The mental health teaching-learning process in occupational therapy: a literature review

Faria, Isabela Brito Alves de; Constantinidis, Teresinha Cid

doi:10.1590/2526-8910.ctoAR391337831

Abstract

Introduction Contemporary academic training has been demanding updates on the skills and competencies to be acquired by future professionals to keep up with changes in the paradigms of health and psychosocial care. The training of occupational therapists for the mental health context is analyzed from the perspective of the teaching-learning process.

Objective The objective of the research was to analyze scientific productions and identify theoretical-methodological references on the teaching of mental health in the training of occupational therapists.

Method An integrative review of the literature was carried out using the descriptors “occupational therapy”, “teaching” and “mental health” in the Web of Science and Scopus databases of articles published between 2020 and 2024.

Results Five scientific articles were part of the final sample of review, being a reflection article and the other experimental articles. The reflection article (n=1) discussed professional practice based on the concepts of meaningful occupation focused on autonomy and social inclusion of users. The experimental articles (n=4) described interventions carried out with students to bring them closer to professional practice, through the effective inclusion of users in the course and curriculum, and encouraging the use of virtual reality devices.

Conclusion Trends were highlighted for carrying out additional research, such as compliance with global teaching standards and the evaluation of user integration and the use of simulation technologies for teaching in the Brazilian reality.

Keywords:
Teaching; Mental Health; Occupational Therapy; Review

Resumo

Introdução A formação acadêmica contemporânea vem exigindo atualizações das habilidades e das competências a serem adquiridas pelos futuros profissionais para acompanhar as mudanças nos paradigmas da saúde e da atenção psicossocial. A formação de terapeutas ocupacionais para o contexto de saúde mental é analisada sobre a perspectiva do processo de ensino-aprendizagem.

Objetivo O objetivo da pesquisa foi analisar as produções científicas e identificar referenciais teóricos-metodológicos sobre o ensino de saúde mental na formação de terapeutas ocupacionais.

Método Foi realizada uma revisão integrativa da literatura utilizando os descritores “occupational therapy”, “teaching” e “mental health” nas bases Web of Science e Scopus de artigos publicados entre 2020 e 2024.

Resultados Cinco artigos científicos integraram a amostra final da revisão, sendo um artigo de reflexão e os demais artigos experimentais. O artigo de reflexão (n=1) discorreu sobre a prática profissional baseada nos conceitos da ocupação significativa voltada para autonomia e inclusão social dos usuários. Os artigos experimentais (n=4) descreveram intervenções realizadas com os alunos para aproximá-los da prática profissional, por meio da inclusão efetiva dos usuários no curso e no currículo, e incentivo ao uso de dispositivos de realidade virtual.

Conclusão Tendências foram sinalizadas para a realização de pesquisas complementares, como o cumprimento das normas mundiais de ensino e a avaliação da integração do usuário e do uso de tecnologias de simulação para o ensino na realidade brasileira.

Palavras-chave:
Ensino; Saúde Mental; Terapia Ocupacional; Revisão

Introduction

Occupational therapy, as a field of knowledge, is historically linked to the health sciences. In its process of development, occupational therapy follows and responds to society, while at the same time constructing new contours and contexts for professional practice. As a profession, it has been shaped by historical, political, and geographical processes, and, above all, by health demands.

Changes in health paradigms require related fields of knowledge to update in order to provide interventions that are appropriate to contemporary characteristics. Epidemiological transformations and shifts in healthcare perspectives have moved towards a new concept of healthcare delivery.

In this understanding, it has become recommended that the comprehension of the health-disease process be based on the social determinants of health, with actions at different levels of healthcare connected to the territory, and, most importantly, placing the individual at the center of care practices (Paim, 2008). Studies on social determinants have increasingly gained space in health discussions. Review research by Machado et al. (2023) provided an updated view of the subject's complexity by discussing its relationship with health inequality in Brazil, social determination in/of health, and the relationship between social determinants and violence.

From the perspective of updating in response to contemporary demands, occupational therapy is undergoing a growing and continuous process, marked by the production of knowledge and the affirmation of the importance of practices that consider the different life contexts of the population served. Furthermore, there is a need for reflection on professional training to address transformations in the health field, a topic that has already been studied in the various professional and academic areas that comprise this field.

Health education has been requiring the use of a wide range of different technologies to keep pace with advancements in healthcare. Technology can be described from various theoretical perspectives and meanings. However, from an everyday and concrete viewpoint, it is common to associate technology with devices that reflect the refinement of software and state-of-the-art equipment. Nevertheless, the complexity of the topic in health requires an expanded perspective on the concept of technology.

The expansion of the topic has progressed to the point where a lexical organization of the main constructs derived from research in the field has become necessary. One example of this is the publication by Silva et al. (2020), which identified several types of educational technologies predominant in research from graduate programs on health education, recognized by the Coordination of Superior Level Staff Improvement (CAPES).

Nogueira et al. (2022) conducted a theoretical review analyzing some terminologies related to the expressions health education and education in health. According to the authors, the teaching-learning process has evolved into a dialogical model that seeks a horizontal relationship between educator and student. This pedagogical approach tends toward problematizing teaching, which encourages the development of the student's ability to build knowledge in a critical and meaningful way to transform social realities through the acquired content.

Campos et al. (2023) present the concept of social technology as something capable of improving the quality of life from a collective and relational perspective. The authors assert that social technologies are tools for rescuing humanized care and, when used in health education, they can enhance learning by fostering the understanding of the act of care and the issues surrounding human suffering (Campos et al., 2023). Thus, health education encompasses the problematization of reconciling theory and practice, which is marked by the dynamic integration of training and assistance.

Regarding training in occupational therapy, Souza et al. (2022) emphasize the need to maintain the balance between education and health. In the same study, the authors began discussing the involvement of users in the training of future health professionals, promoting learning through encouraging the validation of the needs of the population and territory to which students provide care.

In this sense, Kubo & Botomé (2005), the framework adopted by this study, emphasize the significance of continuous action in the development between those involved in the acquisition of knowledge. The authors use the term “teaching-learning process,” which encompasses the relational dimension between teacher, student, environment, and knowledge, all of which must form a horizontal and integrated relationship. They assert that the act of teaching is only realized in the simultaneous existence of learning, thus constituting an indispensable reciprocal relationship between the parties for the realization of the action in question (Kubo & Botomé, 2005).

Studies indicate that the main goal of encouraging health education is to empower students to become agents of transformation in life contexts that require critical and resolutive action in response to the realities encountered, promoting a professional identity capable of transforming lives and acting as a catalyst and generator of social responses (Almeida-Filho & Nunes, 2020; Nogueira et al., 2022).

It is believed that innovations for critical professional practice, aligned with the aforementioned advances, require recognition of the need for updating (Falcón et al., 2006). Curricular innovations in the history of health education follow theoretical trends in the field of pedagogy, with important Brazilian authors such as contextual pedagogy proponents Paulo Freire and Anísio Teixeira, the advocate of democratic and holistic education (Almeida-Filho & Nunes, 2020).

Given this, it is noteworthy that studies addressing the topic of occupational therapy education are rare, and specifically, there are no national studies that explore the teaching-learning process in occupational therapy in the field of mental health. Therefore, this article focuses on analyzing the teaching-learning process for occupational therapists in the context of mental health.

In Brazil, the recognition of mental health as a specialty of occupational therapy occurred through a public document on August 18, 2011. However, the professional practice of occupational therapists in mental health has been present since the establishment of the profession (Brasil, 2011). The history of occupational therapists' involvement in Brazil is closely linked to the paradigm shifts in the field of mental health over the years. The moral and psychiatric perspectives have undergone pressures of varying origins and intensities to be replaced by comprehensive care for individuals experiencing psychological suffering.

Adopting the anti-asylum concept requires constant renewal of the thought processes and questions that sustain the production of care in mental health, as well as necessary changes supported by legal, political, financial, and physical means to advance psychosocial care practices in Brazil. Moreover, it is believed that users, families, and professionals constitute a group of individuals who share the process of health and mental illness.

The complexity and scope of these events in the education of occupational therapists formed the basis for the research question of this article: How is the teaching-learning process for occupational therapists structured to act in the field of mental health? Thus, this study aims to analyze the scientific literature on mental health education in the training of occupational therapists and to identify the theoretical and methodological frameworks used in publications on the teaching-learning process of mental health in occupational therapy. Therefore, this study is relevant to healthcare practice and the scientific community by contributing to discussions on the education of future occupational therapists who will work in the field of mental health.

Method

The systematization and organization of published primary studies enable the production of new knowledge through the establishment of analyses that can lead to valuable findings for the advancement of science. Literature reviews form an unlimited field that interlinks subfields of different disciplines, allowing for the updating of scattered findings in databases.

Meta-analyses, systematic reviews, and integrative reviews are widely recognized in academic settings (Mendes et al., 2008). Other categorizations and terminologies can be found, considering the diversity of types of literature reviews that receive different classifications depending on the methodological framework adopted (Mendes et al., 2008).

The three types of reviews mentioned have in common the intention of gathering scientific productions to answer a question that has not been previously answered by the academic community, with a sufficient level of evidence to affirm or reject hypotheses related to specific research objectives. Each type of review presents specificities regarding its purpose, procedures, and criteria for inclusion/exclusion of the primary studies selected for analysis (Mendes et al., 2008).

The integrative review was chosen for this research, considering the objective of clarifying the understanding of the mental health teaching-learning process in occupational therapy through evidence generated by primary studies. Souza et al. (2010) and Mendes et al. (2008) described six stages for conducting an integrative review, as follows: 1) identification of the theme and formulation of the research question; 2) literature search based on inclusion/exclusion criteria; 3) data collection; 4) analysis of the studies; 5) interpretation and discussion of the results; 6) presentation of the review. Conducting the integrative review following the procedures indicated in the literature tends to ensure that the results are reliable in relation to the reality being studied. Therefore, it is recommended that the researcher responsible follows the commonly guided steps and, when applicable, uses internationally recognized tools for data extraction from primary studies.

The international EQUATOR network is an association of health researchers that provides valuable workforces to systematize and organize health research information worldwide. EQUATOR created guidelines for researchers to produce consistent and appropriate research reports for each type of study. There are at least 15 instruments originally published in English to address the 11 types of studies described by EQUATOR. Some study types have more than one set of guidelines to guide research reports, along with update documents and translations into various languages.

The guideline called Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) (Moher et al., 2009) guides the construction of reports for systematic reviews. This instrument is the one that most closely aligns with the type of research in this article — literature review —, but is not an exact match. The alignment between what is recommended and the reality of the conducted survey allowed the central idea of PRISMA to serve as a guide, and the flowchart proposed by the instrument to graphically represent the phases of the integrative review described earlier (Moher et al., 2009).

Works published in the Web of Science and Scopus databases were included, as they appeared as results of the search strategy developed for the research. All publications in English, Portuguese, and Spanish were included. The time frame considered for the search was from 2020 until March 2024.

Works that were not available in full for free through access via the graduate program credentials to which the authors are linked were excluded. Duplicate publications were excluded. Works that did not address the research question after reading the title and abstract were excluded.

Three descriptors (exact terms) recommended by DeCS/MeSH were adopted, combined with the Boolean operator and: “occupational therapy,” “teaching,” and “mental health.”

The data collection stage required preliminary organization of the content exported from the database. A full reading of the publications was performed after the initial organization and verification of the application of the inclusion and exclusion criteria.

The Web of Science database identified 121 articles as a result of the search strategy used. The application of the criteria for full-text availability and publication within the specified years reduced the number to 42 articles. The Scopus database identified 119 articles as a result of the search strategy, and with the application of the same criteria, the number was reduced to 23 articles.

Excluding publications that appeared in both databases after organizing the information automatically exported by the databases allowed the creation of a single spreadsheet with a total of 51 articles, which moved on to the next stage.

The procedure of reading the title and abstract enabled verification of the relevance to the theme and objectives of the review, which led to the exclusion of 39 articles. The 12 selected publications were read in full, and after a detailed analysis, five works were considered eligible for the final sample, as they were closely related to the topic of mental health education for undergraduate occupational therapy students. Figure 1 illustrates the flowchart of the publication selection stages.

Figure 1
Flowchart of publication selection.

Data from articles were analyzed descriptively considering title, authors, year, magazine, type of study, objective and conclusion. The methodological analysis of the articles allowed the description and contextualization of the main findings in a way related to the topic.

Results

Five articles were included in the sample considering the search from 2020 to 2024. The selected studies have different methodological designs. One of them is a reflection article and the other four articles are derived from experimental research. Information about the characteristics of the articles and the central points such as objective and conclusion are represented in Table 1.

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Table 1
Selected studies.

The study by Osorio & Montaño (2022), a reflective article, was the only one published in the only Brazilian journal identified in the survey. The paper presents a reflection on the practice of Colombian teachers in the psychosocial field regarding mental health education in their home country from a qualitative perspective (Osorio & Montaño, 2022). The main contribution of Osorio & Montaño’s (2022) article stems from the consensus of the teachers — mostly those teaching practical subjects — on directing the training of future occupational therapists who will work in mental health toward the subjective occupations of the users. The discussion brought by the authors, who adopt a perspective close to community-based practice, indicates that subjective occupations are those based on individual interests and capabilities, considering the subject’s habitual contexts as the appropriate space for intervention (Osorio & Montaño, 2022).

Osorio & Montaño (2022) use the term occupation to guide professional practice preparation, recognizing the value of applying this concept as a tool for autonomy and social inclusion. Finally, the authors emphasize that professional training and practice should not be aimed at symptom resolution to avoid the institutionalization of the practice, as the focus should be on the integral approach to the subject in decentralized healthcare services and within the community.

While the article by Osorio & Montaño (2022) was the only one published in a national journal, the article by Sullivan et al. (2021) was the only one published in a journal not specifically focused on occupational therapy. This article was published in the Journal of Higher Education Theory and Practice (JHETP), which focuses on scientific evidence regarding higher education training. The results of the research by Sullivan et al. (2021) highlighted an increase in the sense of preparedness and confidence after going through a simulation of mental health care for users with substance use and abuse demands, showing that the use of simulation technologies as a strategy in the teaching-learning process reduced financial costs for the educational institution, among other positive aspects.

For the authors, the use of technology that simulates direct contact with users can be adopted as a strategy to prepare for real-life patient encounters, reducing stressful factors for students. Moreover, the research pointed out improvements in the students' ability to understand the patient's needs and encourage them to seek treatment, crucial aspects given the need for the therapist's assertive behavior when the user shows initiative and seeks care (Sullivan et al., 2021).

From another perspective, different from the proposed use of simulation technology, the studies by Arblaster et al. (2023) and Scanlan et al. (2020) described aspects related to the approach between students and users from the perspective of valuing the users' contributions to the students' knowledge-building. Scanlan et al. (2020) highlight the need to deepen the types of approaches by identifying facilitators and barriers to involving users in occupational therapy training. Arblaster et al. (2023), in turn, recognize the potential for training through the sharing of mental health experiences by users with students, pointing toward a collaborative development of teaching resources.

In the same vein, Logan et al. (2022) assessed the development of empathy skills in occupational therapy students who had contact with mental health users for the collaborative creation of resources that enabled better ways of approaching and intervening with users guided by the principles of recovery.

Discussion

The international framework published by the World Federation of Occupational Therapists (WFOT) is outlined in the document Minimum Standards for the Education of Occupational Therapists (MSEOT) – Revised 2016. For over 60 years, this document has been periodically revised and updated. It suggests pedagogical practices, teaching strategies, describes important skills and competencies, and, in general, aims to ensure the quality and development of education worldwide, recognizing the specificities of educational programs in each country (World Federation of Occupational Therapy, 2016).

By analyzing the distribution of the articles, it is possible to identify that most of the publications refer to the reality of two countries in Oceania: Australia and New Zealand. In addition to this geographical relationship, it was observed that the authors of the four articles in question (Scanlan et al., 2020; Sullivan et al., 2021; Logan et al., 2022; Arblaster et al., 2023) emphasized the importance of undergraduate courses following the standards advocated by the accreditation of the global occupational therapy organization.

The document Accreditation Standards for Australian Entry-Level Occupational Therapy Education Programs, originally published in 2018, came into effect in Australia in 2020 (Occupational Therapy Council of Australia, 2018). In New Zealand, the document Competencies for Registration and Continuing Practice and the accreditation standards guideline also regulate and set standards for education and professional practice in the country (Occupational Therapy Board of New Zealand, 2022). The existence of a specific occupational therapy document for the region may indicate a stronger technical basis for regulating education in the field, in addition to implying the alignment of the requirements being endorsed by the bodies that organize and control the profession.

Moreover, the four articles in question were conducted at higher levels of evidence (levels three and four), using the criteria from the Agency for Healthcare Research and Quality (AHRQ) of the United States, while the only study conducted in Latin America presented the lowest level of evidence described by the AHRQ (level seven) (Galvão, 2006). Therefore, it can be inferred that by producing research with higher levels of evidence, these institutions also apply the same rigor regarding quality education. At the same time, cultural and economic factors in the region may highlight the importance of higher education, as reflected in the scientific production on the topic.

In three of the studies analyzed (Logan et al., 2022; Arblaster et al., 2023; Scanlan et al., 2020), strategies for connecting students with mental health users to develop skills and competencies for future professionals were emphasized. The experiences involved in these three studies come from higher education institutions where there is a differentiated approach for users to engage with the academic community. In the context of these programs, a new organization in the educational process has been established, involving the participation of users in the design, implementation, and evaluation of the curriculum.

The interaction between students and users, at this level of relationship, goes beyond the usual contact. Typically, in the therapist-user relationship, users communicate about their life experience related to psychological suffering. With the changes brought by the new proposals, there was an increase in empathy and the development of teaching-learning strategies more suited to the real demands of mental health users, contributing to the success of interventions and the exchange of knowledge. The studies highlight the need for institutional support so that these practices can continue to exist, creating ways to keep users and students close, thereby maintaining a beneficial relationship for both sides (Logan et al., 2022; Arblaster et al., 2023; Scanlan et al., 2020).

National studies on active methodologies in health-related undergraduate courses emphasize the importance of student participation in the teaching-learning process (Amaral et al., 2021; Araújo et al., 2024). However, the active participation of patients/users in this process, as presented in the studies above, seems to be underexplored in Brazil.

Still, regarding the international articles analyzed in this study, it is important to highlight the key terms most frequently referenced by all the authors, which appear to guide publications on the topic of the review, such as: “Consumer Participation,” “Occupational Therapy Education,” “Co-Design,” and “Co-production.” These terms are relevant constructs for the research on mental health education for occupational therapy students. However, it is necessary to wait for a consensual development within the academic community to validate a faithful translation of the conceptual description of these terms. Therefore, all the words were kept in their original language (Logan et al., 2022; Arblaster et al., 2023; Scanlan et al., 2020).

The exercise of freely translating into Portuguese and seeking conceptual relationships with what has been indicated by international studies allows for discussions and possible connections with what has been written in Brazil, such as the National Education Plan (PNE) and, more specifically, the National Curriculum Guidelines (DCN) for the occupational therapy course. The PNE does not mention, in its articles, the reference to the participation of users in undergraduate courses in the development or evaluation of curricula as goals or strategies to be achieved by higher education institutions (Brasil, 2014). What is highlighted is the participation of members of the civil community in collective strategies for oversight and monitoring of public policies as components of the National Education Council (CNE) and the National Forum for Education (FNE) (Brasil, 2014).

The DCNs are an essential reference for constructing the pedagogical projects of educational institutions and aim to ensure that the education provided is of quality and socially and professionally relevant at the national level. On December 4, 2020, the National Health Council (CNS) approved the technical opinion of the new proposals for National Curriculum Guidelines for the undergraduate program in occupational therapy, valid nationwide. Throughout the 26 articles, information is provided for implementing the program, from organizational aspects such as workload (a minimum of 3,600 hours completed in 4 years) and activity modalities (theoretical, practical, and complementary), to the essential knowledge that should be addressed in each area of knowledge throughout the program (Brasil, 2020).

It is important to highlight that the use of the term “education” alongside the expression “occupational therapy” may generate ambiguity in Brazil due to the close relationship between occupational therapy and education as a field of practice. This field has been expanding the scope of occupational therapists' practice and, consequently, increasing the number of publications using this term (Brasil, 2018). To clarify any confusion between the two topics, it is necessary to refer to the terms that are being adopted in national studies, which have already initiated a discussion on the training of occupational therapists. National studies have used the term “training” alongside “occupational therapy,” with or without additional qualifiers (Constantinidis & Cunha, 2014; Lopes, 1996; Roriz et al., 2023).

Another term widely used in the articles is “recovery.” This term does not specifically refer to the teaching-learning process of occupational therapy but is related to it. Recovery is a concept that refers to the personal process of recovery and empowerment for individuals facing mental health disorders, focusing on the creation of a meaningful and fulfilling life despite the challenges brought by psychological suffering. In Brazil, this term has gained significance, as discussed in the integrative review on the update of the term in the country (Brandão et al., 2022). The recovery approach involves the creation of strategies that seek new meanings for the history of psychological suffering. The terms “protagonism,” “inclusion,” and “empowerment” alongside “user” are part of this approach (Brandão et al., 2022).

By analyzing the incidence of the term recovery in most of the articles reviewed, one can identify relationships between the practice guided by this approach, training, and professional practice. Based on the results found, it can be inferred that when users are encouraged to take an active role in the formative process, either through the narration of life experiences or other strategies, a new pattern emerges in the teaching-learning process: students themselves understand that the framework they have been taught serves as the starting point for defining and intervening with people in psychological distress. Training supported by the recognition of the individual in their specificity will allow the development of clinical reasoning on another level of relationship and connection established with users, services, professionals, and families.

Further analysis of the articles in the sample revealed three trends that make up the results and frameworks adopted in these studies. It is important to note that the findings from international studies raise questions regarding their relevance to the Brazilian context. There is a need for complementary research that may address the possibility of applying these trends within the Brazilian education system and, more specifically, for teaching occupational therapy in mental health.

The first trend, found in the articles by Arblaster et al. (2023), Logan et al. (2022), and Scanlan et al. (2020), deals with the use of standards and/or recommendations that guide the teaching of occupational therapy. In the case of the studies cited, the parameters recommended by accreditation applied to the World Federation of Occupational Therapists (WFOT), as well as documents regulating and setting standards for teaching and professional practice in the countries of origin of the studies, are mentioned. In Brazil, there is a clear need for studies that address the official parameters guiding the teaching of occupational therapy, such as the DCNs (National Curriculum Guidelines), as well as the WFOT's international framework, especially for the field of mental health within the Brazilian context.

The second trend that would elevate the level of the teaching-learning process stems from promoting the development of horizontalized relationships and reducing stigma towards users (Arblaster et al., 2023; Logan et al., 2022; Scanlan et al., 2020). The studies advocate for the integration of mental health users with students in the perspective of construction and coexistence, not only within the patient-professional realm but also with the goal of fostering a collaborative relationship between students and users. As previously mentioned, there are no known experiences of this nature in the teaching of occupational therapy in Brazil.

The last trend was identified in the article Impact of a virtual role-play simulation in teaching motivational interviewing communication strategies to occupational therapy students for readiness in conducting screening and brief interventions by Sullivan et al. (2021). This trend concerns the use of technologies in the teaching-learning process, such as virtual reality programs that simulate patient interactions and approaches with mental health patients.

The use of virtual reality technologies could be encouraged in Brazil and incorporated into the mental health context as an innovative tool through partnerships with institutions that already utilize the practice in other countries. Some national studies already report experiences using low-tech simulators to foster therapeutic listening skills and the ability to identify the real demands of users (Oliveira et al., 2018). The authors of a study conducted with nursing students made clear the limitations faced in implementing and utilizing this practice, such as the preparation of instructors, availability and training of volunteers, and material and structural support needed for applying clinical simulation cycles (Oliveira et al., 2018).

Another study, also in the context of nursing education, addressing the use of technologies in the teaching-learning process of mental health, was conducted by Rodrigues et al. (2016). The authors described the use of simulated patients as a strategy for developing communication skills in nursing students in collaboration with actors from the institution's educational center. However, in the search for national publications that provide information on the use of simulation technologies for teaching mental health, no studies were found in other higher education courses besides nursing.

In light of the above, it is important to investigate how these trends will be applied in occupational therapy education over the years. Another relevant aspect raised in the discussion is the importance of analyzing the implementation of these trends in alignment with the cultural and historical needs of the psychosocial care system being developed in Brazil.

Regarding Brazil, no publications on mental health education for occupational therapy students were identified in our sample, despite using databases that cover national scientific production and Portuguese keywords. This points to a limitation in the production of knowledge on this topic within the national context.

Moreover, the articles did not discuss organizational aspects of the courses and subjects, such as workload, reference materials, student evaluation methods, class duration, teaching modalities, or semester occurrences. The main findings highlight the need for a robust investigation into Brazilian educational institutions and instructors to understand what is being developed in the country regarding mental health education, given the absence of nationally published research.

The findings highlighted in the previous paragraphs reinforce the discussion on the need for the development of Brazilian research, particularly those with higher evidence levels, to contribute to the field. Furthermore, studies that contribute to the global academic scenario are important for establishing the development and broad dialogue of knowledge in the field of occupational therapy.

Conclusion

In light of the above, it is evident that the topic of mental health education for occupational therapy students has emerging evidence. A trend was detected that encourages close relationships with users as a way to improve skill development, as well as an encouragement for the use of hard technologies (e.g., virtual reality) as a strategy for developing skills and competencies, which may distance the student from direct contact with the real user; these pedagogical incentives appear to be seemingly contradictory.

The meeting of these two perspectives creates a complex scenario, which has been significantly remodeled, especially after the COVID-19 pandemic. Serra et al. (2021) stated the need for change in medical education by remodeling the course's general training plan, a need that is inherent to the fields of knowledge that involve human care for health care. Unfortunately, the selected articles did not address the effects of the pandemic directly on the teaching of occupational therapy for mental health, but this could possibly be an object for future research in the field of teaching for undergraduate students.

The study identified the concepts adopted as references in the places where the topic is being studied, which allows for the direction of research in two ways: the first, within the scope of intervention, guided by the concepts of recovery and community-based practice; and the second, within the scope of structuring the teaching-learning process in occupational therapy, guided by the concepts of consumer participation, co-design, and co-production.

The absence of articles comparing pedagogical strategies adopted for teaching mental health to undergraduate students justifies the need for research on the topic. The presented review highlights the need to understand the reality of education in Brazil, particularly in terms of its formal organization with higher education institutions, the level of user participation with students, and the use of simulation technologies in the curriculum as a teaching strategy. We highlight user participation in the teaching-learning process of occupational therapy in mental health as an innovative strategy in the context of health education at the undergraduate level in Brazil. This approach aligns with proposals for care production from the psychosocial care paradigm, which is a central component of mental health policy in Brazil.

We also emphasize the importance of discussing teaching and learning in occupational therapy for mental health at scientific events focused on occupational therapy education, such as the “National Meeting of Occupational Therapy Educators” and the “National Seminar on Occupational Therapy Research,” as these events are important spaces for scientific dissemination and discussion of knowledge production across different fields of occupational therapy, including mental health, providing opportunities to foster research on the topic.

How to cite:
Faria, I. B. A., & Constantinidis, T. C. (2025). The mental health teaching-learning process in occupational therapy: a literature review. Cadernos Brasileiros de Terapia Ocupacional, 33, e3783. https://doi.org/10.1590/2526-8910.ctoAR391337832

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Brasil. (2020, 4 de dezembro). Resolução CNS nº 650, de 04 de dezembro de 2020. Dispõe sobre as recomendações do Conselho Nacional de Saúde à proposta de Diretrizes Curriculares Nacionais do Curso de Graduação Bacharelado em Terapia Ocupacional. Diário Oficial [da] República Federativa do Brasil, Brasília.
Campos, W. N. V., Medeiros, M. M., Oliveira, R. D., & Silva, L. A. R. (2023). Tecnologia social, ensino em saúde e humanização do cuidado: algumas reflexões. Revista Observatorio de la Economía Latinoamericana, 21(9), 11035-11046.
Constantinidis, T. C., & Cunha, A. C. (2014). A formação em Terapia Ocupacional: entre o ideal e o real. Revista de Terapia Ocupacional da Universidade de São Paulo, 24(2), 149-154.
Falcón, G. S., Erdmann, A. L., & Meirelles, B. H. S. (2006). A complexidade na educação dos profissionais para o cuidado em saúde. Texto & Contexto Enfermagem, 15(2), 343-351.
Araújo, V. A. F, Uchôa-Figueiredo, L. R., & Chriguer, R. S. (2024). As metodologias de aprendizagem ativas e participativas no estágio supervisionado de um curso de fonoaudiologia: uma análise do processo de ensino-aprendizagem. Caderno Pedagógico, 21(5), 1-19.
Galvão, C. M. (2006). Níveis de evidência. Acta Paulista de Enfermagem, 19(2), 5-5.
Kubo, O. M., & Botomé, S. P. (2005). Ensino-aprendizagem: uma interação entre dois processos comportamentais. Interação em Psicologia, 5(1)
Logan, A., Yule, E., Hughes, J., Peters, D., Hadley, M., Betts, B., Jones, L., & Froude, E. (2022). The impact of face-to-face mental health consumer-led teaching on occupational therapy student empathy levels: two group comparison design. Australian Occupational Therapy Journal, 69(6), 703-713.
Lopes, R. E. (1996). A direção que construímos: algumas reflexões sobre a formação do terapeuta ocupacional. Revista de Terapia Ocupacional da Universidade de São Paulo, 4(7), 27-35.
Machado, H. M. B., Silva, N. S., Souza, C. B. V., Wandemberg, L. C. L., Souza, L. R. V. J., & Gondim, D. A. D. (2023). Determinantes sociais em saúde e suas implicações no processo saúde doença da população. Revista Contemporânea, 3(6), 6086-6102.
Mendes, K. D. S., Silveira, R. C. C. P., & Galvão, C. M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto Enfermagem, 17(4), 758-764.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6(7), 1-6.
Nogueira, L. D., Sousa, M. S., Dias, M. S. A., Pinto, V. P. T., Lindsay, A. C., & Machado, M. T. (2022). Educação em saúde e na saúde: conceitos, pressupostos e abordagens teóricas. SANARE - Revista de Políticas Públicas, 21(2), 101-109.
Occupational Therapy Board of New Zealand – OTBOARD. (2022). Competencies for Registration and Continuing Practice. Recuperado em 10 de janeiro de 2024, de https://www.otboard.org.nz/document/4909/Accreditation-Standards_with-Process-Guidelines-.pdf
» https://www.otboard.org.nz/document/4909/Accreditation-Standards_with-Process-Guidelines-.pdf
Occupational Therapy Council of Australia – OTCOUNCIL. (2018). Accreditation standards for australian entry- level occupational therapy education programs Recuperado em 10 de janeiro de 2024, de https://www.otcouncil.com.au/wp-content/uploads/OTC-Accred-Stds-Dec2018-effective-Jan2020.pdf
» https://www.otcouncil.com.au/wp-content/uploads/OTC-Accred-Stds-Dec2018-effective-Jan2020.pdf
Oliveira, S. N., Massaroli, A., Martini, J. G., & Rodrigues, J. (2018). From theory to practice, operating the clinical simulation in Nursing teaching. Revista Brasileira de Enfermagem, 71(Supl. 4), 1791-1798.
Osorio, D. M. R., & Montaño, J. A. M. (2022). Desafíos de la terapia ocupacional en salud mental: reflexiones desde una experiencia de docencia. Cadernos Brasileiros de Terapia Ocupacional, 30, e3222.
Paim, J. S. (2008). Reforma sanitária brasileira: contribuição para a compreensão e crítica (Tese de doutorado). Instituto de Saúde Coletiva, Universidade Federal da Bahia, Bahia.
Rodrigues, J. R., Oliveira, S. N., Massaroli, A., Martini, J. G., Menegon, F. A., Oliveira, W. F., & Santos, R. S. (2016). O uso de paciente simulado como estratégia de ensino em saúde mental. Cadernos Brasileiros de Saúde Mental, 8(18), 1.
Roriz, D. V., Lins, S. R. A., & Farias, M. N. (2023). Terapia ocupacional e educação: um estudo documental sobre a formação acadêmica. Cadernos Brasileiros de Terapia Ocupacional, 31, e3474.
Scanlan, J. N., Logan, A., Arblaster, K., Haracz, K., Fossey, E., Milbourn, B. T., Pépin, G., Machingura, T., & Webster, J. S.. (2020). Mental health consumer involvement in occupational therapy education in Australia and Aotearoa New Zealand. Australian Occupational Therapy Journal, 67(1), 83-93.
Serra, S. T., Taquette, S. R., Bteshe, M., Corrêa, L. M., & Mattos, A. V. V. (2021). Necessidade de mudanças na educação médica e a percepção de professores antes da pandemia da Covid-19. Interface: Comunicacao, Saude, Educacao, 25(Supl. 1), 1-16.
Silva, R., Renovato, R. D., & Araújo, M. A. N. (2020). Dicionário crítico de tecnologias educacionais em saúde: percurso metodológico. Revista Tecnologia e Sociedade, 16(40), 1-11.
Souza, D. F., Sá, A. M. M., Peixoto, I. V. P., Pereira, E. M. S., Sá, P. F., Correa, R. O., Rodrigues, R. M., Freitas, J. J. S., & Brito, C. V. B. (2022). A evolução do ensino em saúde no Brasil e a unidade de referência em reabilitação como cenário de prática acadêmica em terapia ocupacional: uma revisão narrativa. Research, Social Development, 11(10), 1-12.
Souza, M. T., Silva, M. D., & Carvalho, R. (2010). Integrative review: what is it? How to do it? Einstein (Sao Paulo, Brazil), 8(1), 102-106.
Sullivan, A., Albright, G., & Khalid, N. (2021). Impact of a virtual role-play simulation in teaching motivational interviewing communication strategies to occupational therapy students for readiness in conducting screening and brief interventions. Journal of Higher Education Theory and Practice, 21(2), 39-49.
World Federation of Occupational Therapy – WFOT. (2016). Minimum Standards for the Education of Occupational Therapists: Revised 2016 Recuperado em 10 de janeiro de 2024, de https://www.wfot.org/assets/resources/COPYRIGHTED-World-Federation-of-Occupational-Therapists-Minimum-Standards-for-the-Education-of-occupational-therapists-2016a.pdf
» https://www.wfot.org/assets/resources/COPYRIGHTED-World-Federation-of-Occupational-Therapists-Minimum-Standards-for-the-Education-of-occupational-therapists-2016a.pdf

Edited by

Section editor
Profa. Dra. Adriana Miranda Pimentel

Publication Dates

Publication in this collection
07 Apr 2025
Date of issue
2025

History

Received
27 Feb 2024
Reviewed
15 Mar 2024
Reviewed
25 Sept 2024
Accepted
03 Dec 2024

Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado.

[1] Almeida-Filho, N., & Nunes, T. C. M. (2020). Inovações curriculares para formação em saúde inspiradas na obra de Anísio Teixeira. Trabalho, Educação e Saúde, 18(s1), 1-24.

[2] Amaral, A. P. S., Oliveira Boery, R. N. S., Vilela, A. B. A., & Sena, E. L. S. (2021). Metodologias ativas: relato de experiência da participação em curso de especialização na área da Saúde. Revista Docência do Ensino Superior, 11, 1-20.

[3] Arblaster, K., Mackenzie, L., Buus, N., Chen, T., Gill, K., Gomez, L., Hamilton, D., Hancock, N., McCloughen, A., Nicholson, M., Quinn, Y., River, J., Scanlan, J. N., Schneider, C., Schweizer, R., & Wells, K. (2023). Co-design and evaluation of a multidisciplinary teaching resource on mental health recovery involving people with lived experience. Australian Occupational Therapy Journal, 70(3), 354-365.

[4] Brandão, A. D. L., Figueiredo, A. P., & Delgado, P. G. G. (2022). Incorporações e usos do conceito de recovery no contexto da Reforma Psiquiátrica Brasileira: uma revisão da literatura. Trabalho, Educação e Saúde, 20, 1-21.

[5] Brasil. (2011, 28 de agosto). Resolução COFFITO nº 408 de 18 de agosto de 2011. Disciplina a Especialidade Profissional Terapia Ocupacional em Saúde Mental e dá outras providências. Diário Oficial [da] República Federativa do Brasil, Brasília.

[6] Brasil. (2014, 25 de junho). Lei nº 13.005 de 25 de junho de 2014. Aprova o Plano Nacional de Educação - PNE e dá outras providências. Diário Oficial [da] República Federativa do Brasil, Brasília, seção 1.

[7] Brasil. (2018, 26 de dezembro). Resolução COFFITO nº 500 de 26 de dezembro de 2018. Reconhece e disciplina a especialidade de Terapia Ocupacional no Contexto Escolar, define as áreas de atuação e as competências do terapeuta ocupacional especialista em Contexto Escolar e dá outras providências. Diário Oficial [da] República Federativa do Brasil, Brasília.

[8] Brasil. (2020, 4 de dezembro). Resolução CNS nº 650, de 04 de dezembro de 2020. Dispõe sobre as recomendações do Conselho Nacional de Saúde à proposta de Diretrizes Curriculares Nacionais do Curso de Graduação Bacharelado em Terapia Ocupacional. Diário Oficial [da] República Federativa do Brasil, Brasília.

[9] Campos, W. N. V., Medeiros, M. M., Oliveira, R. D., & Silva, L. A. R. (2023). Tecnologia social, ensino em saúde e humanização do cuidado: algumas reflexões. Revista Observatorio de la Economía Latinoamericana, 21(9), 11035-11046.

[10] Constantinidis, T. C., & Cunha, A. C. (2014). A formação em Terapia Ocupacional: entre o ideal e o real. Revista de Terapia Ocupacional da Universidade de São Paulo, 24(2), 149-154.

[11] Falcón, G. S., Erdmann, A. L., & Meirelles, B. H. S. (2006). A complexidade na educação dos profissionais para o cuidado em saúde. Texto & Contexto Enfermagem, 15(2), 343-351.

[12] Araújo, V. A. F, Uchôa-Figueiredo, L. R., & Chriguer, R. S. (2024). As metodologias de aprendizagem ativas e participativas no estágio supervisionado de um curso de fonoaudiologia: uma análise do processo de ensino-aprendizagem. Caderno Pedagógico, 21(5), 1-19.

[13] Galvão, C. M. (2006). Níveis de evidência. Acta Paulista de Enfermagem, 19(2), 5-5.

[14] Kubo, O. M., & Botomé, S. P. (2005). Ensino-aprendizagem: uma interação entre dois processos comportamentais. Interação em Psicologia, 5(1)

[15] Logan, A., Yule, E., Hughes, J., Peters, D., Hadley, M., Betts, B., Jones, L., & Froude, E. (2022). The impact of face-to-face mental health consumer-led teaching on occupational therapy student empathy levels: two group comparison design. Australian Occupational Therapy Journal, 69(6), 703-713.

[16] Lopes, R. E. (1996). A direção que construímos: algumas reflexões sobre a formação do terapeuta ocupacional. Revista de Terapia Ocupacional da Universidade de São Paulo, 4(7), 27-35.

[17] Machado, H. M. B., Silva, N. S., Souza, C. B. V., Wandemberg, L. C. L., Souza, L. R. V. J., & Gondim, D. A. D. (2023). Determinantes sociais em saúde e suas implicações no processo saúde doença da população. Revista Contemporânea, 3(6), 6086-6102.

[18] Mendes, K. D. S., Silveira, R. C. C. P., & Galvão, C. M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto Enfermagem, 17(4), 758-764.

[19] Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6(7), 1-6.

[20] Nogueira, L. D., Sousa, M. S., Dias, M. S. A., Pinto, V. P. T., Lindsay, A. C., & Machado, M. T. (2022). Educação em saúde e na saúde: conceitos, pressupostos e abordagens teóricas. SANARE - Revista de Políticas Públicas, 21(2), 101-109.

[21] Occupational Therapy Board of New Zealand – OTBOARD. (2022). Competencies for Registration and Continuing Practice. Recuperado em 10 de janeiro de 2024, de https://www.otboard.org.nz/document/4909/Accreditation-Standards_with-Process-Guidelines-.pdf
» https://www.otboard.org.nz/document/4909/Accreditation-Standards_with-Process-Guidelines-.pdf

[22] Occupational Therapy Council of Australia – OTCOUNCIL. (2018). Accreditation standards for australian entry- level occupational therapy education programs Recuperado em 10 de janeiro de 2024, de https://www.otcouncil.com.au/wp-content/uploads/OTC-Accred-Stds-Dec2018-effective-Jan2020.pdf
» https://www.otcouncil.com.au/wp-content/uploads/OTC-Accred-Stds-Dec2018-effective-Jan2020.pdf

[23] Oliveira, S. N., Massaroli, A., Martini, J. G., & Rodrigues, J. (2018). From theory to practice, operating the clinical simulation in Nursing teaching. Revista Brasileira de Enfermagem, 71(Supl. 4), 1791-1798.

[24] Osorio, D. M. R., & Montaño, J. A. M. (2022). Desafíos de la terapia ocupacional en salud mental: reflexiones desde una experiencia de docencia. Cadernos Brasileiros de Terapia Ocupacional, 30, e3222.

[25] Paim, J. S. (2008). Reforma sanitária brasileira: contribuição para a compreensão e crítica (Tese de doutorado). Instituto de Saúde Coletiva, Universidade Federal da Bahia, Bahia.

[26] Rodrigues, J. R., Oliveira, S. N., Massaroli, A., Martini, J. G., Menegon, F. A., Oliveira, W. F., & Santos, R. S. (2016). O uso de paciente simulado como estratégia de ensino em saúde mental. Cadernos Brasileiros de Saúde Mental, 8(18), 1.

[27] Roriz, D. V., Lins, S. R. A., & Farias, M. N. (2023). Terapia ocupacional e educação: um estudo documental sobre a formação acadêmica. Cadernos Brasileiros de Terapia Ocupacional, 31, e3474.

[28] Scanlan, J. N., Logan, A., Arblaster, K., Haracz, K., Fossey, E., Milbourn, B. T., Pépin, G., Machingura, T., & Webster, J. S.. (2020). Mental health consumer involvement in occupational therapy education in Australia and Aotearoa New Zealand. Australian Occupational Therapy Journal, 67(1), 83-93.

[29] Serra, S. T., Taquette, S. R., Bteshe, M., Corrêa, L. M., & Mattos, A. V. V. (2021). Necessidade de mudanças na educação médica e a percepção de professores antes da pandemia da Covid-19. Interface: Comunicacao, Saude, Educacao, 25(Supl. 1), 1-16.

[30] Silva, R., Renovato, R. D., & Araújo, M. A. N. (2020). Dicionário crítico de tecnologias educacionais em saúde: percurso metodológico. Revista Tecnologia e Sociedade, 16(40), 1-11.

[31] Souza, D. F., Sá, A. M. M., Peixoto, I. V. P., Pereira, E. M. S., Sá, P. F., Correa, R. O., Rodrigues, R. M., Freitas, J. J. S., & Brito, C. V. B. (2022). A evolução do ensino em saúde no Brasil e a unidade de referência em reabilitação como cenário de prática acadêmica em terapia ocupacional: uma revisão narrativa. Research, Social Development, 11(10), 1-12.

[32] Souza, M. T., Silva, M. D., & Carvalho, R. (2010). Integrative review: what is it? How to do it? Einstein (Sao Paulo, Brazil), 8(1), 102-106.

[33] Sullivan, A., Albright, G., & Khalid, N. (2021). Impact of a virtual role-play simulation in teaching motivational interviewing communication strategies to occupational therapy students for readiness in conducting screening and brief interventions. Journal of Higher Education Theory and Practice, 21(2), 39-49.

[34] World Federation of Occupational Therapy – WFOT. (2016). Minimum Standards for the Education of Occupational Therapists: Revised 2016 Recuperado em 10 de janeiro de 2024, de https://www.wfot.org/assets/resources/COPYRIGHTED-World-Federation-of-Occupational-Therapists-Minimum-Standards-for-the-Education-of-occupational-therapists-2016a.pdf
» https://www.wfot.org/assets/resources/COPYRIGHTED-World-Federation-of-Occupational-Therapists-Minimum-Standards-for-the-Education-of-occupational-therapists-2016a.pdf

Title	Authors (Year)	Journal	Type of study
Mental health consumer involvement in occupational therapy education in Australia and Aotearoa New Zealand	Scanlan et al. (2020)	Aust Occup Ther J	Cross-sectional study	Identify the level of user involvement in the curriculum, as well as the facilitators and barriers to such inclusion.	An increase in user involvement in the curriculum was identified, but the need to effectively ensure the participation of these users in the stages of preparation, application and evaluation of the curriculum was demonstrated. The study reveals the need to establish strategies to ensure user participation (e.g. financial incentives).
Impact of a virtual role-play simulation in teaching motivational interviewing communication strategies to occupational therapy students for readiness in conducting screening and brief interventions	Sullivan et al. (2021)	Journal of Higher Education Theory and Practice	Quasi-experimental study	Evaluate the benefit of using virtual simulation as a strategy for developing students' skills when conducting motivational interviewing.	The use of virtual reality increased the level of preparation and confidence on the part of the students, as well as the development of the ability to understand the user's needs and the incentive to seek treatment.
Challenges for occupational therapy in mental health: an approach from the teaching experience	Osorio & Montaño (2022)	Cad. Bras. Ter. Ocup.	Reflection Article	Reflect on occupational therapy in mental health from the perspective of teaching practice.	The training process must guide the student to approach subjective occupational needs in the usual contexts, reshaping the use of occupation as a tool for autonomy and social inclusion.
The impact of face-to-face mental health consumer-led teaching on occupational therapy student empathy levels: Two group comparison design	Logan et al. (2022)	Aust Occup Ther J	Quasi-experimental study	Measure empathy levels among students who had classes with teachers compared to students who had classes with mental health users.	Occupational therapy students already showed high levels of empathy towards mental health users in both groups, which did not generate statistical significance between the groups, but in the post-test an increase in empathy in the relationship with users was identified.
Co-design and evaluation of a multidisciplinary teaching resource on mental health recovery involving people with lived experience	Arblaster et al. (2023)	Aust Occup Ther J	Mixed method study (quali-quanti)	Collaboratively develop a teaching strategy for undergraduate health professional programs and evaluate the applicability of the strategy for training focused on recovery.	Collaboration to create teaching strategies based on users' life experiences guaranteed the quality of the product, bringing benefits to those involved.