This is a lecture which explores the relationship between everyday occupations, health and well-being. The need for an underpinning theory-base for occupational therapy is presented.

1. Occupation, health and well-being Jackie Taylor October 2011

2. Dr Jackie Taylor: Occupation, Health and Well-being 2 Aims To consider why occupational science is important for occupational therapy To examine the concepts of occupation, health and well-being To explore an occupational perspective on the health and well-being of individuals and communities

3. Dr Jackie Taylor: Occupation, Health and Well-being 3 We have a problem! At some point, occupational therapy lost its way And we keep having identity crises The profession, each service, each individual has to tackle this Or I suppose we could choose to stay lost!

4. Dr Jackie Taylor: Occupation, Health and Well-being 4 The occupational therapist’s dilemma A conflict between 2 paradigms Shall we view people as mechanistic bundles of joints, chemicals and neurones? Then we can help them by manipulation, control and the use of techniques Shall we view people as whole, complex beings-in-context, who have the ability to grow? Then we can work with them as partners to facilitate their growth

5. Dr Jackie Taylor: Occupation, Health and Well-being 5 Our problem Alignment with the medical model? Why did / do we do that? Psychological models? Do we still do this? Social models? Physiotherapy Models? Nursing Models? Practitioners, educators, researchers

6. Dr Jackie Taylor: Occupation, Health and Well-being 6 ‘don’t focus on defining roles, define our principles’ Whiteford, 2004 And demonstrate them to others. . . .

7. Dr Jackie Taylor: Occupation, Health and Well-being 7 What is an occupation? Exercise Answer this question!

8. Dr Jackie Taylor: Occupation, Health and Well-being 8 What is an occupation? ‘chunks of activity within the ongoing stream of human behaviour which are named in the lexicon of the culture’(Yerxa, 1989, p5). ‘An activity or group of activities that engages a person in everyday life, has personal meaning and provides structure to time. Occupations are seen by the individual as part of his / her identity and may be categorised as self care, productivity and / or leisure.’ (Creek, 2006, p205). Doing, being, becoming and belonging (Wilcock, 2006)

9. Dr Jackie Taylor: Occupation, Health and Well-being 9 Some characteristics of an occupation Have meaning and purpose to the individual performing them They also have sociocultural meaning They fill and structure time Tend to be grouped according to purpose: leisure, productivity, self-care Support roles and participation in society Contribute to an individual’s sense of identity

10. Dr Jackie Taylor: Occupation, Health and Well-being 10 What is health? WHO definition ‘a state of complete physical, mental and social well-being, not merely the absence of disease and infirmity’ A multi-dimensional concept People may define it differently according to gender, life-stage, culture

11. Dr Jackie Taylor: Occupation, Health and Well-being 11 Health . . . A reserve to combat problems? Behaviour aimed at healthy lifestyle? Physical fitness? Energy and vitality? Social relationships? Being able to function? Psychosocial well-being?

12. Well-being . . . Physical well-being Mental well-being Social well-being Community well-being All of these can be described occupationally (Wilcock) Dr Jackie Taylor: Occupation, Health and Well-being 12

13. Dr Jackie Taylor: Occupation, Health and Well-being 13 Well-being in the UK 14% have a high level of well-being (‘flourishing’) 14% very low (not including those with a mental health problem) (Huppert, 2008, Mental capital and well-being project)

14. Dr Jackie Taylor: Occupation, Health and Well-being 14 5 ways to well-being. . . Connect – with family, friends, community Be active Take notice – be curious, catch sight of the beautiful, remark on things, savour the moment Keep learning - try something new, rediscover an old interest, set a challenge Give – do something nice for someone, look outwards as well as inwards

15. Dr Jackie Taylor: Occupation, Health and Well-being 15 From ‘Five ways to well-being’ (New Economics Foundation Centre for Well-being, 2009)

16. Dr Jackie Taylor: Occupation, Health and Well-being 16 Did you do your 5 yesterday? Exercise Yesterday – did you Connect Be active Take notice Keep learning Give?

17. Dr Jackie Taylor: Occupation, Health and Well-being 17 Occupational well-being Doble and Caron Santha (2008) We should shift some of our attention away from occupational performance to subjective experience of occupation. 5 critical issues in the literature about occupation in last 20 years ICF 2001 and emphasis on participation Wilcock's doing, being, becoming and belonging people compose or orchestrate their occupational lives a balance of occupations is beneficial to health and well-being the construct of meaning has been developed

18. Dr Jackie Taylor: Occupation, Health and Well-being 18 Occupational well-being A framework for the concept of occupational well-being. 7 occupational needs: Accomplishment Affirmation (Recognition of value from others and self) Agency (Perception of having control) Coherence (Continuity, connection, identity) Companionship Pleasure Renewal (Inner peace, refreshed, re-energised)

19. Dr Jackie Taylor: Occupation, Health and Well-being 19 Health defined occupationally Wilcock (1998) Absence of illness but not necessarily disability A balance of physical, mental and social well-being attained through socially valued and individually meaningful occupation Enhancement of capacity and opportunity to strive for individual potential Community cohesion and opportunity Social integration, support and justice, all within and as part of a sustainable ecology

20. Dr Jackie Taylor: Occupation, Health and Well-being 20 Does occupation contribute to health and well-being? Literature review of 22 studies showed moderate to strong evidence that occupation has an important influence on health and well-being (Law et al 1998) A quantitative study of 120 participants showed a positive correlation between perceived progress in completing personal projects (meaningful occupations) and well-being (Christiansen et al, 1999)

21. Dr Jackie Taylor: Occupation, Health and Well-being 21 The idea of occupational balance What is this? Work-life balance? Is it about allocating the right amount of time to the right kind of occupations? Is it about treading a fine line between order / chaos, health / illness, happiness / sadness? Is it about adding the right ingredients to life?

22. Dr Jackie Taylor: Occupation, Health and Well-being 22 Pentland and McColl, 2008 If we get bogged down trying to find the right configuration, we might not take risks, or do new things Maybe balance and well-being are achieved by an occupational life consistent with one’s values Connect us with our childhood, and culture Disturbed when occupational life is disconnected from values, perhaps when we conform Occupational integrity

23. Dr Jackie Taylor: Occupation, Health and Well-being 23 Some suggested reading Doble, S. E., & Caron Santha, J. (2008). Occupational well-being: rethinking occupational outcomes. Canadian Journal of Occupational Therapy, 75(3), 184-190. Kramer, P., Hinojosa, J., & Royeen, C. B. (Eds.). (2003). Perspectives in human occupation: participation in life. Baltimore: Lippincott, Williams & Wilkins. Kronenberg, F. K., Algado, S. S., & Pollard, N. (Eds.). (2005). Occupational therapy without borders: learning from the spirit of survivors. Edinburgh: Elsevier Churchill Livingstone. Molineux, M. (2004). Occupation for occupational therapists. Oxford: Blackwell Publishing. Schwartz, K. B. (2003). History of occupation. In P. Kramer, J. Hinojosa & C. B. Royeen (Eds.), Perspectives in human occupation: participation in life (pp. 18-31). Baltimore: Lippincott, Williams & Wilkins. Wilcock, A. A. (2006). An occupational perspective of health. Thorofare, NJ: Slack Incorporated.