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The aim of this module following your first practice placement explores the different factors (social, cultural, environmental and personal) that influence participation in human occupation. You will explore the various barriers and enablers to participation that individuals encounter and the relationship between participation and health and wellbeing.

Choose one of the listed stories highlighted below.  Using the Contexts of Participation tool and linking in to the module content, write an essay answering the following question:

How was the person’s participation in occupations promoted or limited by the interaction between the personal, local, social and national factors evident in your story?  What are the actual or potential effects on the person’s health and well-being?

Reflect critically on how this (whole) module has and will contribute to your development as an occupational therapist.  In particular, how you might apply what you have learned to inform your role as facilitating participation in occupations?

A critical reflection ‘facilitates an understanding of one’s own perception of the situation as well as an examination of the underlying assumptions’ (Brunt 2005)

Factors Influencing Participation in Human Occupation

Occupational therapy is a process of treatment that helps a person to participate in the human occupation that they want to do by using daily activities (Taylor 2017). It is the duty of an occupational therapist to assist people in order to recover injury to regain skills, disability to perform in social activities and other cognitive challenges. Through a psychotherapy or individual evaluation the occupational therapist tries to determine the goal of the person (Upton et al. 2014). They provide effective interventions to help the person in order to achieve the goal. The focus of the essay is to understand the story of a person suffering from schizophrenia and discuss various social, cultural, economical and personal factors that influence the participation of a person in human occupation. The patient in this case has suffered from schizophrenia since the college time. The main problem is, she heard a voice of a lady that narrated the daily activities of the patient, for example, if she was going to attend a lecture the voice narrated it like she is going to a lecture, but when she tried to find the lady she could not find anyone.  Such things made her afraid and with increasing illness she started to ignore communicating with friends and society. Then she decided to take help of a psychiatrist and gather knowledge to counter the issue. The paper will provide a brief idea about the relevant social, cultural, economical and personal factors that has created barriers or enablers for the person in order to participate in human occupation and the effect of the illness on the health and well-being of the person.            

Identification of the elements those are relevant to the story regarding socio-cultural values

The critical thinking tool regarding the contexts of participation provides relevant factors that have effect on the person related to participation in human occupation (Thomas and Law 2013). According to the story of schizophrenia, most of the elements of the wheel are relevant to the case considering the socio-cultural value. Daily living activity is one of the important factors in case of schizophrenia. The daily activities like going to college, attending lectures, conversation with the friends and social activities could influence the patient’s condition. Another important element is the local environment. In order to stay in a society it is important to adapt the local environment, otherwise it could affect the living condition of a person and create stress within the person that could trigger the sign of schizophrenia (Wilkinson and Marmot 2003). Economic status of a person is important to consider in the case of schizophrenia, as it is one of the major factor that create pressure and lead to mental distress ((Warner 2013). Education is another factor which is very important for managing the case of schizophrenia, as it provides knowledge about the illness which helps the patient to understand the signs of the illness and motivate them to counter the issue (Bentall 2013). Support network like social support, medical support and family support play an important role in addressing or influencing the issue.  The importance of health and social care is the most important part as it provides effective service in order to treat such illness and without the support of such care service it is impossible to address the issue related to schizophrenia (Tandon et al. 2013).  The additional element is media in the case of schizophrenia it could help to disseminate the important information about schizophrenia so that people could understand the issue related to the illness and avail effective treatment or support a person that is suffering from the illness. Such factors play important role in order to create barriers or enablers for the patient. The positive influence of the element could help the patient to counter the issue in an effective manner, whereas, the negative influence could increase the risk of psychotic symptoms like delusion and hallucination or thought disorder (Frith 2014). 

Barriers to Participation in Human Occupation for a Person with Schizophrenia

The consequence of schizophrenia has destructed the patient to an extent, and then the patient decided to fight with her fear and took move in order to counter the issue. Due to the circumstances she was feeling helpless then she decided to take help f a psychiatrist in order to cure the illness. After suffering from lots of difficulties, discrimination, humiliation and disappointment, she got the help of an experienced psychiatrist, who has helped the patient to resolve the issues related to schizophrenia (Stefansson et al. 2014). The nursing team has helped her to increase her ability to heal. The patient has learned how to turn the violent voice to a positive message. Such turning point in her life has brought positive changes. The nursing professionals have helped her to connect with UK Hearing Voice Network. Such interventions in her life have helped her to cope up with the illness. After that the patient started to collect more articles and books in order to gain knowledge about the illness to create awareness within the community. She has participated in the TED talk in order to share her experience regarding the situation she had faced due to schizophrenia. Such step is difficult to take but it has helped the patient to disseminate the information about the risk factors and consequence if schizophrenia. She has written TED book on her experience that has helped others to understand the consequence of schizophrenia. The patient then again started to attend her college and finally she graduated from British Psychological Society and got the undergraduate award with first class degree. She completed MSc in health Psychology as well. She used to work in the NHS for Early Interventions in psychosis service. In addition she completed PhD, freelance teaching, training, public speaking in order to provide information to the people and help them to address their cognitive problems. Such activities of the patient are valuable in order to cope up with the illness and motivate others to fight with such thought disorders.

The elements of critical thinking tool regarding contexts of participation are correlated to each other in order to create barriers to the participation of the patient in human occupation. As mentioned before that adaptation to local environment is important in order to settle in the society, in this regard, social support is important for the person to connect with the society. Social inequality and humiliation due to the illness create stress within the patient, thus the patient become unfocused and lack the ability to perform daily activities (Swain et al. 2013). The consequence of lacking ability to perform daily activities such as physical activities, disorganization in work, attending college, connecting with people lead to the pressure of unemployment and financial crisis, which in return trigger the sign of the illness thus, the patient lack motivation, feel helpless and fails to participate in the human occupation (Vancampfort et al. 2015). Education is also correlated to the social support and family support that are important in order to encourage the patient to participate in an effective manner. Due to lack of knowledge regarding schizophrenia, people fail to understand the problem of the patient, thus, the patient has to face humiliation and abuse in the society. It affects the thought of the patient and the patient prevent herself to connect with the external environment, thus, become domesticated that increase the risk of psychotic symptoms such as delusion, hallucination and other thought disorders (Cooke 2017). In this way the factors provide negative influence to the participation of the patient and such barriers created by the elements need to be resolved in order to cure the mental distress of the patient in an effective manner.

The Role of Occupational Therapy in Improving Participation in Human Occupation for a Person with Schizophrenia

In order to provide effective care to the patient and help a patient to participate in the human occupation the interaction between the elements of critical thinking tool is important. The most important element regarding this is the service provided by the health care and social care organizations. They are the main source that provides knowledge about the illness in order to create awareness and provide adequate information to the society so that they could provide support to the patient and encourage the patient to participate in the human occupation. Such social and family support enables the patient to interact with the external environment and it could help the patient to reduce the stress (Chien and Chan 2013). Health care service provides effective therapy to help the patient in order to overcome the mental distress and participate effectively in the human occupation. Such help provide improvement to the condition of the patient, thus, enable the patient to carry out daily activities that reduce the pressure of unemployment and financial crisis (Hasan et al. 2013). In addition the involvement of media in the case provides information regarding the illness and effective interventions to counter the issue. Such coordination of the elements enables the patient to participate effectively and achieve the goal.

The main character of the story is interesting. She was suffering from schizophrenia since her college time. The main problem with her is that she used to hear a voice that narrated her daily activities. Such fearful condition started to increase gradually and she started to hear the voice even during sleep. Such thought disorder has affected her personal and social life as well. She has lacked the ability to connect with the people and conduct daily activities. She has started to recognize her as socially isolated. Such condition had severe impact on the patient. The patient became accustomed to the appearance of such voice narrating the daily activities of the patient in the third person as it was unthreatening. The patient always tried to find the voice in order to reassure the presence of the voice. After that the patient started to create emotional connection with the voice and achieved some positive results. She visited to a psychiatrist and admitted in hospital, but the situation become more horrible. She became confused, unhappy and frightened to an extent. The condition became uncontrollable. She started to have some antipsychotic drugs and the side effects of the drugs have increased the level of depression. After such disastrous moment the patient got the help of an experienced psychiatrist and the turning point has brought tremendous changes in her life. The positive step taken by the patient is appreciable. She started to cope up with her illness and join some organization in order to help other people that are suffering from such illness. It provides a positive impact about the character. The patient started to gather knowledge about the illness from various journal and books. Such initiative taken by the patient helps to assume her ability to fight with such severe condition. Her positive thinking and eager to help others has helped her to complete graduation in health psychology. Such shade of the character is encouraging and it provides effective way to manage weakness and turn it into strength.

Conclusion

The consequence of schizophrenia has affected the physical and mental health of the patient to an extent. Due to the illness the patient became unable to attend her college that affects her study and career. The continuous disturbance of the voice made the patient disturbed and anxious. She became moody and started to neglect communication with family and friends group. She started to display negative beliefs in the form of delusion of persecution or grandeur (Boyle 2014). She started to feel controlled by the voice and suffered from mental distress. She started to jump from one content to another during any conversation without any reason that made her erratic to follow.  Such thought disorder known as suspicions or paranoia affected her physical health as well. She lacked the ability to perform daily activities.  She became disorganised in her work, her eating habit got affected and she was suffering from sleeplessness or insomnia. Lack of physical activities resulted in muscle immobility (Lepage, Bodnar and Bowie 2014). Other mental disorder includes poor expression of emotion like she stopped responding in sad or happy moment. Such catatonic behaviour has resulted in psychotic symptoms like hallucination due to which she was suffering from a fear that somebody want to harm her thus prevented herself to participate in the social activities and became isolated and domesticated. She also suffered from some cognitive difficulties like facing problem in remembering something and communication difficulties.  Due to such problem she was taken to a psychiatrist by her friend and admitted in the hospital that made her situation more disastrous. She started to become addicted towards drug thus refused to take medicine provided by the health professionals. The side effects of the drug made her situation more severe. Due to such horrible condition she suffered from mental distress for a long period. Such situation affects the health and well-being of the patient and she started to feel helpless and hopeless as well (Frith 2014).

There are many barriers in the society that increased the risk of the patient and trigger the signs of the illness within the patient. The socio-cultural barriers such as, the humiliation and insult that she had faced in the society had increase her level of stress and she started to neglect connecting with people in the society and prevent herself to participate in the social activities (Cameron 2013). Some childhood trauma was responsible for her condition and other factors that influence the severe condition was her tension regarding study, future, responsibility and relationship. Due to such stress she failed to attend her college that affected her study and career. The barrier related to lack of education or proper information about schizophrenia affected the support network. Due to lack of information the patient failed to recognize he illness and started to ignore it, thus, the illness affects her physical and mental health to an extent. The people of the society started to humiliate her for the illness and her behaviour. Thus, she became domesticated. Such circumstances have played an important role in order to demotivate the patient. Thus she prevented herself from sharing anything with the friends and family and did not express her emotion. Thus, such barriers made the condition more difficult. After suffering from such psychotic disorder and a period of helplessness she decided to fight against such barriers to resolve her issue. The support of her mother and friends that have helped to encourage her to take step in order to treat the illness even after suffering from hospitalization. She has availed the help of health care and the efficient health professionals that has helped her to increase her ability to heal. The knowledge she has gained from her experience and other journals or books has inspired her to study about the illness. The help of media like TED talk programme has helped her to share her experience with others to provide them information regarding schizophrenia and help them to understand the consequence. Through such process she has countered the barriers of social discrimination and provided a message regarding how the enablers have helped her to convert her weakness into strength.

According to the research, only 1% population is suffered from schizophrenia, thus the consequence and factors that could influence the situation of schizophrenia is unknown to most of the people (Bland 2015). Thus it is important to provide value to the ideas of the patient in order to create awareness regarding schizophrenia. In order to understand the condition in depth it is important to done some research about the illness (Jauhar et al. 2014). The research literature would provide details about the factors that are responsible for the occurrence of schizophrenia within a person. It would provide effective interventions in order to cope up with the condition of mental distress (Weiner 2013). The health care and social care service providers need to contribute effectively in order to provide efficient care service to the people with need (French and Swain 2011). It is important to disseminate the importance of occupational therapy in order to cure the illness in an effective manner. Information about proper therapy need to be provided to the individual so that people could avail the treatment process and address the issue of schizophrenia in an effective manner ((Kronenberg 2013). In case of schizophrenia, the patients fail to communicate with friends or family. In order to counter the issue Psychopathology and mood detection therapy is another effective intervention that could help the patients to share their problem with the health professionals. In this way the health professionals could understand the central problem and requirements of the patients and could provide effective treatment in order to cure the illness. The patient could be motivated through such process (Vancampfort et al. 2013). Creating awareness is important in order to control the socio-cultural factors that could trigger the condition of the patient and increase the risk factors. In this regard, media could play an important role in order to provide information to the individual. Involvement of social media could make the process faster (Mitchell, Hollingshead and Coppersmith 2015). In addition, to gather knowledge regarding the illness relevant journals and books could be read. Journal of occupational therapy could help to understand the process of such therapy in resolving the issue of schizophrenia. Books and journal related to schizophrenia could help to understand the issue related to the illness in depth. These are the positive steps that could be taken in order to understand the problems and treatment related to schizophrenia and could help to provide better intervention to counter the issue in an effective manner (Ran et al. 2015).

Conclusion

From the above analysis it can e concluded that, occupational therapist play an important role in order to provide effective care in order to treat the patient with injury, disability and cognitive challenges through participation in the daily activities. The patient in the story was suffering from schizophrenia thus lacked the ability to perform daily activities. The voice she used to hear started to haunt her and due such hallucination she failed to connect with the external environment and became domesticated. There are many factors that influence the condition of the patient. They have both the ability to create barriers and enablers. Such condition has affected the health and well-being of the patient to an extent. The condition has reduced the ability of the patient to participate in the human occupation. However, through effective occupational therapy, social and family support and education related to the illness could help the patient to address the issue. Journal and books related to the illness could help the occupational therapist to introduce innovation in the therapy that could help them to provide service in an effective manner.

Critical reflection is a process to create meaning of an experience. The process of critical reflection helps the students to recognize their mistakes, introduce effective solutions and improve their skill (Rymes 2015). The responsibility of an occupational therapist is to provide treatment to the disabled patients through effective therapeutic utilization of regular activities (Scaffa and Reitz 2013). Thus, it is important for an occupational therapist to reflect on their experience regarding their practice to improve their skill and provide effective care service to the patients. As an occupational therapist I will reflect on one of my experience regarding schizophrenia and provide the contribution of the experience in developing my skill in the following paper. The experience is about the circumstances of a schizophrenia patient. The patient got the illness during college days. The problem with the patient is that she heard a voice of a lady narrating the activities she had been doing like when the patient was going to attend a lecture, she could hear a voice narrating it like she is going to a lecture. The situation became regular to her life and started to haunt her even during sleep, which made her anxious and frighten. She started to avoid meeting with friends, fail to communicate with the society and became domesticated.  The patient had shared that she had faced humiliation that forced her to feel lonely and demotivated. Then the patient had decided to take help of a psychiatrist in order to understand her situation. The psychiatrist had informed her about the consequence of schizophrenia and provided concern that had helped her to understand that due to some stress and childhood traumas she is suffering from such mental distress and ensured that through some occupational therapy she could resolve such issues. After that the patient started to gather knowledge about schizophrenia through articles, books and other medical support in order to counter her issue. The story has encouraged me to an extent and the effort of the patient is inspiring in order to learn the way of managing mental distress like schizophrenia. The experience with the patient has helped me a lot to understand the signs of such illness and factors like stress, past trauma and social deprivation that could trigger the signs within a patient (Lepage, Bodnar and Bowie 2014). The experience had helped me to understand that it is important to provide adequate information to the patient about their illness in order to motivate them to cure such illness (Vohs and Lysaker 2014). The experience has helped me to understand effective way of counselling such patients. At first I was quite surprise after encounter the story as I feel it would happen in movies or stories, thus I failed to understand the situation of the patient. In order to connect with the story I have done some research on schizophrenia to understand the signs and effect of the illness. I have read some journals like British journal of occupational therapy to understand the contribution of such treatment to schizophrenia. Books on disability studies have helped me to recognize the circumstances of schizophrenia. Such research has helped me to develop the paper. In future I would like to encounter some interviews with other patients that are suffering from same illness, as it would help me to understand the consequence of schizophrenia with different perception. Thus, as an occupational therapist, I have decided to include such strategies in my practice in order to improve my skill and establish myself as a successful occupational therapist in future.

References

Bentall, R.P. ed., 2013. Reconstructing schizophrenia. Routledge.

Bland, M., 2015. An introduction to medical statistics. Oxford University Press (UK).

Boyle, M., 2014. Schizophrenia: A scientific delusion?. Routledge.

Cameron, C. ed., 2013. Disability studies: A student's guide. Sage.

Chien, W.T. and Chan, S.W., 2013. The effectiveness of mutual support group intervention for Chinese families of people with schizophrenia: a randomised controlled trial with 24-month follow-up. International journal of nursing studies, 50(10), pp.1326-1340.

Cooke, A., 2017. Understanding psychosis and schizophrenia: why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality… and what can help. British Psychological Society.

French, S. and Swain, J., 2011. Working with disabled people in policy and practice: A social model. Palgrave Macmillan.

Frith, C.D., 2014. The cognitive neuropsychology of schizophrenia. Psychology press.

Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W.F., Thibaut, F., Möller, H.J. and WFSBP Task force on Treatment Guidelines for Schizophrenia, 2013. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. The world journal of biological psychiatry, 14(1), pp.2-44.

Jauhar, S., McKenna, P.J., Radua, J., Fung, E., Salvador, R. and Laws, K.R., 2014. Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. The British Journal of Psychiatry, 204(1), pp.20-29.

Kronenberg, F., 2013. Doing Well-Doing Right Together: A practical wisdom approach to making occupational therapy matter. New Zealand Journal of Occupational Therapy, 60(1), p.24.

Lepage, M., Bodnar, M. and Bowie, C.R., 2014. Neurocognition: clinical and functional outcomes in schizophrenia. The Canadian Journal of Psychiatry, 59(1), pp.5-12.

Mitchell, M., Hollingshead, K. and Coppersmith, G., 2015. Quantifying the language of schizophrenia in social media. In Proceedings of the 2nd workshop on Computational linguistics and clinical psychology: From linguistic signal to clinical reality(pp. 11-20).

Ran, M.S., Chan, C.W., Ng, S.M., Guo, L.T. and Xiang, M.Z., 2015. The effectiveness of psychoeducational family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area. Psychological medicine, 45(10), pp.2197-2204.

Rymes, B., 2015. Classroom discourse analysis: A tool for critical reflection. Routledge.

Scaffa, M.E. and Reitz, S.M., 2013. Occupational therapy community-based practice settings. FA Davis.

Stefansson, H., Meyer-Lindenberg, A., Steinberg, S., Magnusdottir, B., Morgen, K., Arnarsdottir, S., Bjornsdottir, G., Walters, G.B., Jonsdottir, G.A., Doyle, O.M. and Tost, H., 2014. CNVs conferring risk of autism or schizophrenia affect cognition in controls. Nature, 505(7483), p.361.

Swain, J., French, S., Barnes, C. and Thomas, C. eds., 2013. Disabling barriers-enabling environments. Sage.

Tandon, R., Gaebel, W., Barch, D.M., Bustillo, J., Gur, R.E., Heckers, S., Malaspina, D., Owen, M.J., Schultz, S., Tsuang, M. and Van Os, J., 2013. Definition and description of schizophrenia in the DSM-5. Schizophrenia research, 150(1), pp.3-10.

Taylor, R.R., 2017. Kielhofner's Research in Occupational Therapy: Methods of Inquiry for Enhancing Practice. FA Davis.

Thomas, A. and Law, M., 2013. Research utilization and evidence-based practice in occupational therapy: A scoping study. American Journal of Occupational Therapy, 67(4), pp.e55-e65.

Upton, D., Stephens, D., Williams, B. and Scurlock-Evans, L., 2014. Occupational therapists' attitudes, knowledge, and implementation of evidence-based practice: a systematic review of published research. British Journal of Occupational Therapy, 77(1), pp.24-38.

Vancampfort, D., De Hert, M., Stubbs, B., Ward, P.B., Rosenbaum, S., Soundy, A. and Probst, M., 2015. Negative symptoms are associated with lower autonomous motivation towards physical activity in people with schizophrenia. Comprehensive Psychiatry, 56, pp.128-132.

Vancampfort, D., De Hert, M., Vansteenkiste, M., De Herdt, A., Scheewe, T.W., Soundy, A., Stubbs, B. and Probst, M., 2013. The importance of self-determined motivation towards physical activity in patients with schizophrenia. Psychiatry Research, 210(3), pp.812-818.

Vohs, J.L. and Lysaker, P.H., 2014. Metacognitive mastery and intrinsic motivation in schizophrenia. The Journal of nervous and mental disease, 202(1), pp.74-77.

Warner, R., 2013. Recovery from schizophrenia: Psychiatry and political economy. Routledge.

Weiner, I.B., 2013. Psychodiagnosis in schizophrenia. Routledge.

Wilkinson, R.G. and Marmot, M. eds., 2003. Social determinants of health: the solid facts. World Health Organization.

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