Occupational Therapy in Mental Health

Occupational therapy (OT) helps people participate in the daily activities that matter most to them when a health condition, injury, or life circumstance makes this difficult.

Mental health occupational therapy (sometimes called behavioral health OT) is a core and essential practice area of occupational therapy.

All occupational therapists are trained in mental health assessment and intervention as part of their professional education. Mental health OT focuses on using meaningful, real-life activities—such as routines, self-care, work, relationships, and leisure—to support emotional well-being and help people manage the day-to-day impact of mental health conditions.

Mental health OT may be a dedicated specialty practice area, or it may be integrated into occupational therapy services across nearly all settings—from hospitals and schools to outpatient clinics and community programs. Because mental health affects how people function in every aspect of daily life, occupational therapy’s role in mental health is both broad and foundational.

You may have found this article because you or a loved one has been referred to a mental health occupational therapist, or because you are considering this practice area yourself. Either way, this guide is designed to answer common questions about what mental health occupational therapy is, how occupational therapy professionals are trained to provide this care, and why this work is so vital.

What mental health training do OTs receive?

While some occupational therapists and OT assistants specialize in providing mental health care, all OTs receive training in mental health approaches as part of their education. In the United States alone, this represents a skilled workforce of approximately 250,000 clinicians with foundational mental health training.

In accredited OT graduate programs, students complete coursework in psychology, psychopathology, therapeutic use of self, group dynamics, and evidence-based mental health interventions, alongside their training in assessment, clinical reasoning, and trauma-informed care.

Even outside of traditional mental health settings, occupational therapists are well equipped to support the emotional side of recovery. This might look like helping patients manage stress, build coping strategies, and maintain roles and routines that support overall well-being alongside their physical recovery.

After graduation and licensure, OTs may further develop their mental health expertise through post-professional certifications and continuing education, like those in sensory processing, cognitive-behavioral approaches, trauma-informed care, motivational interviewing, and substance use recovery.

Find a mental health OT near you

One of the most tangile ways to learn about mental health OT is to learn about the providers near you. You can use the OT Directory below to find a mental health OT in your area. See our full OT directory here.

Mental health OT settings

Occupational therapists work among interdisciplinary teams in a variety of settings to provide mental health treatment. These are some of the most common settings where you might find an OT providing mental health care.

Inpatient Psychiatric Hospitals

In psychiatric hospitals, OTs primarily work with patients in a group setting to develop life skills, support healthy routines, and provide opportunities for meaningful occupational engagement during admission. Groups might include arts and crafts, movement activities, or group games, along with education. Patients in these settings may be dealing with severe mental health crises, such as major depression, psychosis, or suicidality, so safety and stabilization is the primary goal.

OTs work closely with psychiatrists, mental health counselors, nurses, social workers, and teachers to coordinate therapeutic programming focused on building coping skills, establishing safety, and preparing patients to successfully return home. See our guide on types of therapists to understand OTs unique role amongst all therapists.

Outpatient Mental Health Clinics

In outpatient clinics, including partial hospitalization programs (PHP) and intensive outpatient programs (IOP), OTs work with clients to maintain stability in their daily lives. Therapy often focuses on easing the transition back into the community, building work-related skills, and strengthening daily life skills like stress management and maintaining healthy habits.

Community Wellness Programs

Occupational therapists may also support mental wellness for individuals, families, and communities as part of transitional housing programs, community re-entry programs, community day-treatment settings and community wellness programs.

Non-Psychiatric Settings

OTs in acute care settings may address emotional regulation, coping, and functional needs as a part of patients’ overall medical recovery and discharge planning, even if their primary concern is not a mental health condition. For example, an OT might teach a hospitalized child breathing and grounding techniques to manage anxiety before a procedure, or set goals to help an adult patient return to meaningful roles that promote their overall wellness.

What does an OT mental health evaluation entail?

A mental health occupational therapist looks at how a person’s mental health affects their ability to participate in daily life. An evaluation typically includes creating an occupational profile, which helps your OT get to know your roles, routines, interests, strengths and goals for treatment.

Along with observation and interview, your OT may use a mix of formal and informal assessments to better understand your current symptoms, support systems, and environment. All of this helps guide a treatment plan that’s centered on helping you get back to doing what matters most to you.

OT Mental Health Assessments

Here is a list of the standardized and non-standardized assessments a common in mental health settings (this gives you an idea of the specific areas OTs may look at related to how mental health shows up in everyday life):

Daily Activities and Social Participation

• The Occupational Profile

• Canadian Occupational Performance Measure (COPM)

• The Short Child Occupational Profile (SCOPE)

• The Occupational Self Assessment (OSA)

• Child Occupational Self Assessment (COSA)

Sleep

• Pittsburgh Sleep Quality Index

• Children’s Sleep Habits Questionnaire (CSHQ)

Mental Health Factors

• Beck Anxiety Inventory (BAI)

• Beck Depression Inventory (BDI)

• General Anxiety Disorder Assessment - 7 item (GAD-7)

• Patient Health Questionnaire (PHQ-9)

• Social Functioning Questionnaire (SFQ)

• World Health Organization Well-Being Index (WHO-5)

Cognition/ Executive Functioning

• Allen Cognitive Level Screen

• Behavior Rating Inventory of Executive Function (BRIEF)

• Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2)

• Saint Louis University Mental Status Examination (SLUMS)

Sensory Processing

• Sensory Processing Measure (SPM)

• Sensory Profile™ 2

After the evaluation, your OT will work with you to set actionable goals for treatment. Therapy is most effective when you are motivated to reach your goals, so OT evaluations tend to be highly collaborative and client-centered.

What does mental health OT treatment entail?

Mental health occupational therapy is a function-centered approach to mental health care. Rather than focusing solely on symptom reduction, occupational therapy addresses how mental health conditions affect a person’s ability to participate in daily life — and helps people build the skills, routines, and environments needed to support recovery, well-being, and meaningful participation.

Core elements of mental health OT treatment include:

1. Activity- and occupation-based interventions
Occupational therapists use real-world, meaningful activities — such as self-care tasks, work routines, leisure pursuits, and social participation — as therapeutic tools. In adult psychiatric inpatient settings, activity-based occupational therapy groups are associated with improved participation and mood outcomes.

2. Addressing lifestyle medicine pillars through daily habits and routines
Occupational therapy treatment naturally incorporates core lifestyle medicine domains — including sleep, physical activity, stress regulation, and social connection — because these factors directly influence daily functioning and mental health. For example, research in occupational therapy practice underscores that disruptions in daily routines (especially sleep–wake cycles) are linked to poorer mental health outcomes, and that routine-based interventions can improve sleep and balance in everyday life.

This principle is explored further in OT Potential’s podcast episodes on pediatric sleep and occupational therapy and mental health & sleep, which highlight how OTs use routines, environmental support, and activity design to support both sleep and emotional well-being.

3. Psychosocial and psychoeducational interventions
Occupational therapy commonly includes social skills training, coping strategy development, emotion regulation practice, and psychoeducation delivered through meaningful activity, both individually and in groups. Research consistently shows that psychosocial intervention is one of the most investigated OT intervention types for people with serious mental illness, often delivered alongside cognitive and exercise-focused components.

4. Collaborative goal setting and client-centered care
OT treatment is inherently client-centered: goals are developed collaboratively based on the individual’s values, roles, and priorities. Client-centered occupational therapy has been shown to reduce depression, anxiety, and stress in older adults while enhancing daily functioning and participation, demonstrating the clinical value of tailoring therapy to what matters most to each person.

5. Bridging medical and behavioral health care
Occupational therapists are trained to integrate understanding of both medical and behavioral health factors into care, enabling them to support individuals whose mental health needs overlap with physical, neurological, or chronic health conditions. This biopsychosocial lens allows OTs to collaborate with interdisciplinary teams — including physicians, neurologists, psychiatrists, and counselors — and to design interventions that simultaneously address emotional well-being and functional impact.

For example, experiences of depression are common in neurodegenerative conditions like dementia and Parkinson’s disease, where symptoms arise from both neurological change and psychosocial stressors. Occupational therapists address this intersection by adapting environments and routines while promoting engagement in meaningful activity — themes explored in the OT Potential episode OT and Depression in Neurodegenerative Diseases.

Why payers should care: When occupational therapy is well-integrated across the care continuum — including discharge planning and community support — it supports early intervention and functional recovery, which research links to reduced work absence and healthcare utilization.

How are OTs different than other mental health providers?

When you think about mental health treatment, you might imagine psychiatrists prescribing medications or counselors providing “talk” therapy. So where does occupational therapy fit into a mental health treatment team?

While “talk” therapy uses therapeutic conversation to help people process, understand, and change their thoughts and behaviors, occupational therapists practice through doing—helping clients put those skills to work to promote function and performance in everyday life.

For example, a talk therapist might help someone identify stressors and understand patterns behind their anxiety, while an OT might help that person build a morning routine that reduces overwhelm, practice coping skills during work or self-care tasks, or modify an environment to better support regulation and focus.

OTs often work in tandem with other mental health care providers to provide coordinated and well-rounded care. You can learn more about different types of therapy and therapists here.

The rich history of OT and mental health care

While mental health is now a relatively small practice area in occupational therapy, the OT profession was actually born out of the need for humane and person-centered mental health care for U.S. Soliders returning home in the early 1900s.

OTs believed then that meaningful activities, like arts and crafts, handiwork, and daily routines, could support recovery by helping patients feel purposeful and engaged. At a time when psychiatric institutions were notorious for poor living conditions, this approach was radical—and effective.

The role of OT in mental health has changed over the past century, but that core belief remains the same: participating in meaningful occupations is transformative, and can play a powerful role in supporting mental health.

Trends in mental health OT

One of the most consequential trends shaping mental health occupational therapy today is inconsistent recognition by payers and mental health systems.

In some states and practice settings, occupational therapy is clearly included in statutes and regulations defining who can provide licensed mental health services. In others, occupational therapy professionals are excluded—or their role is left ambiguous—despite formal training in mental health assessment, intervention, and functional recovery. As a result, OTs may be required members of mental health teams in some environments, while being ineligible for reimbursement or formal recognition in others.

This inconsistency is not just a professional challenge—it is a system-level problem. The article “Occupational therapy: A potential solution to the behavioral health workforce shortage” shows that excluding occupational therapy from mental health reimbursement frameworks limits access to care and underutilizes a workforce of more than 250,000 trained occupational therapy professionals in the United States who are already equipped to support mental health through daily life participation, routines, and recovery-oriented care.

At a societal level, this misalignment matters. Mental health needs continue to outpace available services, particularly in schools, community settings, and underserved populations. When occupational therapy is excluded from payer recognition—especially within Medicaid programs—it creates barriers to early intervention and prevention, increasing reliance on higher-cost, crisis-driven care.

In response, dOT advocates are working hard to pass the Occupational Therapy Mental Health Parity Act, which would expand Medicaid coverage to allow OTs to provide more mental health and behavioral health services in schools, communities and beyond.

Resources for mental health OTs

Phew! We’ve covered a lot of the essentials about mental health OT, but there is always still more to learn! So, we will leave you with some resources for further exploration:

Articles and Statements by the AOTA on mental health OT:

• Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice

• Mental Health Special Interest Section

• Occupational Therapy in Acute Mental Health: A Closer Look

• Addressing self-stigma in mental health treatment

• Occupational therapy addressing mental & behavioral health in non-psychiatric settings

Resources for interventions: 

• AOTA School Mental Health Toolkit

• AOTA Practice Guidelines for Adults Living With Serious Mental Illness

• AOTA Mental health needs of transgender & gender diverse individuals Toolkit

• Back Pocket Curriculum (Teens)

• SAMHSA Evidence-Based Practices Resource Center

• Motivational Interviewing

Related books for OTs, clients and caregivers

• The Anxious Generation

• Behind Their Screens: What Teens Are Facing (and Adults Are Missing)

• Connections Over Compliance

• Parenting with Love and Logic

• The “How to Talk” Series

• The Power of Showing Up

• Trauma-Responsive Pedagogy

• The Whole-Brain Child

Conclusion

Mental health occupational therapy is essential, effective, and too often overlooked.

We hope this article helped make its value clear. If you have questions, ask them below—and if you believe in expanding access to meaningful, function-focused mental health care, we invite you to join us in advocating for mental health OT.