Occupational Therapy-Informed Rehabilitation for Homeless Individuals with Mental Illness: A Thai Policy-Linked Model of Restorative Life Activities

Abstract

Purpose: People experiencing homelessness with mental illness in Thailand face substantial structural barriers to sustained care and psychosocial rehabilitation. This study aimed to describe and evaluate the feasibility of an occupational therapy–informed, policy-linked rehabilitation model implemented within Thai governmental shelter systems. Materials and Methods: The Restorative Life Activities for the Worthy model was implemented across 14 public shelters involving 495 clients and 52 staff members. A mixed-methods design was employed. Of 84 screened clients, 60 met eligibility criteria and were followed quantitatively. Five standardized instruments assessed health-related quality of life, functional performance, cognitive stability, psychiatric symptoms, and individualized rehabilitation outcomes. Staff training outcomes were also evaluated. Results: Among 60 tracked clients, 47.6% participated in multiple intervention components, with 45 demonstrating functional gains. Vocational engagement included internal shelter-based roles (51.2%) and external employment (28.6%). The Individualized Rehabilitation Assessment demonstrated moderate reliability (r = 0.673). Assessment of Work Performance results showed a significant gender difference in process skills favoring males (p =.012), with no differences by substance use history. Post-training, 57.1% of staff demonstrated adequate application of rehabilitation principles. Discussion: Findings indicate that structured, occupation-based rehabilitation can be feasibly integrated into resource-constrained shelter systems when aligned with policy frameworks and supported by task-adapted workforce roles. Conclusion: The model aligns with WHO’s ICOPE framework and Buddhist concepts of “right livelihood,” introducing a vocationalist role to address service gaps. Findings support feasibility within Thailand’s public welfare system and relevance for policy-informed psychosocial rehabilitation in Southeast Asian contexts.