Most people would expect - hope - that purposeful activity would be an important element of all forms of mental health care. This is true both in community settings and in residential care. I quoted a short extract from a letter I had received in the introductory chapter, from a man describing his experiences on a psychiatric inpatient ward. This is not at all what residential units should be like. It may indeed be a fantasy, but I can imagine a world in which a day spent in a residential mental health unit would involve practical steps towards health in the form of physical exercise - a trip to a gym or to a swimming pool, perhaps - and purposeful activity during the day; activity that is therapeutic, is geared towards the 'five ways to well-being' and is meaningful to each person. I simply don't think that is too much to ask for.
Work is known to be important in promoting recovery for those who have experienced mental health problems10 but people face major challenges in the employment market.11 Occupational therapy addresses 'the nature, balance, pattern and context of occupations and activities in the lives of individuals, family groups and communities'12 but occupational therapists, like other professions, are also rapidly developing skills in psychological therapies. Like social workers, occupational therapists also have a particular focus on issues of social inclusion, with many people reporting a dearth of meaningful, therapeutic, purposeful activity in mental health care; something many people equate to an over-reliance on medical approaches. Occupational therapy - again perhaps with a more appropriate name, and again perhaps with shades of 'social pedagogy' - should be central to psychosocial services.