Professor Sheila the Baroness Hollins was appointed as RCOT President in 2015; a role that she initially only intended to fill for three years.
One of the UK’s foremost authorities on learning disability and mental health, the crossbench peer is the founder of Books Beyond Words, a pioneering UK charity that works to transform people’s lives through creating word-free picture books with an international reach, to help people with communication disabilities explore and share life events, relationships and wellbeing.
Baroness Hollins is also Professor Emeritus in Psychiatry of Intellectual Disability at St George’s University of London and Honorary Professor of Spirituality, Theology and Health, at University of Durham, working over her distinguished career as a consultant psychiatrist, teacher, researcher and policymaker in intellectual disability and health.
She has been President of both the Royal College of Psychiatrists and the British Medical Association and was appointed an Independent Member of the House of Lords in 2010, where she speaks on mental health and disability issues.
Baroness Hollins has supported RCOT with various campaigns and reports for almost a decade, including our Living not existing report and Improving Lives, Saving Money campaign.
Now she is ready to step down from her role, but not before reflecting on why she took up the invite to become our President and how the profession can continue to raise its profile and make its influence felt in the right places.
She says: ‘One of the main reasons I became your President is because quite a few of my family members have had wonderful treatment and support from occupational therapists.
'When I trained as a doctor and psychiatrist, we didn't really meet many occupational therapists, and when we did, it was very much in the “‘making baskets” era, without us really understanding the skill set that you have.
‘It was only when my own family started benefiting from your skills that I began to realise that you are rather a hidden profession. And yet to me, one of the most important in terms of people's wellbeing.’
Ultimately, she feels, this is because of occupational therapists’ dual, or holistic training in both physical and mental health. One of Baroness Hollins’ early achievements in the House of Lords was to fiercely argue for - and succeed in passing – an amendment to the Health and Social Care Act in 2012.
She explains: ‘It's been known as the “parity of esteem amendment" and the idea was that when we talk about health, we should be thinking about both physical and mental health. Because – while it’s beginning to change now - when you asked people then what “health” means, most people came up with a physical health condition.’
And it’s no surprise that, as President of the Royal College of Psychiatrists, she also introduced its strapline ‘No health without mental health’.
But what she came to realise, she says, is that ‘it’s occupational therapists who seem uniquely placed to be able to work across both mental and physical health and understand that better than so many other professions’.
So why do so many occupational therapists tell us that they feel the value of their experience and expertise isn't always recognised? And what can we, as occupational therapists, do to get better recognised and get our voices heard in the right places?
‘I think occupational therapists are no different to many other groups, including doctors and senior doctors who also think they have no influence,’ she says after some thought. ‘And you're wrong. You do have influence, but you must learn how to use it.’
Potentially, that’s about occupational therapists getting on the right leadership courses, as well as the importance of being able to tell our stories well, she adds.
‘I began to learn some of this when I was seconded to the Department of Health to be an adviser on learning disability and autism,’ she says. ‘I realised there were some very bright and able civil servants who were generalists, but who didn't know what we as clinicians know. And the best way to help them understand was to be able to tell them stories.
‘The thing that made a difference wasn't putting government on the defensive. It was informing them about how a little change could make a big difference, because what they're really looking for are the things that are going to make things better. A problem-solving approach. And occupational therapists are brilliant at that.’
She adds: ‘If you want to achieve change, the skill is just the kind of skill that you need with the people you're supporting; which is about small change, big difference. It's about persuasion. It's about influence. It's about understanding how the environment works and how decisions are made.’
In essence, occupational therapists have been trained to think differently to other people, such as doctors and healthcare managers, she reflects: ‘Healthcare managers can often jump to the wrong conclusions when presented with information, because they are not well enough informed, or because they haven't understood the issue.
‘It's about engaging in leadership. Occupational therapists would be perfect people to get involved in integrated care boards, for example. [It’s about] have we got an occupational therapist on our patch who is representing our perspective?’
Last November, Baroness Hollins published her final report as Chair of the Independent Care (Education) and Treatment Review (IC(E)TR) programme for people with a learning disability and autistic people in inpatient settings.
It’s the culmination of four years of work - having been tasked by the government to look at the way in which autistic people and people with learning disabilities have been detained in long term segregation.
With 13 recommendations, including that all staff working with people with a learning disability and/or autistic people should be delivering therapeutic and human rights-based care, this piece of work exemplifies this perfectly.
'We need huge systemic and culture change;’ she says. ‘People can't come out of hospital because they haven't got suitable homes or sensory environments. But occupational therapists could really contribute towards that.’
Ultimately, when it comes to what needs to change within the support systems that occupational therapist work in, so that people can get the better care and outcomes that they really need, it’s about a model of care that’s not ‘led by numbers’ but is interdisciplinary and community based.
‘We talk person centred and then we turn people into cases,’ she concludes. ‘And when we're short of resources, the answer isn't to gatekeep. The answer is to empower... and occupational therapists could really help to change the culture.’
The way forward
As Baroness Hollins steps down, RCOT has taken the opportunity to review the roles of President and Vice President. These roles were set up to help give a voice to, and advocate for, RCOT and the profession in UK government, parliament and health/research authorities.
Since we appointed these roles, we’ve made significant progress in our public affairs work. We now have the connections to make direct contact with UK government, parliament and health/research authorities.
In future, we’ll take a more flexible approach, working with high profile supporters and collaborating with different individuals who can best support specific campaigns and projects. We won’t be continuing with the roles of President and Vice President.
We would like to thank our President, Baroness Hollins, and Vice Presidents, Sir Mansel Aylward CB, Sir Clive Booth and Colin Ettinger, for their service to RCOT and the occupational therapy profession.