Occupational Therapy and Mental Health: A brief history, changing roles, and current workforce
- Sarah
- Jan 8
- 5 min read
Occupational therapy (OT) emerged in the early 20th century with strong roots in treating people with mental illness. Over the last century the profession expanded into physical rehabilitation, pediatrics, geriatrics, and many other areas; yet OT’s original conceptual framework — using meaningful activity (“occupation”) to restore health and purpose — remains central to mental health practice. Despite this legacy, the proportion of occupational therapy practitioners (OTPs) working in traditional mental/behavioral-health settings has declined, creating a gap between the profession’s historical identity and its contemporary workforce distribution.
Origins of Occupational Therapy
The philosophical and clinical origins of OT link back to moral-treatment movements and early psychiatric reformers who promoted purposeful activity (crafts, work, routines) as therapeutic for people with chronic mental illness. Founding figures and early WWI-era “reconstruction aides” used arts, crafts, and routine-building to support both soldiers and institutionalized patients. These ideas were foundational when OT was “born” as a profession in the 1910s–1920s.
Growth, Diversification, and Mid-century Change
Through the first half of the 20th century and particularly after World War I and World War II, the profession expanded rapidly. OT’s role in physical rehabilitation (e.g., for war injuries) grew, and as medical rehabilitation services expanded, many OTs began to practice in hospitals and rehab settings. At the same time, mental health remained an important domain of OT practice, however, the relative share of practitioners in psychiatry began to change as the profession diversified.
Deinstitutionalization
A major system-level change affecting OT’s presence in mental health was psychiatric deinstitutionalization from the mid-20th century onward. Large reductions in state hospital populations and a move toward community-based care altered service models had an impact on the amount of clients to treat, thus, positions to fill. While deinstitutionalization intended to expand community supports, in practice many community services were underfunded; simultaneously, OT positions shifted into physical rehabilitation, outpatient and medical settings where reimbursement and employment growth were stronger. This period saw a decline in the percentage of OTs practicing in traditional psychiatric hospitals and inpatient mental-health settings.
Declines in the Workforce of OTPs in Mental-health
Historical professional-survey data illustrate these changes over time. In the 1970s, large percentages of occupational therapists worked in psychiatric settings, some historical analyses report figures such as ~36% in 1973. By the 2000s and 2010s that share had dropped substantially: AOTA and related reports documented that mental-health practice as a setting declined to less than 5% in recent workforce surveys.
Contributing factors to this decline include reimbursement structures, evolving curricula, and changes in health systems.
Systemic policy and funding shifts: Deinstitutionalization and the uneven roll-out of community mental-health infrastructure redirected care pathways; in many cases, funding and reimbursement favored medical rehabilitation, home health, and physical disability therapies over community behavioral-health roles.
Workforce specialization and market demand: Growth in hospitals, outpatient rehab, pediatrics, and geriatrics created many OT jobs in non-psychiatric settings. As a result, therapists commonly followed employment opportunity and reimbursement strength.
Clinical education and fieldwork emphasis: Curricula and clinical placements that emphasize physical rehabilitation and pediatrics mean fewer students have immersive mental-health placements -- this shapes career choices upon graduation.
Stigma and visibility: Mental-health roles are often less visible and less “codified” in some care delivery models compared with physical rehabilitation, reducing pipelines and referral pathways for OTPs into behavioral health.
By the Numbers
Estimating the absolute number of OTs working in mental health depends on two inputs: (1) an estimate of total OTs employed in the U.S. and (2) the proportion of those OTs practicing in mental/behavioral-health settings.
Total OTs: Public workforce data sources vary. Data aggregators and labor sources report different totals. For example, DataUSA reported ~143,151 occupational therapists in 2023; other industry reports place the figure in a similar range.
Proportion in mental health: Recent workforce reports and peer-reviewed articles found that a small share of OTs currently practice in behavioral/mental-health settings. The American Occupational Therapy Association (AOTA) 2019 workforce data and related summaries have reported “fewer than 5%” of OTs working in mental-health settings. More recent citations in 2023–2025 literature and a 2024 psychiatry journal piece report that OTPs working in behavioral health make up about 2.2% of the occupational-therapy workforce. Based upon the total number of working OTs reported, an approximate 3,100–3,200 occupational therapists in the United States are currently working in mental/behavioral-health settings. This is further broken down into inpatient and community-based sectors, including outpatient and in-community.
Recent Shifts
Since the COVID-19 era, policies have seen renewed advocacy and attention to mental-health roles for OT because of rising population mental-health needs, These trends have been seen across college campuses, in community crisis services, and integrated primary care. AOTA and other advocates have pushed for stronger federal and state recognition, reimbursement, and workforce development aimed at expanding OT in behavioral health (e.g., integration into Certified Community Behavioral Health Clinics (CCBHCs), 988 crisis responses, and campus mental-health programs). Research and practice guidelines emphasize OT’s unique contribution to mental-health outcomes, and some states/organizations are piloting expanded roles for OTPs in community behavioral-health teams.
Bottom Line
Occupational therapy began with a strong mental-health focus, and the profession’s theoretical foundation remains well suited to mental-health promotion, prevention, and intervention. However, workforce, funding, and systemic changes over decades shifted many practitioners into other practice areas. Current estimates indicate that only a small fraction of U.S. occupational therapists, roughly 2–5% by recent survey-based measures, work in dedicated mental/behavioral-health settings. The profession and policy advocates are now working to reverse underrepresentation by expanding training, reimbursement pathways, and integrated-care roles that can better connect OT skills to growing need in mental-health care.
Limitations
Different sources report different totals for the OT workforce (AOTA membership counts vs. government employment vs. data aggregators), and “mental health” is defined differently across surveys (inpatient psychiatry only vs. community behavioral health vs. integrated settings). As a result, recent peer-reviewed and association data was used to create a transparent estimate and presented upper/lower bounds where sources diverged.
References
American Occupational Therapy Association. (2022). Overview of OT in mental health.
https://www.aota.org/-/media/corporate/files/advocacy/federal/overview-of-ot-
in-mental-health.pdf
American Occupational Therapy Association. (2019). Mental health and well
being. https://www.aota.org/practice/clinical-topics/mental-health
American Occupational Therapy Association. (2024). State of the Profession / AOTA
workforce and salary survey summaries. https://www.aota.org/career/state-of-the-
profession
Boschee, M. A. (2004). An analysis of the factors leading occupational therapy away
from mental health practice. Oregon State University.
Burson, K., et al. (2017). Mental health promotion, prevention, and intervention in
occupational therapy practice. American Journal of Occupational Therapy. 71(2).
DataUSA. (2023). Occupational therapists — employment profile.
George, P. (2023). Cycles of Reform in the History of Psychosis Treatment in the United
States. SSM Mental Health, March 2022. https://doi.org/101016/j.ssmmh.2023.100205
Jesus, T. S. et al. (2025). Education of Occupational Therapists in Mental Health: A Global
Survey of Educators Regarding Perceived Facilitators and Barriers. International
Journal of Environmental Research and Public Health, 22(7), 1009.
Read et al. (2024). A Potential Solution to the Behavioral Health Workforce
Shortage. Psychiatric Services, 75(7). https://doi.org/10.1176/appi.ps.20230298
Segal, S. P., et al. (2020). Community Care and Deinstitutionalization: A review.
PubMed Central 521-7. https://doi.org/10.1093/sw/24.6.521
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