Background: Health care systems are changing and with them, the role and scope of occupational therapy. The inpatient mental health setting is one area where change has been rapid and expansive, directly impacting on the role of occupational therapy. Literature pertaining to the current practice of occupational therapy in this setting is currently overshadowed by a focus on community-based care. This article aims to describe and summarize the recently published literature regarding current practices of occupational therapy in this important setting. Methods: Current practices were identified with reference to policy documents, text books and journal articles dating from 1990 to the present day. Findings: There was found to be a paucity of current literature relating to occupational therapy practice in acute mental health. From the literature that was available, four core elements of occupational therapy practice in acute mental health were identified: individual assessment, individual treatment, therapeutic groups, and discharge planning. Conclusions: It is suggested that the development and communication of the occupational therapy role focusing on the four core elements of practice will provide a sound base for the development of the clinical role of occupational therapy in acute mental health. Occupational therapists working in the acute mental health setting are encouraged to be aware of the available literature pertaining to this area and establish a renewed focus on clinical research to evaluate current practice and to guide debate on emerging occupational therapy roles.