Prison Occupational Therapy: The Light in the Dark
My name is Charlotte and I’m a specialist occupational therapist working within HM prison service. I have been an OT since 2015, graduating from the University of East Anglia with a 2:1. I am employed by the NHS and work within a specialist mental health unit within the prison establishment. Prior to this I worked within a mental health OT service covering acute wards, rehabilitation units and patient’s homes.
When people think of prisons, they imagine high walls, barbed wire and locked doors. Perceptions of individuals detained in prison can be equally gloomy. Have you ever stopped to wonder what led that individual to crime and the circumstances of their own life which led to them being in the criminal justice system. Childhood trauma, abuse, poverty and substance use are all core factors influencing offending behaviour, with high numbers of prisoners having significant mental illness. If you read the background of these individuals within hospital notes, would you want to help in your role? Individuals with mental health needs in the justice system are some of the most vulnerable individuals in society, who are in dire need of support from health and justice professionals.
I’m an occupational therapist working within HMP Durham, a regional remand prison, where those charged await sentencing or release for various crimes, spanning from robbery to murder. My patients are those transferred to our specialist mental health unit for assessment and treatment, due to being in acute mental crisis and at high risk to them self and potentially suicide. This model was designed as an innovative way to support those in highest need whilst in custody as a result of long waiting lists for mental health hospital transfer and high need for intensive mental health support, in prison.
My daily practice aims to explore these individual’s occupational performance (ability to complete daily activities) and support them to be able to achieve this, both in an adapted way within the prison environment and in preparation for hospital or release. In doing so, engagement in meaningful occupations assists in reducing suicide and self-harm behaviours and supports recovery from mental illness. Furthermore exploration of new learning/skills and activities aims to reduce engagement in criminal activities and improve ability to function independently. These interventions completed both one to one and in groups includes; daily living skill development (cooking, budgeting, personal care etc) educational/vocational activities, creative hobbies, social skills and emotional regulation.
Prison occupational therapy continues to be a generally rare posting within the NHS despite significant research globally highlighting the essential need for OTs in prisons, based on the reasons stated above. More interest and understanding of the role is needed from the future frontline and practicing therapists to increase commissioning of these posts.
It is a rewarding career which encourages creativity, problem solving and working with often undervalued individuals to improve their lives.