Enabling Empowerment: Using Simulations versus Real Occupations

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Abstract
This study shows how the organization of occupational therapy determines occupational therapists' potential and limits for enabling the empowerment of adults who attend mental health day programmes. Drawing from the full ethnography, this paper shows how the organization of practice determines invisibly whether occupational therapists are more likely to involve people in simulations or in the real occupations of their everyday world. The study explores the use of simulations versus real occupations by tracing everyday practice to the locations, facilities, and scheduling context in which practice occurs. Practice is further traced to the philosophic and funding context of programmes. The final part of the analysis outlines how the use of simulations versus real occupations is shaped by particular ideas about mental health, professional practice, health services, welfare, and the market place. The analysis of an institutional ethnography offers a blueprint for change.

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