occupations is central to the OT profession (Fisher et al., 2024). While existing literature is not specific to occupational therapists, the relevance and influence of the impact of the environment on healthcare staff's role and functions aligns with our study findings for occupational therapists in APIUs.

Participants reported that their open communication style and occupation‐focussed approach enhanced service users' participation and contributed to interactions distinct from other members of the multidisciplinary team. This is supported by literature highlighting that different engagement styles of occupational therapists, such as inclusive, welcoming and nurturing approaches, can increase service users' engagement in therapy (Adelle et al., 2025; Birken & Bryant, 2019; Bryant et al., 2016; Ngooi et al., 2021).

4.2. Scope of practice and maintaining professional identity

Most participants felt their scope of practice reflected the OTA (2017) Scope of Practice Framework, though some interviewees reported broader roles that often changed depending on environmental influences. Others felt they did not work to full scope. Limitations to scope were discussed by all participants, mostly those inherent to the APIU environment, such as an inability to evaluate and assess long‐term intervention impacts due to short admissions. Participants described being an incomplete occupational therapist when unable to fulfil all components of the OT process or scope of practice. This is interesting when the OT process, as defined by the American Occupational Therapy Association (2020), includes evaluation, intervention and outcomes. Walder et al. (2022) note that short hospital stays and funding requirements influence occupational therapists' roles, which can affect professional identity. While the OTA Scope of Practice Framework states that occupational therapists enhance individuals' and groups' participation through any or all of a variety of ways (OTA, 2017), some early career participants felt their experiences did not align with their expectations shaped by their education.

In OT‐specific roles, supportive leadership and advocacy were identified as protective factors that supported participants' professional identity. Scanlan and Hazelton (2019) note that maintaining professional identity can increase wellbeing and job satisfaction and protect against burnout. Yan et al. (2025) further support this link, identifying a triangular relationship between professional identity, job satisfaction, and burnout. Using occupational specific language, linking theory to practice, continued professional development and supervision can support professional identity (Walder et al., 2022; Yan et al., 2025). Professional organisations such as OTA also play a role in supporting occupational therapists to maintain professional identity and advocate for their role. The OTA Mental Health Capability Framework includes advocating for the role within the multidisciplinary team as a key criterion when working with other health professionals, carers and families (OTA, 2025).

Specific to the Australian health system and discussed in this study was the influence of the NDIS on the role of occupational therapists in Australian APIUs. While participants recognise the importance of NDIS supports for discharge and community support, they raised concerns about time and resource constraints. Participants often had to choose between face‐to‐face therapy sessions or completing NDIS applications due to resource constraints. Walder et al. (2022) acknowledge the challenges of adapting to new ways of working while maintaining professional identity. The authors suggest that changes to practice must align with core OT philosophy. Evidence suggests that advocacy is also vital for maintaining professional identity (McKinnon et al., 2024; Walder et al., 2022).

4.3. Resourcing the role

Most participants in this study were aged under 30, early in their OT careers (within the first 5 years), and had less than 3 years' experience in APIUs. This reflects a higher proportion of early career occupational therapists compared to the Australian OT workforce, where the average length of time as an occupational therapist was 11.6 years in 2019 (AHPRA, 2022). In 2023, the average age of Australian occupational therapists was 37.4 years, with approximately 33% aged under 30 (AHPRA, 2023). Some participants described structured graduate programs that included education and peer support, while other services provided minimal support, including one where supervision often did not happen.

Results suggest that resources, including training, supervision, staffing levels and physical resources of meeting/session spaces and desk/storage spaces, impact occupational therapists' ability to perform their role. Many participants worked as sole occupational therapists within the APIU or in a part‐time or job share role. Often, they expressed a desire to increase their capacity but were constrained by budgets. The Australian National Mental Health Workforce Strategy identified critical workforce shortages in allied health professions in mental health and acknowledged that professions may not be operating at their full scope of practice (Department of Health and Aged Care, 2022). The first priority in the strategy is to address the critical shortages. However, addressing workforce shortages requires an increase in sustainable investment.

4.4. Implications for practice and education

The limited resources and related impacts reported by study participants support OTA's (2019, 2022) recommendation for increased funding for OT in mental health. More specifically, this study demonstrates that further funding to support increased OT presence, including for additional staff, professional development and supervision in Australian APIUs is needed to enable occupational therapists to provide optimal occupation‐based care to service users.

Another implication for practice is advocacy for the OT role within APIUs. Increased funding and advocacy for OT roles in APIUs could also address participants' feelings of being incomplete occupational therapists. This study suggests that the discrepancy between how participants conceptualise their role and what is feasible in APIUs may compromise their professional identity. Walder et al. (2022) discuss the importance of advocacy in supporting professional identity. Adelle et al. (2025) argue that greater recognition of occupational therapists' contributions in APIUs is needed within the multidisciplinary team. This may be achieved through advocacy, such as clearly articulating clinical reasoning when collaborating across disciplines. In practice, recognising advocacy as a function of the OT role and providing supervision and frameworks to support this are essential.

This study highlights discharge support and planning as an important component of the OT role in APIUs. Including this as a component of the role in guidelines such as the OTA (2025) Mental Health Capability Framework could further support capability development in this area.

Walder et al. (2022) recommend occupation‐focussed university curricula to support professional identity development and enhance advocacy skills, better preparing students for the workforce. Education providers can also help students manage role expectations by emphasising the importance of each stage of the OT process, reinforcing that therapists may work in any or all stages. This is also relevant for mental health graduate programs as mentioned by some participants.

4.5. Strengths and limitations

This study is the first to describe the role of OT in APIUs in Australia, contributing valuable insight into the role, its functions and scope of practice. The use of mixed methods research design is a strength of this study, providing both static data on individuals' roles, workplaces and functions and rich insights into participants' perspectives. Additionally, this study includes responses from six Australian states/territories, in both metro and regional areas and includes child, youth, adult, older adult, forensic, youth justice and neuropsychiatry populations, providing a detailed picture of the OT role across Australian APIUs.

There are also limitations to this study. Although the survey was open to all occupational therapists in Australia, no responses were received from rural areas, and most respondents were from Victoria. This somewhat aligns with the distribution of mental health occupational therapists in Australia, with Victoria having the largest population (896), followed by New South Wales (641) and Queensland (579) (Australian Institute of Health and Welfare, 2024). The intended sample size for survey participants was not met due to time constraints of the project, despite sending reminders. However, as a descriptive cross‐sectional study, this discrepancy does not significantly affect the quantitative results (Wang & Cheng, 2020). The voluntary nature of survey and interview research raises potential for self‐selection bias and may lead to a non‐representative sample. However, responses were received from diverse settings and locations, capturing a broad range of perspectives. Data on the grade/level and number of full‐time equivalent occupational therapists in APIUs across Australia were collected; however, because grading systems vary between states, these data cannot be compared. Additionally, although the researchers aimed to receive responses from occupational therapists with a broad range of experiences, most respondents were early in their careers. This research did not examine the correlation of responses with length of time worked in APIUs or allow for distinction between providing and receiving supervision.

4.6. Future research

The impact of completing NDIS related reports and applications on OT roles in APIUs mentioned by participants could be further explored to enhance and guide practice in this area. Within APIUs, a lack of external supports such as NDIS can often be a barrier to discharge. Although not discussed by participants in this study, research into the implications of this process on occupational therapists' role could provide further insight into how practice is being shaped in these settings.

While this study provides valuable initial insights into occupational therapists' roles in Australian APIUs, strategies to increase the sample size and diversity are needed. One approach could be forming a steering committee of occupational therapists working in APIUs from all states and territories to champion recruitment. Further analysis of occupational therapists' grades/levels, years of experience and therapists' time use in APIUs would provide a clearer picture of the current workforce and whether similar challenges are faced by mid‐career and senior occupational therapists, with potential to inform more effective professional development strategies. Additionally, conducting a similar study with service users of OT services in APIUs would offer valuable insights to inform practice in this setting.

Lastly, mapping curriculum content against occupational therapists' experiences of their work in APIUs could support the development of learning activities that would best support OT practice in this area of mental health services.

5. CONCLUSION

The role of occupational therapists in Australian APIUs shares many common functions, challenges and experiences. There appears to be a cyclic effect where resource limitations restrict the role, which then results in challenges for occupational therapists in demonstrating their value within the multidisciplinary team. This then further impacts the receival of funding and relevant referrals to facilitate the performance of their role and thus demonstrate their value. Crucially, this may have implications for the strength of professional identity.

AUTHOR CONTRIBUTIONS

R. K. and G. P. conceived the study. L. vD. designed the methodology and reviewed the literature with supervision from R. K. and G. P. Interviews were conducted and transcribed by L. vD. All researchers contributed to data analysis. L. vD. wrote the manuscript, which R. K. and G. P. reviewed.

CONFLICT OF INTEREST STATEMENT

The authors have no conflict of interest to declare.

ETHICS STATEMENT

This study received ethical approval from the Deakin University Human Ethics Advisory Group (approval number HEAG‐H 73_2024), was conducted in accordance with all relevant ethical guidelines, and was in line with the Research Data Management Procedure determined by Deakin University.

ACKNOWLEDGMENTS

During the preparation of this work, the authors used Open AI's ChatGPT (GPT‐5.3) to check for grammatical errors in drafting some of the text and for generating ideas for theme names. The output was checked, refined, and confirmed by the authors before inclusion.

DATA AVAILABILITY STATEMENT

Research data are not available due to privacy or ethical restrictions.

REFERENCES

  1. Adelle, A. , Bedford, K. , McMahon, S. , Dun, C. , Starbuck, R. , & Doroud, N. (2025). The role of occupational therapists in acute mental health inpatient settings: A systematic scoping review. Australian Occupational Therapy Journal, 72(3), e70032. 10.1111/1440-1630.70032 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alsabhan, T. , Alrimali, K. , Alsaleh, S. , Alnassfan, T. , Altuwayrib, S. , Alanazi, A. , Alduaij, M. , & Almuayli, S. (2025). The impact of quality of work and life environments on job satisfaction among healthcare professionals: A systematic review. Cuestiones de Fisioterapia, 54(3), 52–76. [Google Scholar]
  3. American Occupational Therapy Association . (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74, 7412410010. 10.5014/ajot.2020.74S2001 [DOI] [PubMed] [Google Scholar]
  4. Australian Health Ministers' Advisory Council . (2013). A national framework for recovery‐oriented mental health services: Policy and theory. Commonwealth of Australia. https://www.health.gov.au/sites/default/files/documents/2021/04/a-national-framework-for-recovery-oriented-mental-health-services-policy-and-theory.pdf [Google Scholar]
  5. Australian Health Practitioner Regulation Agency . (2022). Occupational therapy workforce analysis. AHPRA & National Boards. https://www.ahpra.gov.au/documents/default.aspx?record=WD22%2f32126&dbid=AP&chksum=P2v2l5fRl5JGTJWHvP08MQ%3d%3d&_gl=1*10g73ma*_ga*MTYzMzUzODkzLjE3MjI2NjU2NzY.*_ga_F1G6LRCHZB*MTcyODc5MzY3MS42LjEuMTcyODc5Mzc2NC4wLjAuMA [Google Scholar]
  6. Australian Health Practitioner Regulation Agency . (2023). Occupational therapy workforce. AHPRA. https://www.ahpra.gov.au/documents/default.aspx?record=WD24%2f33600&dbid=AP&chksum=E4VYYwmdPXBaNF25U0VNnw%3d%3d&_gl=1*rw6kb9*_ga*MTYzMzUzODkzLjE3MjI2NjU2NzY.*_ga_F1G6LRCHZB*MTcyODc5MzY3MS42LjEuMTcyODc5Mzc2NC4wLjAuMA [Google Scholar]
  7. Australian Institute of Health and Welfare . (2024). Mental health workforce. Australian Government. https://www.aihw.gov.au/mental-health/topic-areas/workforce [Google Scholar]
  8. Barbic, S. P. , Chan, N. , Rangi, A. , Bradley, J. , Pattison, R. , Brockmeyer, K. , Leznoff, S. , Smolski, Y. , Toor, G. , Bray, B. , Leon, A. , Jenkins, M. , & Mathias, S. (2019). Health provider and service‐user experiences of sensory modulation rooms in an acute inpatient psychiatry setting. PLoS One, 14(11), e0225238. 10.1371/journal.pone.0225238 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Birken, M. , & Bryant, W. (2019). A photovoice study of user experiences of an occupational therapy department within an acute inpatient mental health setting. British Journal of Occupational Therapy, 82(9), 532–543. 10.1177/0308022619836954 [DOI] [Google Scholar]
  10. Braun, V. , & Clarke, V. (2022). Thematic analysis a practical guide. Sage Publications Ltd. [Google Scholar]
  11. Bryant, W. , Cordingley, K. , Sims, K. , Dokal‐Marandi, J. , Pritchard, H. , Stannard, V. , & Adamako, E. (2016). Collaborative research exploring mental health service user perspectives on acute inpatient occupational therapy. British Journal of Occupational Therapy, 79(10), 607–613. 10.1177/0308022616650899 [DOI] [Google Scholar]
  12. Carpenter, C. (2016). Phenomenology and rehabilitation research. In Liamputtong P., Anderson K., & Bondas T. (Eds.), Research methods in health (pp. 157–176). Oxford University Press. [Google Scholar]
  13. Cresswell, J. W. , & Plano Clark, V. (2026). Designing and conducting mixed methods research (4th ed.). Sage Publications, Inc. [Google Scholar]
  14. Department of Health . (2015). Acute inpatient services. State Government of Victoria. https://www.health.vic.gov.au/mental-health-services/acute-inpatient-services [Google Scholar]
  15. Department of Health . (2021). Victoria's mental health and wellbeing workforce strategy 2021–2024. State Government of Victoria. https://www.health.vic.gov.au/strategy‐and‐planning/mental‐health‐workforce‐strategy [Google Scholar]
  16. Department of Health . (2025). Acute mental health services. State Government of Victoria. https://www.health.vic.gov.au/mental-health-services/acute-mental-health-services [Google Scholar]
  17. Department of Health and Aged Care . (2022). National mental health workforce strategy: 2022–2032. Commonwealth of Australia. https://www.health.gov.au/sites/default/files/2023‐10/national‐mental‐health‐workforce‐strategy‐2022‐2032.pdf [Google Scholar]
  18. Dickerson, A. E. (2024). Securing samples and performance sites. In Taylor R. (Ed.), Kielhofner's research in occupational therapy: Methods of inquiry for enhancing practice (3rd ed., pp. 423–460). F. A. Davis Company. [Google Scholar]
  19. Fetters, M. D. , Curry, L. A. , & Creswell, J. W. (2013). Achieving integration in mixed methods designs—Principles and practices. Health Services Research, 48(6pt2), 2134–2156. 10.1111/1475-6773.12117 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Fisher, G. , Haglund, L. , & Ullah, M. M. (2024). The environment and human occupation. In Taylor R. R., Bowyer P., & Fisher G. (Eds.), Kielhofner's model of human occupation: Theory and application (6th ed., pp. 93–109). Wolters Kluwer. [Google Scholar]
  21. Fitzgerald, M. (2016). The potential role of the occupational therapist in acute psychiatric services: A comparative evaluation. International Journal of Therapy and Rehabilitation, 23(11), 514–518. 10.12968/ijtr.2016.23.11.514 [DOI] [Google Scholar]
  22. Gallagher, M. , Bagatell, N. , Godwin, K. , & Peters, D. (2023). Using practice‐based inquiry to enact occupation‐centered, justice‐oriented practice in an acute mental health setting. American Journal of Occupational Therapy, 77(1), 7701205060. 10.5014/ajot.2023.050046 [DOI] [PubMed] [Google Scholar]
  23. García‐Gestal, U. , Talavera‐Valverde, M.‐Á. , & Souto‐Gómez, A.‐I. (2024). Occupational therapy in psychiatric short‐term hospitalization units: Scoping review. Community Mental Health Journal, 60, 1283–1307. 10.1007/s10597-024-01286-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Hickey, R. (2016). An exploration into occupational therapists' use of creativity within psychiatric intensive care units. Journal of Psychiatric Intensive Care, 12(2), 89–107. 10.20299/jpi.2016.011 [DOI] [Google Scholar]
  25. Levick, J. , Broome, K. , Oprescu, F. , & Gray, M. (2025). Key principles to support occupational engagement in mental health inpatient units. Hong Kong Journal of Occupational Therapy, 38(1), 67–74. 10.1177/15691861251328585 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Lloyd, C. , & Williams, P. L. (2010). Occupational therapy in the modern adult acute mental health setting: A review of current practice. International Journal of Therapy and Rehabilitation, 17(9), 436–442. 10.12968/ijtr.2010.17.9.78038 [DOI] [Google Scholar]
  27. Lumivero . (2024). NVivo, version 14.23.3. [Computer Software]
  28. Malterud, K. , Siersma, V. D. , & Guassora, A. D. (2016). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research, 26(13), 1753–1760. 10.1177/1049732315617444 [DOI] [PubMed] [Google Scholar]
  29. Marshall, C. A. , McIntosh, E. , Sohrabi, A. , & Amir, A. (2019). Boredom in inpatient mental healthcare settings: A scoping review. British Journal of Occupational Therapy, 83(1), 41–51. 10.1177/0308022619876558 [DOI] [Google Scholar]
  30. McKinnon, S. , Petrone, N. , & Tarbet, A. (2024). The role of an occupational therapy practitioner in professional advocacy: A scoping review. Translational Science in Occupation, 1(2), 1–19. 10.32873/unmc.dc.tso.1.2.02 [DOI] [Google Scholar]
  31. Ngooi, B. X. , Wong, S. R. , Chen, J. D. , Koh, V. S. Y. , Ng, A. R. W. , Sahrol, S. B. , Lai, J. K. W. , Lim, J. C.‐S. , Fong, N. C. E. , & Tan, W. R. (2021). Benefits of occupational therapy activity‐based groups in a Singapore acute psychiatric ward: Participants' perspectives. Occupational Therapy in Mental Health, 37(1), 38–55. 10.1080/0164212X.2021.1874591 [DOI] [Google Scholar]
  32. Ngooi, B. X. , Wong, S. R. , Chen, J. D. , & Yin Koh, V. S. (2022). Exploring the use of activity‐based group therapy in increasing self‐efficacy and subjective well‐being in acute mental health. Hong Kong Journal of Occupational Therapy, 35(1), 52–61. 10.1177/15691861221075798 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Occupational Therapy Australia . (2017). Position paper: Occupational therapy scope of practice framework. Occupational Therapy Australia. https://connect.otaus.com.au/resources/details/051f30a0-1167-4791-8352-33b17a900412 [Google Scholar]
  34. Occupational Therapy Australia . (2019). Royal commission into Victoria's mental health system, Occupational Therapy Australia submission. Occupational Therapy Australia. https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://rcvmhs.archive.royalcommission.vic.gov.au/Occupational_Therapy_Australia.pdf&ved=2ahUKEwibu4LO3PCNAxXksVYBHYVaAxIQFnoECBgQAQ&usg=AOvVaw3zRzcv6Anx1K1rggbKUCAL [Google Scholar]
  35. Occupational Therapy Australia . (2022). Occupational Therapy Australia submission to the mental health select Committee: Inquiry into the opportunities to improve mental health outcomes for Queenslanders. Occupational Therapy Australia. https://otaus.com.au/resources/ota‐submission‐to‐the‐qld‐mental‐health‐select‐committee‐mental‐health‐outcomes‐for‐queenslanders [Google Scholar]
  36. Occupational Therapy Australia . (2025). Mental health occupational therapy capability framework. Occupational Therapy Australia. https://otaus.com.au/resources/mental-health-capability-framework [Google Scholar]
  37. Plastow, N. A. , Joubert, L. , Chotoo, Y. , Nowers, A. , Greeff, M. , Strydom, T. , Theron, M. , & van Niekerk, E. (2018). The immediate effect of African drumming on the mental well‐being of adults with mood disorders: An uncontrolled pretest–posttest pilot study. American Journal of Occupational Therapy, 72(5), 1–6. 10.5014/ajot.2018.021055 [DOI] [PubMed] [Google Scholar]
  38. Pownell, K. , Sarsam, M. , Hannah, K. , Horner, G. , & Villanueva, T. (2023). The acceptability of a recovery group intervention in acute inpatient mental health wards. Community Mental Health Journal, 59, 1275–1282. 10.1007/s10597-023-01110-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Qualtrics . (2024). Qualtrics XM, version 082024 [Computer software]. https://www.qualtrics.com/
  40. Radnitz, A. , Christopher, C. , & Gurayah, T. (2019). Occupational therapy groups as a vehicle to address interpersonal relationship problems: mental health care users' perceptions. South African Journal of Occupational Therapy, 49(2), 4–10. 10.17159/2310-3833/2019/vol49n2a2 [DOI] [Google Scholar]
  41. Ramano, E. M. , de Beer, M. , & Roos, J. L. (2021). The perceptions of adult psychiatric inpatients with major depressive disorder towards occupational therapy activity‐based groups. The South African Journal of Psychiatry, 27, 1612. 10.4102/sajpsychiatry.v27i0.1612 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Ramano, E. M. , de Beer, M. , Roos, J. L. , & Becker, P. J. (2017). A comparison of two occupational therapy group programs on the functioning of patients with major depressive disorders. Minerva Psichiatrica, 58(3), 125–134. 10.23736/S0391-1772.17.01935-5 [DOI] [Google Scholar]
  43. Rice, M. S. , Stein, F. , & Tomlin, G. (2019). Clinical research in occupational therapy (6th ed.). Slack Incorporated. [Google Scholar]
  44. Scanlan, J. N. , & Hazelton, T. (2019). Relationships between job satisfaction, burnout, professional identity and meaningfulness of work activities for occupational therapists working in mental health. Australian Occupational Therapy Journal, 66, 581–590. 10.1111/1440-1630.12596 [DOI] [PubMed] [Google Scholar]
  45. Schofield, M. J. , & Forrester‐Knauss, C. (2016). Surveys and questionnaires in health research. In Liamputtong P., Anderson K., & Bondas T. (Eds.), Research methods in health (3rd ed., pp. 235–256). Oxford University Press. [Google Scholar]
  46. Shetty, R. S. , Kamath, G. B. , Rodrigues, L. L. R. , Nandineni, R. D. , & Shetty, S. R. (2024). The impact of the physical environment on staff in healthcare facilities: A systematic literature review. Buildings, 14(9), 2773. 10.3390/buildings14092773 [DOI] [Google Scholar]
  47. Skaltsi, P. , Konstantinou, G. , Papagathangelou, M. , Angelopoulos, E. , & Papageorgiou, C. C. (2021). The role of occupational therapy within an acute mental health setting: A naturalistic cohort study. Psychiatric Annals, 51(3), 131–139. 10.3928/00485713-20210207-01 [DOI] [Google Scholar]
  48. Stanley, M. (2023). Qualitative descriptive: A very good place to start. In Nayar S. & Stanley M. (Eds.), Qualitative research methodologies for occupational science and occupational therapy (2nd ed., pp. 52–67). Taylor & Francis Group. [Google Scholar]
  49. Taylor, R. R. , Bowyer, P. , & Fisher, G. (2024). Kielhofner's model of human occupation: Theory and application (6th ed.). Wolters Kluwer. [Google Scholar]
  50. Versitano, S. , Butler, G. , & Perkes, I. (2024). Art and other group therapies with adolescents in inpatient mental health care. International Journal of Art Therapy, 29(2), 80–87. 10.1080/17454832.2023.2217891 [DOI] [Google Scholar]
  51. Walder, K. , Bissett, M. , Molineaux, M. , & Whiteford, G. (2022). Understanding professional identity in occupational therapy: A scoping review. Scandinavian Journal of Occupational Therapy, 29(3), 175–197. 10.1080/11038128.2021.1974548 [DOI] [PubMed] [Google Scholar]
  52. Wang, X. , & Cheng, Z. (2020). Cross‐sectional studies: Strengths, weaknesses, and recommendations. Chest, 158, S65–S71. 10.1016/j.chest.2020.03.012 [DOI] [PubMed] [Google Scholar]
  53. Wright, L. , Meredith, P. , & Bennett, S. (2022). Sensory approaches in psychiatric units: Patterns and influences of use in one Australian health region. Australian Occupational Therapy Journal, 69(5), 559–573. 10.1111/1440-1630.12813 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Yan, W. , Ohlsen, S. , & Wood, E. (2025). Factors affecting retention of occupational therapists in adult mental health service: A systematic review with narrative synthesis. British Journal of Occupational Therapy, 88(2), 70–84. 10.1177/0308022624128 [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Zoom Video Communications . (2024). Zoom, version 5.17.7 [Computer software]. https//zoom.us

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