New Occupational Therapists in South Africa Feel Unready for Mental Health Work, Study Finds

Newly qualified occupational therapists in South Africa are stepping into mental health roles that many of them do not feel fully prepared to handle, according to a qualitative study published in BMC Medical Education. The research, conducted by Itumeleng Tsatsi of the University of the Witwatersrand and Olindah Silaule of the University of Cape Town, explored how graduates with one to five years of professional experience perceive the adequacy of their undergraduate training for mental health practice. The findings arrive at a critical moment for a health system in which workforce shortages mean that junior clinicians often carry substantial responsibility for psychiatric and community mental health services from their very first day on the job.

The study employed a qualitative descriptive design, a methodology suited to capturing the lived experience of professionals navigating the transition from student to practitioner. Thirteen occupational therapists participated in semi-structured interviews, a sample size consistent with the norms of qualitative inquiry, where depth of insight matters more than statistical generalizability. The interviews were audio-recorded and transcribed verbatim, then analysed using Braun and Clarke’s reflexive thematic analysis, a widely used approach that involves systematic coding of transcript data and the iterative development of themes that capture patterns of meaning across participant accounts. The researchers used NVivo 15, a dedicated qualitative data analysis software package, to manage and organize the coding process.

Trustworthiness, the qualitative equivalent of validity, was addressed through several established techniques. The authors describe the use of reflexivity, in which researchers critically examine how their own backgrounds and assumptions might shape the interpretation of data. Peer debriefing allowed colleagues to challenge and refine emerging interpretations, while triangulation helped ensure that findings were anchored in multiple perspectives within the dataset. The maintenance of an audit trail, a documented record of analytical decisions from raw transcript to final theme, further strengthens confidence in the study’s conclusions. Ethical clearance was granted by the University of the Witwatersrand Human Research Ethics Committee under clearance number H24/03/29, and all participants provided written informed consent before data collection began.

From the analysis, three major themes emerged. The first concerns the genuine strengths of the mental health curriculum as currently taught in South African occupational therapy programmes. Participants identified expert teaching as a foundation of their learning, praising the knowledge and clinical experience of academic staff who delivered the mental health content. They also highlighted meaningful undergraduate clinical supervision, describing placements in which experienced clinicians guided their developing skills in real-world settings. Multidisciplinary learning experiences, in which students trained alongside future doctors, nurses, psychologists and social workers, were credited with building an understanding of how mental health care functions as a team endeavour. Taken together, these elements gave many participants a sense that their education had, in important respects, prepared them for the demands of mental health practice.

The second theme, however, reveals significant gaps between what the curriculum delivers and what the realities of practice demand. Participants reported limited preparation for culturally responsive practice, a shortfall with particular weight in South Africa, where therapists routinely serve clients whose languages, belief systems and cultural frameworks around mental illness differ markedly from their own. Without explicit training in how to adapt assessment and intervention to diverse cultural contexts, graduates described uncertainty about whether their therapeutic approaches were appropriate or effective for the communities they served. This gap is not merely academic; in mental health care, where trust and communication are central to outcomes, cultural misalignment can undermine treatment adherence and therapeutic relationships.

Participants also described feeling underprepared for complex mental health presentations. Undergraduate training, they indicated, did not always expose them to the severity, acuity or diagnostic diversity of the cases they encountered once qualified. Clients with co-occurring psychiatric and physical conditions, acute crises, or severe and persistent mental illness presented challenges that exceeded the scenarios they had practised as students. Related to this was a third shortcoming: limited confidence in applying occupational therapy interventions specifically within mental health contexts. Occupational therapy in psychiatry involves distinct techniques, from activity-based rehabilitation to vocational and social skills training, and participants suggested that the translation of general occupational therapy principles into mental health settings had not been sufficiently rehearsed during their studies.

The third theme captures the participants’ own recommendations for reform, and these form perhaps the most actionable part of the study. Graduates called for expanded community-based mental health training, arguing that learning within the communities where clients actually live would build the contextual competence that hospital-based placements cannot fully provide. Community-based education has gained traction globally as a strategy for aligning health professional training with population needs, and the participants’ experiences suggest that South African occupational therapy programmes could benefit from deepening this component. They further recommended integrating physical and mental health teaching throughout the curriculum, rather than treating them as separate streams, reflecting the growing recognition that the two domains are inseparable in real clinical populations.

The recommendations also extended to the structure and consistency of training itself. Participants urged improved supervision and feedback during clinical placements, emphasizing that the quality of guidance received as a student shapes confidence as a practitioner. Inconsistent experiences across undergraduate mental health curricula emerged as another concern, with graduates from different training pathways describing markedly different levels of exposure to mental health content. Greater standardization, or at minimum greater alignment, across programmes could help ensure that all newly qualified occupational therapists enter the workforce with a comparable baseline of mental health competence. The authors conclude that undergraduate occupational therapy education in South Africa provides an important foundation for mental health practice, but that it could be strengthened through greater cultural responsiveness, expanded community-based learning, improved supervision and feedback, and greater curricular consistency.

The significance of these findings extends beyond occupational therapy. In resource-constrained health systems, newly qualified professionals are frequently the backbone of service delivery, and South Africa’s persistent shortages of mental health specialists mean that occupational therapists often fill roles that would, in better-resourced settings, be staffed by more experienced clinicians. The transition from student to practitioner is a well-documented period of vulnerability, marked by reality shock, reduced confidence and, in some cases, early attrition from the profession. When that transition occurs with limited supervision, as the study’s background notes, the stakes for both clinician wellbeing and patient safety rise considerably. Understanding precisely where educational preparation falls short is therefore a prerequisite for designing interventions that protect the workforce and the populations it serves.

The study, published on 6 October 2026 as an open access article, was supported in part by the Female Academic Leadership Fellowship, which allowed the first author to dedicate time to the conception, data collection and writing of the research. The authors declare no competing interests. While the qualitative design means the findings describe the experiences of thirteen therapists rather than measuring preparedness across the entire profession, the consistency of the themes and the methodological safeguards employed lend weight to the conclusions. For educators, the message is clear: the foundations are sound, but the gaps in cultural training, exposure to complexity and community-based practice are real and fixable. For the graduates themselves, the study offers validation that their struggles reflect systemic curriculum limitations rather than personal inadequacy, and a roadmap for the reforms that could make the next generation of South African mental health practitioners better equipped for the work awaiting them.

Subject of Research: Preparedness of newly qualified occupational therapists for mental health practice in South Africa

Article Title: Perceptions of preparedness for mental health practice among newly qualified occupational therapists in South Africa

Article References: Tsatsi, I., & Silaule, O. (2026). Perceptions of preparedness for mental health practice among newly qualified occupational therapists in South Africa. BMC Medical Education. https://doi.org/10.1186/s12909-026-10387-4

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10387-4

Keywords: occupational therapy, mental health, health professional education, South Africa, undergraduate curriculum, qualitative research, thematic analysis, clinical supervision, community-based training, culturally responsive practice, workforce preparedness, BMC Medical Education