This month, Hospital Capsules was
written by Elizabeth P. Ridgeway, O.T.R., occupational therapy
consultant for the Bureau of Mental Health, Department of Welfare,
Pennsylvania has created 277 jobs
for recreation personnel in its state mental hospitals. How
did this come about? Because of:
- Fifty thousand patients in the
state mental hospitals who need recreation, not only as a human
right, but as a means of recovery.
- An occupational therapist, employed
in the department of welfare, who was convinced of the vital
necessity of such activities, who knew state hospital conditions
and personnel needed it.
- A departmental committee on patient
activity which studied the potential of therapeutically oriented
patient activities, as well as the problems which interfere
with their effective use, and made personnel recommendations.
- A citizen mental health organization
which has developed public opinion to the point where it is
impolite to oppose mental health appropriations.
- A secretary of welfare who is
dedicated to the improvement of mental hospitals and is an effective
politician; a governor with the courage to stake his political
life on the necessity of adequate mental health appropriations;
and a legislature with the statesmanship to place mental health
The patients are, of course, the
vital reason for the program. Without the awareness that life
can be a rewarding experience, no patient will make the tremendous
effort necessary to recovery. The central question in developing
the treatment program was: “What activity experiences
does this patient need in order to grow?” And recreation
always was part of the answer.
The occupational therapist acted
on the principle that any activity was beneficial if in the
hands of a mature person with a capacity for establishing patient
relationships. Suitable staff people were selected and a program
developed in accordance with their skills. The result was a
program predominantly recreational, and its success proved the
vital place of recreation in a psychiatric setting. As the program
grew, it was decided that it could not be administered successfully
without division heads—separate persons to head the recreation,
occupational therapy, industry, and volunteer services. At the
same time, it was essential these services be integrated.
The committee on patient activities,
made up of clinical directors, nurses, and activity department
heads, has been a major support and resource. The committee
studied problems, collected data, considered policies, listened
to reports, investigated what has been done in other states;
it helped spread concepts and supported new policies.
Within the department of welfare
and the bureau of mental health, the climate has been conducive
to the development of patient-centered activity policies. In
the process of policy development one of the most difficult
decisions concerned preparation required of recreation personnel.
While much can be accomplished by lay personnel (in fact their
psychiatric naiveté has positive value at some points),
there are important values in having psychiatrically trained
recreation workers at key points. This was provided by the creation
of the position of activity therapist with a specialty in recreation,
music, art, and so on. A board review has been set to consider
criteria and evaluate preparation of each candidate. A knowledge
of psychodynamics and of the differential therapeutics of activities
will be expected of persons qualifying for these positions.
The recreation leader position (activity instructor), however,
requires recreation skills only. There will always be a place
for workers in this category; the specially qualified therapist
should be reserved for special treatment situations or supervision.
The most serious compromise made
in classification was in not requiring the recreation supervisor
to qualify as a recreation therapist. This compromise was made
realistically in order to obtain the very real values offered
by experienced hospital recreation workers.
Dual preparation requirements (clinical
as well as professional recreation subjects) create many problems
in the educational area. An educational procedure proposed and
discussed in psychiatric circles is the establishment of a core
curriculum consisting of clinical subjects to be the same for
all activities personnel, with specialized electives in art,
music, social recreation, crafts, and so on. This would take
the place of the present curriculum in occupational therapy
and music therapy and would produce persons qualified for staff
positions in all activity therapies. Additional preparation
would be indicated for supervisory positions in any specialty
or for coordinators.
You in professional recreation
are now undergoing the establishment of your own standards in
hospital recreation. We urge you to consider joining together
with other professional disciplines in establishing such a core
curriculum, for personnel so educated would better meet patients’