This research sought to determine which therapist barriers prevent client-centred practice the most, and which methods are perceived as being most effective in resolving therapist barriers. A list of barriers that therapists bring to client-centred practice and methods to resolve these was identified from the literature and formed the basis of a questionnaire sent to 60 occupational therapists in the United Kingdom. The results showed that the therapist and client having different goals was the barrier which most prevented client-centred practice. The high ratings of other statements suggested that the values, beliefs and attitudes of therapists and of the employment culture make client-centred practice uncomfortable to use and hence prevent its implementation. Case examples showing how to practice in a client-centred fashion were rated as the most effective method of barrier removal.

Purpose The purpose of this paper is to outline the role played by different aspects of the social, physical and organisational environments in preventing behaviour described as challenging in people with learning disabilities. Design/methodology/approach Conceptual elaboration drawing on research and practice literature. Findings Community placements for people with learning disabilities should develop the characteristics of capable environments. Such characteristics are associated with prevention of challenging behaviour and improved quality of life outcomes. Originality/value The notion of the capable environment may help to shift the focus from the individual who displays behaviour described as challenging to the characteristics of the social, physical and organisational supports that they receive.

Introduction: Social inclusion is a recent policy driver, which aims to develop fair access to opportunity for marginalised groups: a major goal in keeping with the values of occupational therapists. Evaluation of progress towards social inclusion includes listening to individuals' experiences of inclusion or exclusion in their local communities. This research aimed to explore the experiences of social inclusion for mental health service users when engaged in everyday community occupations and to identify possible factors that influenced the service user experience. Method: Eight in-depth interviews with mental health service users were carried out, using interpretative phenomenological analysis to recount participants' life world perspectives. Findings: The findings revealed three themes: the outside experience, which described features of the social, physical and economic environment that influenced inclusion; the internal disability, which described features within participants themselves that influenced inclusion; and an active lifestyle, which described how features of occupation influenced inclusion. Feelings of inclusion or exclusion were predominantly linked to the response received from others, which was at times stigmatising and hostile. Conclusion: Given the negative impact of the reactions of society, occupational therapists need to prioritise working with local communities to facilitate their capacity to support social inclusion, as well as focusing on individual skill acquisition.

The current financial climate in health and social care is challenging: occupational therapists who work in mental health services need urgently to demonstrate clinical effectiveness and value for money in comparison to other interventions. In doing so they will help to ensure that service users in the United Kingdom can continue to benefit from occupational therapy interventions. In this opinion piece, a basic introduction to types of evaluation, costs and consequences is provided, as well as a description of research studies into the provision of occupational therapy for service users with mental health problems that include economic evaluations. Finally, methods to produce this vital information are suggested for practitioners, managers and researchers.

The view that the profession of occupational therapy will flourish in the 21st century was expressed before the banking system and financial market collapse in 2008. The profession now competes for scarce resources as austerity measures take effect. A summit meeting at the College of Occupational Therapists, in May 2013, discussed how to improve the profession's understanding and use of health economics. At this meeting, short-, medium-, and longer-term approaches were discussed, with the aim of improving the quality and quantity of publications on economic evaluations in occupational therapy. Despite an increasing number of publications on health economics across professions, occupational therapy lags behind. This focus is now vital for the profession.