OBJECTIVE Severe workforce shortages in occupational therapy require an examination of viable practice areas for occupational therapists. The mental health practice area has experienced greater shortages than have other areas of occupational therapy; in South Carolina, only 2% of occupational therapists work in mental health. This study was undertaken to examine the use of occupational therapists in mental health settings in South Carolina. METHODS A survey was sent to administrators at 52 South Carolina mental health facilities to collect information on the use of occupational therapists, the associated economic issues, and the perception of the roles of occupational therapists. RESULTS Among the 34 respondents, 39% hired occupational therapists on a part-time or contractual basis, and 17% had full-time occupational therapist positions; 33% hired certified occupational therapy assistants on a part-time or contractual basis, and 11% had full-time certified occupational therapy assistant positions. Occupational therapy positions decreased over a 5-year period, and respondents cited the cost of salaries and problematic recruitment as two of the major contributing factors. The need for occupational therapy services was ranked as the number one factor both for increased and decreased use of occupational therapists. Personnel factors were highly ranked for facilities with decreased use whereas patient-related factors were highly ranked for facilities with increased use. CONCLUSIONS The findings highlight factors that may contribute to recent trends of fewer occupational therapists in South Carolina choosing mental health as a primary practice area.