By Riya Shah
Aman, a high school graduate, was excited to transition into a post-secondary institution. His first few months were challenging. The havoc of finding his lecture rooms across campus threw him off instantly. Aman knew he had to make a new identity for himself; he was no longer a high school student. He was a post-secondary freshman, and this new title came with new obligations. Unexpectedly, Aman navigated a world where instructors gave scarce feedback and barely knew his name; no one checked in on him to make sure his transition was going smoothly. Workload accumulated to near-impossible heights, and good marks were harder to attain. Aman’s fumbled sleep schedule and increased stress made it challenging to manage all his daily activities. Aman felt alone and isolated with little knowledge of whom he could reach out to. Post-secondary students are one of the most vulnerable groups who experience profound life changes as they transition from high school to post-secondary education. In 2020, approximately 2.2 million students were enrolled in post-secondary institutions in Canada, and often their needs were unaddressed (1). Data suggests that this number has increased yearly since 2000 (1). In Ontario alone, almost 1 million post-secondary students were enrolled in a post-secondary institution between 2019-2020 (2). Every post-secondary student’s experience with this transition is completely idiosyncratic; the types of changes one experiences and how it impacts their mental and physical well-being are unique.
The Impact of Change
Transitioning to post-secondary education is a significant shift experienced by students, and changes associated with this transition are inevitable (3). These students might be living independently, taking up a job, battling copious amounts of stress, managing their own money, and adapting to a new academic environment. Research suggests that individuals often experience stress from change that impacts self-continuity and self-concept (4), like what post-secondary students encounter. Over the past 10 years, post-secondary students’ mental health has become a public health concern (3). Current data proposes that the majority of those attending post-secondary education in Canada belong to the 18-25-year-old age group, a period in which young adults utilize maladaptive ways of coping with stress that they usually experience in post-secondary settings (3). Increased stress among the post-secondary population has exacerbated adverse outcomes such as mental illness (3). A meta-analysis of the development of mental illness among Canadian post-secondary students during the COVID-19 pandemic found that the rates of depression and anxiety were higher among students compared to the general population (5). Post-secondary students are also more likely to contemplate dropping out of school because of poor mental health and high levels of stress in a new environment (6). A prevalence study investigating suicide attempts among teenagers transitioning to young adulthood in post-secondary institutions found that students experienced self-injury and suicidal ideation with concurrent depressive and anxiety disorders (7). Students turn to risky behaviors due to insufficient support available to them. Excessive stress in post-secondary environments has been associated with burnout and poor academic performance (3, 8). These findings demonstrate how post-secondary students are more likely to experience functional challenges in their education, work-life balance, and navigating in a new environment due to stressful demands.
Current Resources and Supports
Across various post-secondary institutions, students might have access to health and wellness services, but many are unaware of the support available to them. When transitioning to a post-secondary institution, students become their own advocates and face a new challenge to search for services critical to well-being. Researchers have found that post-secondary institutions lack the availability of professionals with the skills and knowledge to attend to post-secondary students’ mental health and functional needs (9). A study in London, Ontario, discovered that more effective interventions are needed to reduce the risk of self-harm and target post-secondary students’ mental health (10). Campuses across Canada have recognized that post-secondary students find it difficult to function due to overwhelming responsibilities assigned to them and their overall academic performance is impacted (11). Nationally, post-secondary institutions need student-centered, socially inclusive, and strengths and resilience-based wellness services to ensure students are well-equipped to function and manage the many activities in their daily routines while also being satisfied with their academic performance (11). A student-centered approach ensures students can take charge of their education, with opportunities catering to their needs, and resilience-based services will develop and nurture skills to overcome adversities common in post-secondary institutions (11).
Anna Shvets (Pexels)
Health and wellness professionals such as nurses, counselors, academic advisors, and disability advisors traditionally assess and provide support to post-secondary students who face challenges in their academics and well-being (12). However, post-secondary institutions continue to lack the provision of services that focus on improving functional performance in daily activities related to academics and personal life for students, as well as improving the mental health of students in a holistic and student-centered way (12). Occupational therapists are well-equipped to address the needs of post-secondary students. Although occupational therapy is rarely observed in post-secondary contexts, research has begun to investigate the role of occupational therapy (OT) in addressing student functional performance, participation in activities, and managing appropriate mental health (13,14). For those unaware, OT is a healthcare field that enables individuals to participate in daily activities meaningful to them (15). OT allows therapists to understand how one’s current routines and habits relate to well-being and participation in activities, or “occupations” (15). Occupational therapists take a holistic approach to make sense of the physical, mental, social, and environmental barriers preventing engagement in day-to-day activities (15). This perspective on well-being is centered on the idea that engaging in occupation is an essential part of being human, and that with different life events, engagement might be impacted (15).
Meelan Bawjee (Unsplash)
The Emerging Role of Occupational Therapists
OT has historically played a substantial role in supporting individuals to get back to their daily activities and problem-solving around the barriers impeding performance in activities in various contexts associated with healthcare. Although OT is commonly practiced in hospitals, rehabilitation settings, public schools, and homes/communities, OT involvement in post-secondary institutions is an emerging area of practice in which OT can be an asset to the support available to post-secondary students. Recently, OT has been recognized as a field to expand its role in post-secondary education due to its keen interest in holistically optimizing independence, well-being, and health promotion. Researchers have found that occupational therapists have the skill set to understand the physical and psychosocial challenges among the post-secondary population (16). It was found that student outcomes were positive after participating in OT programs in the post-secondary institution in that academic performance was enhanced, students gained more confidence, stress was lessened, and social skills to manage multiple responsibilities throughout the day were improved (16). Occupational therapists played an important role in helping students find healthy ways to cope with stress, navigate a new environment, improve study skills, make social connections, and participate in leisure activities (16). Occupational therapists are also well-positioned to advocate for their clients and support their clients to advocate for themselves. A study on OT in post-secondary transition planning demonstrated that occupational therapists are uniquely situated to help post-secondary students self-determine what support they need and establish goals to improve well-being and performance in school (17). Students felt empowered and supported to request accommodations, identify personally meaningful activities while in school, and problem-solve to lessen the effect of mental health challenges and stress (17). From an OT perspective, these skills are important as barriers to engaging in academics and personal activities as a post-secondary student are prominent, given the high levels of stress and change.
Although it is evident that occupational therapists provide a unique set of skills to post-secondary institutions and support students in their education and work-life balance, research is warranted to understand what other interventions can be used across the student population and the level of funding required. Research to investigate how occupational therapists can support disabled students and students struggling with challenges with other social determinants of health is needed to make this emerging role more established in this setting. Moreover, OT is a regulated health profession, but the standards of professional practice for a setting like post-secondary institutions have yet to be established. Advocating for this role and the notion that post-secondary students can benefit from the support of more student success personnel is important to ensure the benefits of OT are acknowledged to those who need it.
Ultimately, occupational therapists are uniquely suited to support post-secondary students in their journey of education and functional performance in activities meaningful to them. The increasing rates of mental health challenges and social isolation among post-secondary students have supported the idea that OT is a growing and important tool needed in this setting. With further leadership, advocacy, and research, it is my hope that both the OT community and post-secondary establishments can collaborate to provide students with improved resources.
Featured illustration by Virginia (Ginny) Chiu for rehabINK.
To refer to this article, it can be cited as:
Shah R. The Emerging Role of Occupational Therapy in Post-Secondary Institutions. rehabINK. 2023:Issue#14. Available from: https://rehabinkmag.com
- Statista Research Department. Number of students enrolled in post-secondary institutions in Canada from 2000-2020 [Internet]. 2022 [updated 2022; cited 2022 14 Nov]. Available from https://www.statista.com/statistics/447739/enrollment-of-postsecondary-students-in-canada/
- Statista Research Department. Average tuition fee for full-time Canadian undergraduate students in Canada [Internet]. 2022 [updated 2022; cited 2022 14 Nov]. Available from https://www.statista.com/31/request/custom-solution/1/form/corporate?source=paidforecast
- Linden B. Cross-Canada Release of the Post-Secondary Student Stressors Index (PSSI): Protocol for a Cross-sectional, Repeated Measures Study. JMIR Research Protocols. 2021 Aug 31;10(8):e27713.
- Wisse B, Sleebos E. When change causes stress: Effects of self-construal and change consequences. Journal of business and psychology. 2016 Jun;31(2):249-64.
- Zhu J, Racine N, Xie EB, Park J, Watt J, Eirich R, Dobson K, Madigan S. Post-secondary student mental health during COVID-19: a meta-analysis. Frontiers in Psychiatry. 2021;12.
- Hjorth CF, Bilgrav L, Frandsen LS, Overgaard C, Torp-Pedersen C, Nielsen B, Bøggild H. Mental health and school dropout across educational levels and genders: a 4.8-year follow-up study. BMC public health. 2016 Dec;16(1):1-2.
- Gollust SE, Eisenberg D, Golberstein E. Prevalence and correlates of self-injury among university students. Journal of American college health. 2008 Mar 1;56(5):491-8.
- Keyes CL, Eisenberg D, Perry GS, Dube SR, Kroenke K, Dhingra SS. The relationship of level of positive mental health with current mental disorders in predicting suicidal behavior and academic impairment in college students. Journal of American college health. 2012 Feb 1;60(2):126-33.
- Christensen B. Preparing Students with Disabilities for Postsecondary Life.
- Griffin K, Twynstra J, Gilliland JA, Seabrook JA. Correlates of self-harm in university students: a cross-sectional study. Journal of American college health. 2021 Mar 27:1-8.
- Mohawk. Report on Mohawk’s Mental Health and Wellness Plan [Internet]. N.d. [updated n.d.; cited 2022 14 Nov]. Available from https://campusmentalhealth.ca/wp-content/uploads/2018/03/New-Vision-of-Wellness-Mohawk.pdf
- Fournier E. How Post-Secondary Institutions Can Support Student Mental Health. Mental Health. 2022 Aug 30;30:3.
- Eismann MM, Weisshaar R, Capretta C, Cleary DS, Kirby AV, Persch AC. Characteristics of students receiving occupational therapy services in transition and factors related to postsecondary success. The American Journal of Occupational Therapy. 2017 May;71(3):7103100010p1-8.
- Pierce D, Sakemiller L, Spence A, LoBianco T. Effectiveness of transition readiness interventions by school-based occupational therapy personnel. OTJR: Occupation, Participation and Health. 2020 Jan;40(1):27-35.
- CAOT. How does Occupational Therapy Help? [Internet]. 2022 [updated 2022; cited 2022 14 Nov]. Available from https://caot.ca/site/aboutot/howOThelp?nav=sidebar.
- Keptner KM, McCarthy K. Mapping Occupational Therapy Practice with Postsecondary Students: A Scoping Review. Open J Occup Ther. 2020 Jan 15;8(1):1–17.
- Angell AM, Carroll TC, Bagatell N, Chen C, Kramer JM, Schwartz A, et al. Understanding self-determination as a crucial component in promoting the distinct value of occupational therapy in post-secondary transition planning. J Occup Ther Sch Early Interv. 2019 Jan 2;12(1):129–43.