Occupational therapy services offered in behavioral health remain low despite the growing number of individuals with behavioral health and psychosocial needs who could benefit from these services. Concurrently, in academia, all occupational therapy and occupational therapy assistant students must complete at least one fieldwork focused primarily on mental health, behavioral health, and/or psychosocial needs. Research is limited regarding these fieldwork experiences, especially among occupational therapy assistant students. This project aimed to understand this gap better and comprehend how these experiences impact readiness to work with individuals labeled with a serious mental illness. Forty-five occupational therapy assistant students completed pre- and post-questionnaires regarding their experiences working with individuals with mental health, behavioral health, and/or psychosocial needs. Conventional content analysis and dialogic analysis revealed notable improvements in student perceptions and competencies as a result of their fieldwork experiences. Persistent safety concerns from pre- to post-fieldwork highlight the need for occupational therapy assistant programs to incorporate targeted educational content and experiential learning to address this issue. Responses underscore the critical role of this fieldwork in promoting holistic practice and reaffirming occupational therapy's foundational roots in supporting mental health and well-being.