When people think about Occupational Therapy the most common ideas which emerge revolve around physical rehabilitation and/or work within learning disabilities. Less commonly thought of are the areas within mental health and socially excluded groups. Placed within this latter category is Forensic Occupational Therapy.
Forensic Occupational Therapists (FOTs) work with service users who present as a risk of offending or who have a history of offending, and are concerned with promoting their occupational well-being.
In a keynote lecture at the National Forensic Occupational Therapy Conference (2004), Duncan (2004) stated that:
“Forensic occupational therapy engages people and facilitates their participation in meaningful life activities whilst assisting in the development of their increasing personal capacity and pro-social values, identity and skills.” Duncan (2004)
FOTs primarily work with those who have mental health problems, cognitive and/or social difficulties within secure environments which include but are not exclusive to; High secure units, Prisons and Community outreach services. Following the OT process FOTs aim to re-establish, maintain and develop the service users occupational functioning through encouraging independence, self-efficacy, a positive identity and whilst addressing their offending behaviours (COT 2011).
There is a wealth of different interventions which FOTs can utilise within this area, here are a few examples:
At present most FOTs work with those who are experiencing mental health difficulties which is a crucial role, however the links between occupational performance, offending behaviour and alienation are increasingly being recognised. The Social Exclusion Unit 2002 report , claims that custodial sentences are not succeeding in reducing reoffending levels and can also have a detrimental effect on an individual’s mental health and wellbeing including the erosion of effective life skills. This is therefore a prime opportunity for Occupational Therapists to be further integrated into forensic settings – helping service users to engage in meaningful and fulfilling occupations whilst reintegrating them into their society in a positive and pro-social way, excluding alienation and anti-social behaviour (Couldrick 2004).
It is important when thinking about Forensic Occupational Therapy to acknowledge the complex nature of both the service users and the environments, and how these provide frequent challenges for FOTs (Watkins 2001). For example creating and providing a therapeutic environment and program within a secure setting can prove to be very restricting.
Other areas of consideration include conflicting philosophies of therapy vs. punishment, the culture of the environment - in particular Prison regimes and regulations, and in accessing appropriate and ‘safe’ resources to facilitate assessment and interventions. FOTs may also come up against personal and professional issues where client-centred values of unconditional positive regard may be challenged, for example when faced with service users who have committed serious/sexual offences. It is when issues such as these arise that the importance and benefits of clinical supervision and reflection are openly recognized (Duncan 2003).
I find that the below quote by Martin Luther King can provide an encouragement for those embarking on this area of Occupational Therapy.
‘When we look beneath the surface, beneath the impulsive evil deed, we see within our enemy – a measure of goodness and know that the viciousness and evilness in his acts are not quite representative of all that he is. We see him in a new light.” Martin Luther King.