Recreational Therapy May Reduce Dependence on Antipsychotic Medication


Responding to a 2011 report by the Office of the Inspector General which revealed that nursing homes across the country were using atypical antipsychotic medications to treat residents with dementia, the Centers for Medicare & Medicaid Services (CMS) created the National Partnership to Improve Dementia Care. Using these atypical antipsychotic medications for “off label” uses (e.g., they are not approved to treat behavioral disorders in persons with dementia) is problematic as the Food and Drug Administration (FDA) warned in 2005 that the “treatment of behavioral disorders in elderly patients with dementia with atypical antipsychotic medications is associated with increased mortality.”

“This partnership is focused on delivering health care that is person-centered, comprehensive, and interdisciplinary,” reads a report from the CMS website. “By improving dementia care through the use of individualized, person-centered care approaches, CMS hopes to continue to reduce the use of unnecessary antipsychotic medications in nursing homes and eventually other care settings as well.”

Recreational therapy (RT) is one of these person-centered approaches to dementia care. Dr. Gretchen Snethen, PhD, is the Assistant Director at the Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities, and an expert on the use of recreational therapy to treat people with mental health conditions.

“Recreational therapy (RT) is a treatment approach that uses interest-based activities to help improve people’s function and engagement in meaningful roles,” she explains. “Because of those positive experiences, it may be beneficial for traditional symptom reduction as well.” These types of person-centered treatment services also have a beneficial impact on individuals living with mental health conditions.

“We all have leisure activities that we’re interested in,” Dr. Snethen observes. “For individuals living with mental health conditions, they’ve been engaged in activities prior to their diagnosis—maybe they were a pet owner, a runner, or a painter for instance. They had these activities they found enjoyable. Regardless of diagnosis, when they’re institutionalized or even receiving community-based services, those things are often put on the back burner.” She goes to note that too often our medical system, including the mental health system, focuses on addressing immediate symptom reduction through medication as opposed to supporting individuals to engage in activities they enjoy in the community.

“With recreational therapy, there are strategies we can use to identify those meaningful activities to increase community participation, explore barriers and facilitators, and then provide the supports to help individuals increase independent engagement. It’s never a one-size fits all approach,” she adds. “Art is a good example. Some individuals may need support to find and participate in classes, because creating art is what supports their recovery. Others may be more interested in engaging with the arts in their community, without creating it. The point is to meet people where they are, and help them develop strategies to participate as independently as possible in the activities of their choice.” Participation in recreational activities can have a major impact on personal recovery and wellbeing. Snethen goes on to discuss, “Individuals formulate positive identities through the recreational activities they participate in. This can have a beneficial impact on one’s mood, stress levels, as well other functional skills like planning and organization. Plus, recreation is fun!”

Dr. Snethen also points out that staff who utilize recreational therapy are often more connected to the people they support and are more engaged in their work. Instead of just focusing on medication management, they talk to their participants, discovering their interests and passions. “They begin to see them as people first.”

The DirectCourse/College of Recovery and Community Inclusion online curriculum is built around a recovery and community inclusion/participation framework. CRCI is founded on the belief that everyone has the right to lead a life of full participation in the community in the valued social roles of their choice. CRCI online courses help direct service community mental health providers develop the attitudes, knowledge, and skills necessary to competently and compassionately support individuals to live satisfying, successful, and self-directed lives. Courses such as Seeing the Person First: Understanding Mental Health Conditions and Understanding Community Inclusion can support providers in increasing their knowledge about the importance of participation, such focusing on interest-based activities to support recovery and increased community participation. 

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