Addressing Functional Cognition During Acute Psychiatric Hospitalization

Abstract

Serious mental illness (SMI) often presents with cognitive impairments that significantly impact occupational performance and quality of life. Occupational therapists (OTs) possess the training to address functional cognition, yet their role in acute psychiatric settings remains underdeveloped and ambiguous. This doctoral capstone project aimed to identify and implement evidence-based OT assessments and interventions to address functional cognition among inpatients with SMI at Eskenazi Health’s Mental Health Recovery Center (MHRC). Guided by an integrated Occupational Adaptation (OA) and Metacognitive Reflection and Insight Therapy (MERIT) framework, the student conducted a narrative review and synthesized findings into clinical practice over a 14-week experience. Weekly field notes outlining treatment approaches informed a discussion of practice implications in the context of evidence-based findings. Outcome measures were implemented to assess metacognition, insight, and judgment, while occupation-based interventions were used to improve participation and well-being through the development of metacognitive awareness, self-reflection, executive functioning, and social cognition. Results support the inclusion of functional cognitive assessment and intervention in acute psychiatric OT services and highlight the value of metacognitive and occupation-based approaches in promoting recovery for patients with SMI. Continued research, theory development, program advancement, and professional advocacy for OT’s role in mental health is warranted to advance quality of care and improve long-term outcomes for individuals with SMI.