Supporting Veteran Mental Health Through Metacognitive Reflection and Insight Therapy for the Occupational Therapist (MERIT-OT): A Quality Improvement Doctoral Capstone Project Report

Abstract

Background: Veterans are at over 50% higher risk of experiencing mental health crises compared to the general population, negatively impacting occupational engagement and quality of life. With roots in mental health practice, OT is primed to meet these uniquely complex healthcare needs. Research shows improving factors of metacognition through interventions like MERIT-OT can improve self-agency and recovery from mental health crises. However, OT at the IN VA has not yet been utilized within the mental health care teams. For MERIT-OT research to move forward at the IN VA, the barriers and facilitators to implementation at this site needed to be understood. Methods: A DCE student completed a 14-week quality improvement project to support the role of OT in mental health services within the IN VA, eliciting appropriate patient populations to implement MERIT-OT research in the future. Program implementation included OT staff training and advocacy, MERIT-OT resource building, and clinical skills building through mental health group interventions. Data was collected through activity analysis of staff workflow, informal discussion, staff survey, self-assessment journalling of MERIT-OT integration, and pre/post assessment of domiciliary groups. Results: Increased knowledge, access, and the likelihood of OT staff implementation of mental health resources. New OT integration into existing suicide prevention follow-up programs. Deeper understanding of MERIT-OT principles, barriers/ facilitators, and appropriate opportunities for future research. Conclusion: Integration of MERIT-OT within OT’s newly established and growing roles in mental health services at the IN VA healthcare system will improve the quality of care, meet the growing need for mental health professionals, and support rigor and fidelity within the field of mental health OT.