OTalk

#OTalk – 30 March 2021 – Exploring the purpose of OT in prisons

This chat will be hosted by Deborah Murphy @Murphlemurph 

When tasked with transforming a leisure-based day service in a prison to being an Occupational Therapy led therapeutic service in 2014, I searched for evidence to base my service design on. To my surprise there was almost nothing written about Occupational Therapy in prisons, and it was necessary to develop a ‘service model’ through trial and error. Although I had brought along over a decade’s clinical experience from forensic hospitals, it was evident that prisoners and OT’s within prisons had unique needs and aims. 

In contrast to the very slow turnover of men with ‘severe and enduring’ mental health needs within forensics, working in a remand prison demanded prioritising need within a rapidly changing population of 1300 prisoners.  It became apparent that our service needed to be responsive to men with multiple complex needs.  Alongside those with mental health issues, prisons have an over representation of men on the autistic spectrum, and other neurodevelopmental disorders, ADHD, personality disorder, and brain injuries.  We are much more likely to encounter those who are acutely suicidal and self-harming, and those with presentations related to acute emotional trauma.  Many have multiple complex social problems including family breakdown, immigration issues, problematic substance use, homelessness which are of immediate concern.

In 2017 the RCOT produced a factsheet related to OT in prisons, however none of the evidence presented related to the English prison context.  The research presented referred to 3 UK studies, but these were all examples from forensic services, a system very different to that of prisons, one was US prison and focussed specifically on an interdisciplinary substance use program from 13 years previously, with limited transferability to contemporary mental health practice in the UK, and one was from a Singaporean prison.  Closer to home (a fantastic) initiative of an OT setting up a choir in a prison in Belfast is mentioned, but such a niche example held little in the way of guiding our general practice.  I wondered how as OTs in prisons we might be able to build a more local relevant knowledge base?

Over the past 7 years I have assertively networked with OT’s across the UK and beyond in attempt to establish whether I am developing my service along principles consistent with other OT’s.  It has become increasingly evident that OT’s in prisons are a disparate bunch, with no coherent model of practice.  Although many are doing fantastic work in their own spheres, what we offer is largely subject to the trends of the geographical area, and the motivations of the service managers in that area.  

Against this backdrop we joined forces with the RCOT forensic special interest group in 2020 and the forum was renamed the #ForensicPrisonForum to acknowledge our diversity.  In recognition of our unique needs we also formed a ‘splinter’ group of OT’s who work in diverse areas of the justice system.  This justice-based OT forum #JBOT is not affiliated to our professional body and is open to anyone and everyone with an OT role related to the justice system.  Here we can consider how we develop our practice and create an evidence base in the numerous new and exciting roles which OT is expanding into within the justice system.  We hope to use our considerable shared practice experience to create guidance for others entering into these roles. 

We are keen to promote the diversity of our roles and to reach out to students and practitioners interested in this area of work.  I decided to bring some of the questions we commonly consider to this broader forum at #OTalk and look forward to hearing people’s thoughts and views.

Question 1. What interested you in coming along to tonight’s talk? What might you find appealing/unappealing about working in a prison setting and what made, or might make you consider working in this area? 

Question 2. What historical, social, psychological factors do you feel might impact people’s life ‘choices’ & contribute to their committing criminal offences? Do you have examples of approaches/ interventions OTs might use to increase the life chances of those in prison?

Question 3. Unconditional positive regard can be challenging when faced with those who perpetrate particular offences. How might we manage more difficult feelings in our practice, and how might such feelings influence the service we provide as OT’s? 

Question 4.  It is generally accepted in the Criminal Justice system that preventing reoffending is a poor measure of therapy outcomes, due to complex social factors motivating offending; So what outcomes might OTs look for to measure success? What might a good outcome look like?

Question 5.  Many people believe those in prison are unworthy of our time & attention. How might we persuade people (including prison personnel) that those in prison are worthy of healthcare generally & OT specifically? What might we say about the occupational needs we are meeting?

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