The settings and roles of occupational therapists working in Ireland in mental health have changed greatly over the last decade. Occupational therapy's central tenet, however, that of focusing on occupation and the belief that it is vital in maintaining and promoting people's health and wellbeing, has not. If occupational therapists wish to remain a strong presence in mental health, they will have to adopt many generic roles and work activities while developing and maintaining unique discipline-specific roles. It is time for occupational therapists to focus on occupation, government policy and evidence-based practice in order to identify specialist roles for occupational therapy in mental health. Through this process, health promotion, social inclusion and supported employment stand out as three key areas with which occupational therapy has a good fit.