Impact of Occupational Therapy on the Global Burden Of Mental and Substance Use Disorders

The burden of mental and substance use disorders exists globally whether reported or not. According to many global surveys and longitudinal studies, populations with mental and substance use disorders contribute to a larger burden of diseases than any other communicable or non-communicable disease worldwide due to the limited accessibility and availability of services (Mannelli & Wu, 2019; Degenhardt et al., 2018; Erskine et al., 2015; Whiteford et al., 2013). Globally, one in six people who suffer from a substance use disorder receive treatment each year without distinguishing economic or social factors related to services (Whiteford, Ferrari, & Degenardt, 2016; Erskine et al., 2015; Mannelli & Wu, 2019). Based on various Global Burden of Disease (GBD) studies, the burden of mental and substance use disorders have increased by 37.6% between 1990 and 2010 due to the increase of population growth and aging (Whiteford, Ferrari, & Degendardt, 2016). Nonetheless, the individuals diagnosed with mental and substance use disorders are not the only ones affected by this global burden but also the families, friends, corporations, and healthcare workers who require greater support (Merikangas & McClair, 2012). The profession of occupational therapy identifies drug use as an occupation, acknowledges the injustices formed around dysfunction, and addresses the various contexts that constrain people from participating in a meaningful, healthy lifestyle (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019).

The prevalence of mental and substance use disorders vary significantly across countries with clear differences geographically, culturally, socially, politically, and economically hindering the accessibility and availability of services (Degenhardt et al., 2018; Merikangas & McClair, 2012). Although mental and substance use disorders critically vary among environmental and contextual factors, the research for effective treatments and programming has been scarce when accounting for the causal-temporal relationship (Merikangas & McClair, 2012). Many epidemiological studies have identified a global need to improve disease education, advance prevention and treatment protocols, and promote awareness while reducing stigma, but outstanding barriers restrict healthcare services from reaching optimal, cost-effective practices to populations in need (Mannelli & Wu, 2019; Degenhardt et al., 2018). The priority must focus on reducing costs and increasing long-term availability and accessibility of treatment to larger populations with mental and substance use disorders (Mannelli & Wu, 2019). Despite the personal and economic costs, the treatment rates for people with mental and substance use disorders are low, with treatment gaps of more than 90% in developing countries (Whiteford et al., 2013). The combination of stigma about mental and substance use disorders and the vast treatment gaps constrain the use of available resources, even in high income countries where a higher proportion of health budgets are spent to address these issues (Whiteford et al., 2013; Degenhardt et al., 2018). The density of international data on drug use patterns has highlighted the universal nature of substance abuse and the impact of untreated mental illness in the community (Merikangas & McClair, 2012; Whiteford, Ferrari, & Degendardt, 2016). The emergent awareness of a client-centered approach aims to direct quality individualized care to diminish practices that create barriers to treatment access and continued care (Mannelli & Wu, 2019). Many factors, both directly and indirectly, hinder the healthcare needs unmet for populations experiencing mental and substance use disorders globally where occupational therapy practitioners may ameliorate healthcare services (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019).

People engaged in and recovering from drug addiction encounter concerns with occupational participation and require services emphasizing environmental supports, integrative care, and the promotion of meaningful alternatives to replace drug-based affiliations (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). The needs of clients with mental and substance use disorders are vast and vulnerable to setback to aversive routines if not addressed with a structural and meaningful approach (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapists cannot overlook drug use as a risky occupation that exposes individuals to injustices such as alienation, imbalance, deprivation, and discrimination (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Instead, occupational therapy’s unique practice acknowledges the holistic perspective of populations with chronic health conditions and addresses these dimensions during evaluation, intervention, and outcome measurement based on a client-centered approach (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapists manage their clients’ needs by conforming to roles that achieve client-centered outcomes and functionality (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). An occupational therapist may explore the political and financial opportunities for clients with mental and substance use disorders by advocating for quality, cost-effective care based on their clients’ values (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapists may play the role of a facilitator by identifying and reducing obstacles within physical and social environments as well as educating or coaching the client about the impact of cultural, personal, temporal, and virtual contexts (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapy practitioners are strategically positioned to work in various settings and establish interprofessional collaboration and partnership with organizations (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). The goal of interprofessional collaboration and partnership focuses on facilitating effective intervention and programming for individuals, groups, and communities (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapy may direct interventions for mental and substance use disorder populations to alter educational trajectory, social participation, vocational attribution, familial responsibilities, and adaptive functioning (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). The distinctive and wholesome practice of occupational therapy promotes specialized, cost-effective care accustomed to clients’ value-based needs across contexts and supports the opportunity to reduce the burden of mental and substance use disorders worldwide (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019; Mannelli & Wu, 2019).

The unmet healthcare needs of people with mental and substance use disorders contributes to a global burden across all countries (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019; Mannelli & Wu, 2019). Many contextual factors restrict the availability and accessibility of healthcare services required by vast populations to thrive (Merikangas & McClair, 2012). The current healthcare services do not address the basic needs of people with mental and substance use disorders to relieve global burden and other attributable diseases (Mannelli & Wu, 2019; Degenhardt et al., 2018; Merikangas & McClair, 2012). The profession of occupational therapy offers unique services by addressing the needs and values of people with mental and substance use disorders (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapy focuses on a client-centered approach and navigates clients around contextual barriers through a holistic perspective (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapists promote health and wellness for people with mental and substance use disorders by conforming to role in support of their clients’ needs (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Although occupational therapists do not frequently work with this population, their specialized skillsets encourage structured routines and alternative activities from aversive behaviors elicited from substance use (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). The implementation of occupational therapy services worldwide can minimize the global burden of mental and substance use disorders and other attributable conditions (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019).

References

• Degenhardt et al. (2018). The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 5, 987-1012. http://dx.doi.org/10.1016/S2215-0366(18)30337-7.
• Erskine, H. E., Moffitt, T. E., Copeland, W. E., Costello, E. J., Ferrair, A. J., Patton, G., Degenhardt, L., Vos, T., Whiteford, H. A., & Scott, J. G. (2015). A heavy burden on young minds: The global burden of mental and substance use disorders in children and youth. Journal of Psychological Medicine. 45(7), 1551-1563. https://www.doi.org/10.1017/S0033291714002888.
• Mannelli, P. & Wu, L. (2019). Clinical epidemiology of substance use disorders: Understanding patterns, sharing knowledge, planning interventions. Indian Journal of Medical Research. 149, 443-445. https://www.doi.org/10.4103/ijmr.IJMR_3_19.
• Merikangas, K. R. & McClair, V. L. (2012). Epidemiology of substance use disorders. Journal of Human Genetics. 131(6), 779-789. https://www.doi.org/10.1007/s00439-012-1168-0.
• Sy, M. P., Delos Reyes, R. C., Roraldo, P., & Ohshima, N. (2019). Uncovering the lived experiences of Filipino drug recoverees towards occupational participation and justice through an interpretative phenomenological analysis. Scandinavian Journal of Occupational Therapy. https://doi.org/10.1080/11038128.2019.1642380.
• Whiteford, H., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., Burstein, R., Murray, C., & Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. The Lancet. 382, 1575-1586. http://dx.doi.org/10.1016/S0140-6736(13)61611-6.
• Whiteford, H., Ferrari, A., & Degenhardt, L. (2016). Global burden of disease studies: Implications for mental and substance use disorders. Health Affairs. 35(6), 1114-1120. https://www.doi.org/10.1377/hlthaff.2016.0082.