Being present and heard: The pivotal role of leadership, responsiveness, and future-focussed thinking in policy advocacy

Given all health and social care sits within context, there is an imperative for occupational therapists to be socio-politically aware and advocate for both the occupational therapy profession and the consumers of occupational therapy services (Kirsh, 2015). As such, occupational therapists need to be heard and present where key effectual decisions are being made about how to prioritise and allocate resources at global, national, state, and local levels (Lane et al., 2019; Zwolsman, 2020). Effective policy advocacy work in occupational therapy must be strategic and occur through the lens of our values and philosophy (Berndt, 2017). This editorial will focus on the role of leadership, responsiveness to societal trends, issues, and needs and future-focussed thinking in policy advocacy.

In 2010, members of state divisions of the Australian Association of Occupational Therapists voted to join Occupational Therapy Australia Limited, thus creating national leadership and a voice for collective advocacy. One of the roles of peak bodies or professional associations is to lobby and advocate to influence policy and system design. In 2012, Sylvia Rodger asked all occupational therapists to ‘confidently take up and lead causes, being confident in the uniform voice that Occupational Therapy Australia provides’ (Rodger, 2012, p. 178). This voice is one method to provide a strategic focus on influencing change that is likely to have a systemic effect and raise the profile of occupational therapy within powerful entities. This advocacy may in turn lead to future invitations to contribute and be involved in decision making. Consistent with decisions being made at all levels of government, so too should advocacy leadership occur at all levels of practice (Bissett et al., 2021; Rodger, 2012).

Advocacy functions may include speaking up in decision making meetings and in multi-disciplinary teams (Brian et al., 2015), responding to discussion papers, making representation to government bodies and funding organisations, preparing consultation papers and submissions in response to proposed government policy changes or to reviews, such as Royal Commissions, and raising issues of concerns regarding the policy stances of the different parties before elections. Some examples of leadership from Occupational Therapy Australia include (1) advocating against the introduction of independent assessments for those people seeking to have NDIS funding for the first time. This avoided the replacement of functional assessments by occupational therapists with assessments by non-clinicians to determine need for services (Occupational Therapy Australia, 2021b). (2) Lobbying to increase occupational therapy fees for services to veterans which had remained the same for many years and this advocacy continues (Occupational Therapy Australia, 2021a).

Australian occupational therapists have expertise in broad areas but especially in addressing the growing societal need for mental health services, chronic disease management, addressing complex needs of older adults, dementia care, and pain management (Occupational Therapy Australia, 2023). In particular, incidences of mental health concerns appear to be rising (Australian Institute of Health and Welfare, 2024), and in response to this trend, Occupational Therapy Australia commissioned the ‘Thinking Ahead Mental Health Project’ that developed the Mental Health Strategy that included advocacy to promote and profile the value of mental health occupational therapy services to government and other sector stakeholders, using evidence to demonstrate the effectiveness of occupational therapy (Occupational Therapy Australia, 2022). Another example of innovative advocacy work is demonstrated by Crawford et al. (2023) in working with children seeking asylum in Australian immigration detention.

A societal issue that is an area of increasing concern is that of loneliness among older people living in both the community and residential care (Barbosa Neves et al., 2019; Gardiner et al., 2020). The erosion of time and funding for occupational therapists to undertake occupation-based and goal directed practice in aged care was addressed in the submission Occupational Therapy Australia made to the Royal Commission in Aged Care Quality and Safety. They listened to members' concerns and shared stories of occupational therapists having to provide services that were not occupationally based and did not offer choice or control to the older people receiving the service (Occupational Therapy Australia, 2019).

Being ready to respond in a timely way to issues that arise and opportunistic events such as Royal Commissions requires engaging with change and awareness of what the future may bring. An example of an uncertain future is the growing role of artificial intelligence in practice and the influence this could have on policy, data privacy, and efficiency (Medenica et al., 2023). In addition, a previous editorial has proposed a call to action for more health policy and systems research recognising the role this plays in strengthening the rehabilitation context (Frontera et al., 2023).

There is increased awareness of the need to adequately equip occupational therapists with the skills and knowledge to effectively lobby. Fortune and colleagues (2013) called for the need for greater political adeptness for occupational therapists to practice in increasingly complex practice environments, highlighting the opportunities for students to develop these through project, role emerging and work-integrated learning placements. In a Canadian study, Lavoie-Trudeau et al. (2023) highlighted the need for occupational therapy education programmes to teach students effective change agent competencies to develop advocacy and communication skills needed for practice at micro and macro levels.

A scoping review examining the intersect between policy and practice in occupational therapy (Lencucha & Shikako-Thomas, 2019) found nine papers out of 64 were from an Australian context. In general, this review concluded with an international call for occupational therapists to be more politically aware, become more involved and to keep the occupational therapy values at the forefront when influencing or acting on policy (Lencucha & Shikako-Thomas, 2019). The profile of occupational therapy is growing, and there is an imperative for a tailored proactive approach to policy across the breadth and scope of occupational therapy. The responsibility for policy advocacy sits with all occupational therapists to be politically aware and action oriented when it comes to responding to policy changes. Methods for being responsive and proactive may involve ‘reaching out’ into the political environment and being sensitive to timing of these approaches (Osman et al., 2020).

Carolyn M. Murray: Conceptualization; writing—original draft; writing—review and editing; project administration. Stephen Isbel: Conceptualization; writing—original draft; writing—review and editing. Carol McKinstry: Conceptualization; writing—original draft; writing—review and editing.

Professor Carol McKinstry is a Board Director of Occupational Therapy Australia and previous Occupational Therapy Australia President.