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ii Rationale: Consumers of the mental health system with serious mental illness have been deprived of meaningful occupations since de-institutionalization began in the late 20th century. Community mental health policy has failed to focus on the meaningful occupational lives of this group of service users. Given the disparity in activity and meaningful time use for people with serious mental illness when compared to the general population, it is clear that a treatment that draws attention to occupational balance and engagement is needed. As balanced time use has been shown to increase community adjustment and life satisfaction, it is an important area of focus. Objectives: The purpose of this study was to pilot test the efficacy of a new occupational time use intervention, provisionally titled “Action over Inertia, ” designed to increase occupational balance and engagement in the lives of people with serious mental illness living in the community. Methods: A prospective, multi-centre randomized controlled trial of the intervention, involving 5 Assertive Community Treatment (ACT) teams in southeastern Ontario, ran in Fall 2007/Winter 2008. 18 ACT clients took part in the 12 week intervention, which was delivered by the ACT team occupational therapists. Results: Time use, used as a measure of occupational balance, shifted away from sleep to increased general activity in the treatment group (p=0.05). Treatment and control groups did not differ on occupational engagement measures after the completion of the trial. Feedback on the clinical utility of the intervention was very positive from both therapists and treatment participants. Conclusions: This pilot test revealed initially positive data on the efficacy and clinical utility of the intervention. Further study of the “Action over Inertia ” intervention is needed on a larger scale, potentially with a longer treatment timeline to further investigate its usefulness. iii

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