Tess Arruda, Occupational Therapist
The definition of health, according to the World Health Organization, is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity. When it comes to treating an individual for any physical ailments, it is important to consider the social, emotional, and mental factors that may be contributing to illness or disability. Approaching health in the most holistic way by treating the whole person is the future of health care. I reached out to Tess Arruda, an occupational therapist, to talk about her experience working with adolescents in a psychiatric unit at a community hospital. Tess was kind enough to speak with me and shed light on her experience as an allied health worker and provided a lot of insight on health care, mental health care, and the connection between the two.
JENNIFER MARTIN: Good afternoon and thank you for carving time out of your schedule to chat with me today. Please tell me a little bit about yourself, your education, current employment, position, and role.
TESS ARRUDA: No Problem, Jennifer, it’s my pleasure. My name is Tess Arruda and I am an occupational therapist. I graduated from Worcester state university with a Bachelor of Science in occupational studies and psychology and a master’s in occupational therapy. I currently work as an Occupational Therapist (OT) at a community hospital in Boston, Ma specifically on the acute psychiatry units where I work across the lifespan but spend most of my time on the adolescent psychiatry unit. I have been working in this setting for over two years and have spent the past year and a half as the lead OT on the adolescent unit. When people are looking for the abbreviated version of what OT’s do I often say “we help people do what they need to do and want to do in life”. The things we need to do in life can include bathing, toileting, paying bills, cleaning the home etc. and the things that people want to do can be hiking, playing guitar, sculpting- activities that bring joy and meaning to individuals’ lives. As an OT, in any setting we work in (skilled nursing facility, rehab hospital, pediatric clinics etc) our goal is always to assist patients in becoming the most independent, functional, and fulfilled in their daily lives. On an acute inpatient adolescent psychiatry unit, our goal is the exact same, but the way in which we reach this goal is different from other settings within the field. Our primary treatment method is through group therapy, and we offer a variety of groups focusing on achieving self-regulation, promoting autonomy and self-advocacy skills, building self-awareness, improving safety and safety awareness, and developing life skills. In addition to group therapy, we offer individual OT services to focus on clients more individualized needs which may include developing specific coping strategies, safety planning, substance use etc.
JM: Occupational therapists certainly do seem to wear a lot of hats! From your experience working with adolescents in the psychiatric unit, what are the most common diagnoses that you encounter and what impact do these diagnoses play in adolescents’ ability to learn at school and function in the community?
TA: The most common diagnoses are PTSD, Major Depressive disorder, and Generalized Anxiety disorder. Often times when kids come into the hospital, a major stressor for them is school, even if they are an excellent student. Kids with mental illness can experience periods where symptoms worsen which can result in being unable to get out of bed and take care of themselves, which can lead to excessive tardiness and absenteeism, which then leads to missed schoolwork and falling grades. When kids begin to feel they are doing poorly in school, this can significantly impact their mental health and a cyclical pattern may form. In addition to the impact on school, kids with mental illness often find themselves isolating when they are experiencing poor mental health which leads them to not spend time with friends and family or do the activities they once enjoyed (sports team, music, skateboarding etc); the lack of physical activity in conjunction with social isolation can also lead to worsening of mental health symptoms.
JM: You mentioned that a primary treatment method is group therapy, what are some of the other non-pharmaceutical interventions and activities that you incorporate into the therapy/treatment of your patients that you find to specifically help to alleviate symptoms and improve their mental health/self-regulation?
TA: As mentioned previous, as occupational therapist our overarching goal is to increase independence, quality of life, and overall health maintenance. Our group interventions vary each day and can vary with the population we have on the unit at any point. A major group topic is developing coping strategies in order to promote emotional regulation. Because every child is different and different coping skills work for different kids, we do a variety of coping skills groups so everyone has the ability to trial strategies that work best for them. Our sensory groups include a variety of sensory tools for each sensory system (visual, tactile, olfactory, gustatory, auditory and proprioceptive) and children are given the autonomy to select and engage in tools of their choice. Some of the most common and well received sensory tools are weighted blankets and lap pads and deep pressure massagers, because joint compression is perceived as relaxing and calming. Also, we utilize frozen orange massages, where a frozen orange is rolled across a child’s temples and forehead, which is a grounding strategy that is very beneficial. Also kids really enjoy frozen washcloths (wet a frozen washcloth, rinse excess water, squeeze together in ball or tie into knots and freeze!), which is essentially a frozen fidget allowing kids to get the cold input while also focusing on completing a mind teaser. We also do a variety of mindfulness/grounding strategies including guided imagery, meditation, progressive muscle relaxations and yoga. These strategies can require a lot of practice, as kids often are intimidated by these strategies but they tend to be well received in some children and its an affordable and accessible coping strategy. Mindfulness does not just include following guided meditations or sitting in silence. One common mindfulness strategy we utilize is called “Zentangles” which combines mindfulness and art expression. This mindfulness strategy is similar to “doodling” and is about focusing on creating patterns and lines as opposed to focusing on creating a specific image. This relaxing strategy allows even the non-artistic child to create something complex and beautiful while also achieving a “flow state”. We often use art as a way to talk about heavier topics such as identity, self-esteem, anger, anxiety, and sadness. Art can serve as a form of self-expression when kids are unable to convey how they feel with words and use their artwork to communicate with the world. Art can also be used as a method of healing. Painting, modeling clay, coloring, sketching, origami and collaging are just a few art mediums we teach kids to utilize as healthy coping mechanisms.
JM: You certainly do quite a lot in your contribution to the overall treatment of the adolescents you work with. It is really refreshing to hear how much of a focus there is on their mental health and how it is connected to so many factors influencing their health, wellness and ability to live a productive and happy life. Unfortunately, not nearly enough adolescents get the mental health care they need. What do you feel are some of the most common barriers to adolescents getting mental health treatment?
TA: Working in a city hospital, I’m able to see a variety of clients with different ethnicities, religious views, educational backgrounds, and socioeconomic statuses. What we know from research and what I see firsthand every day is that kids have difficulty or are unable to achieve love, belongingness, self-actualization etc. when their basic needs are not being met such as having proper shelter, food, sleep for example. Children in families of low socioeconomic status can be at higher risk of experiencing a loss of these basic needs and safety, which may result in home insecurity, removed from their family home by social services, or physical health side effects. It is very difficult to work on a child’s mental health when there is little to no stability in their home life. This is not just limited to families of lower socioeconomic standing. Divorce, death of a parent, domestic violence, child abuse and neglect are present in families of all higher socioeconomic status. Children need to be nurtured and cared for and need to feel safe in order for kids to be able to work on higher-level skills such as self-advocacy, self-esteem, goal and future-based thinking.
From my standpoint, one of the biggest barriers to receiving proper mental health treatment is there not being enough education and prevention in place due to the stigma that exists. There have been wonderful strides in recent years to educate people on mental health, however, there is so much work to be done. For most families, as well as the client, it is hard to accept a mental illness diagnosis. There tends to be a significant amount of shame and guilt that comes along with having mental illness or having a child with mental illness which can prevent people from asking for help. In addition to this, there is just not enough support in the community for people with mental illness or not enough education on how to receive community support. In some cities, there are a lot of community supports available, but there is a lack of education and knowledge on how to effectively utilize these services.
JM: I absolutely agree with you on all of the points you made. It is unfortunate that stigma, and lack of education, among other issues, are prevention our youth from being able to get the proper and available resources that they need. As you know. we’re dealing with even more challenges recently that we had not previously encountered. Over the past 18 months, the entire country has faced many challenges across all age groups in various ways as it relates to their mental and physical health. What have you found to be some of the main challenges the kids you have worked with in your facility faced during Covid-19?
TA: COVID-19 has been detrimental to adolescents in a variety of ways. I have seen children and teens have to isolate in a tiny hospital room for 14 days with minimal social interaction except for occasional medical staff to attend to them physically. I also see how the anxiety of getting Covid has absolutely debilitated some children. Most commonly, I have seen how the lack of daily structure, physical activity, and social interaction has fostered mental health challenges in adolescents. Despite what most may assume about teens, they really do thrive on structure and routine, and the drastic change from having a highly structured day with very little “down time” to having essentially no structure or routines significantly impacts them. Another common issue we have observed was a disrupted sleep-wake cycle. Many kids came to the hospital and reported being up all-night playing video games, online social media use, and sleeping most of the day. Sometimes the opposite and they just not receiving enough sleep at all. In addition to not receiving enough sleep, which has a significant impact on mental and physical health, many children had stopped engaging in activities that brought them joy and fulfillment and were methods of safe emotional release (sports team, music/band, after school programs). Teens were not physically exerting themselves and were engaging in mostly sedentary activities such as playing on phones or on computers and had minimal face-to-face interactions with other. As a result, our goals in OT were focused on how to build and promote new and healthy routines focusing on how to regain a regular sleep pattern, practicing sleep hygiene strategies, promoting healthy habits such as exercising and regular meals, and how to engage with others in a safe manner.
JM: The lack of structure, uncertainty in these times, and disruption in social interactions are devastating for everyone and hearing about the impact on adolescents is very eye opening. I really appreciate you taking the time to speak with me and share your experience working with adolescents. I think that it is extremely important that all health care and allied health care workers are able to understand the importance of recognizing mental health and have the ability to work with and provide services for those living with mental illness in a way that is appropriate and most successful for the individual. As we wrap up this interview, is there anything else you’d like to speak about regarding mental health advocacy and overcoming mental health stigma?
TA: The best thing we can do is keep talking about mental illness. It is not going away just by avoiding the conversations, and from what I’ve learned over the past 18 months is that it is becoming increasingly more serious in our communities. The one thing I want to communicate to all healthcare providers (not just the ones who work in mental health) is to stay informed about mental illness. There is a mind-body connection to overall health, and you cannot treat one without the other.
I want to sincerely thank Tess Arruda for taking the time to speak with me and A Friend of Mind on the importance of providing proper mental health resources to adolescents and its connection and importance to successfully treating the individual’s health in the most holistic way.