OTalk

#OTalk 23 February 2021 – The challenges and opportunities of delivering occupation-focused interventions in secure mental health services

This week’s chat is hosted by @ForensicOT_ELFT, the Official Twitter account for the East London Foundation Trust Forensic Occupational Therapy teams working at the John Howard Centre in Hackney and Wolfson House in Haringey.

Service users admitted to secure mental health services are typically defined as forensic patients. Based on the determination of what is both clinically appropriate and safe, forensic patients may be detained in mental health facilities or in the community. Forensic mental health services have a dual responsibility, to both treat the person with mental illness and protect the community, with a significant focus on safety (Whiteford G at al., 2019).

Forensic patients can be subject to lengthy admissions and may also experience stigma associated with their forensic status. Key outcome measures in current forensic mental health service provision include limiting the risk of relapse, readmission and engagement in unsafe behaviours. However, these foci may come at the expense of opportunities for occupational engagement and can result in occupational deprivation. Research suggests that the long-term effects on people living in occupationally restricted environments include social isolation and exclusion (Whiteford G at al., 2019).

The role of occupational therapy in any mental health setting is to enable people to maximise their independence in productivity, self-care and leisure through occupation. The ultimate aim of occupational therapy in a forensic mental health setting, however, is to enable patients to experience occupational enrichment and achieve optimal occupational functioning (RCOT, 2019). 

The focus of the occupational therapy teams working at the John Howard Centre and Wolfson House is to provide occupation-focused interventions which ensure occupational enrichment and reduce the risk of occupational deprivation, and the negative long term effects this can have on patients. 

Questions to consider

  1. What are your perceptions of, or experience of working in, forensic occupational therapy?
  1. What is your understanding of occupational deprivation?
  1. What is your understanding of occupational enrichment?
  1. What do you think the challenges may be working in a forensic mental health setting?
  1. What do you think the occupation-focused opportunities are working in this setting? 

References

Whiteford G at al. (2019) Combatting occupational deprivation and advancing occupational justice in institutional settings: Using a practice-based enquiry approach for service transformation. British Journal of Occupational Therapy. Volume: 83 issue: 1, page(s): 52-61

Royal College of Occupational Therapy (2019) Occupational therapists’ use of occupation-focused practice in secure hospitals Practice guideline (Second edition)

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