Document Type

Critically Appraised Topic

Publication Date

2011

Clinical Scenario

While working with clients with schizophrenia in a community-based mental health program during my fieldwork, I noticed the participants’ enjoyment and increased engagement of our outdoor activities. Reflecting on my own personal feelings of well-being when outside, I wondered about the effects outdoor interventions have on person with mental illness. I also work for an inclusive adventure-based recreation program, serving people of all abilities. Having seen both the challenge and growth of participants as they stepped out of their comfort zones during our adventure trips, I began to wonder about merging these two experiences: what effect would being challenged in the outdoors have on adults with mental illness? There are lots of adventure-based programs for at-risk youth but I was unaware of such programs targeted towards adults. I was also curious about the generalizability of the experiences during these adventure-based programs into real-life situations and the possibility of making these experiences a practical clinical application for occupational therapy practice.

Experiential learning is a popular education style that believes learning by doing is essential for success. This matches the essential belief in occupational therapy that change and growth develop through engagement in occupation. Adventure-based interventions use this fundamental concept to create change within a person that may otherwise be difficult to obtain using traditional methods. Motivation, physical fitness, self-efficacy and a sense of mastery are key concepts that persons with mental illness struggle with that can affect every aspect of their lives and can be fostered in experiential learning environments. The traditional rehabilitation model for persons with mental illness lacks adventure-based interventions and may be missing an essential opportunity to helping those achieve and maintain recovery.

Clinical Question

What is the influence of adventure-based interventions on engagement and effectiveness of treatment for adults with mental illness?

Clinical Bottom Line

These articles considered the broad-scope implementation of adventure-based interventions ranging from year-long residential placements to one-day a week programs with varying activities. Although results in each study varied, there was a consistent positive impact in physical fitness, attendance and self-esteem found in each adventure-based intervention with special consideration to follow-up care being needed.

The “best” evidenced case-control study gave special attention to the feasibility in the clinical setting, specifically comparing standard clinic recreation to adventure-based treatment, taking into consideration implementation of such programs as a new standard intervention for persons with mental illness. This study was also well done and clearly written, making its implications more usable for the mental health community.

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