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  • Roots of recovery: Occupational therapy at the heart of health equity

Roots of recovery: Occupational therapy at the heart of health equity

Criminal justice system

Place-based systems of care take responsibility for all people living within a given area, bringing organisations together around the population they serve.93 An example of this is occupational therapists working within prison services.

 

People who are incarcerated or detained, from young offenders through to those serving longer sentences, can have complex health and care needs. They have the right to health and wellbeing94 and should have access to good integrated health and care support.95

Occupational therapy offers a valuable contribution to working with the general prison population (many of whom may have experienced occupational deprivation during their life due to social, economic and environmental factors) as part of a ‘whole prisons approach’ in which the wider determinants of health are addressed. Interventions might include:

  • health promotion activities,
  • life skills programmes,
  • interventions to help people who are incarcerated or detained gain insight into lifestyle choices and that promote prosocial behaviour; and
  • helping prepare for re-integration into the community, including through educational and vocational rehabilitation programmes.

Occupational therapists also work in partnership with prison services to identify and address an individual’s health, care and environmental needs, as well as risk factors, particularly for those with additional needs due to mental or physical ill-health or learning disabilities.96

Key components for delivery

Establish and support occupational therapists where they can:

  • Work with prison offender managers/resettlement officers to design effective interventions to support individuals to take up opportunities within the prison and post release.
  • Advise on design of prison facilities to encourage productive engagement and accessibility.
  • Meet the legislative requirements for the assessment of social care needs in prisons and approved premises.97.98

Return on investment

Occupational therapy within prison services aims to equip people with the life skills that they may not have gained earlier in life. Intervention prevents reoffending by building in protective factors such as thinking and decision-making skills, using a person’s strengths and developing a positive sense of identity, which leads to greater resilience both during and after a prison sentence.

Case study - HMP Cardiff

Introduction
The mental health team within HMP Cardiff provides assessment, care and treatment for those in custody that require input from either primary or secondary care services.  The occupational therapy team have a clear mission statement of encouraging and facilitating occupational engagement in an environment of occupational deprivation.

Awareness
During the COVID-19 pandemic those being newly received into custody needed to isolate for fourteen days before they could mix with the rest of the population. The occupational therapy service realised it would need to change practices to ensure that activities and input were available to this group to manage the excessive time confined to their cells.

Action
The service produced temporary isolation care plan templates.  The care plan included their wishes about how they would like to maintain contact with the service during isolation as well as what resources could be provided to ensure that they could engage in activity while isolated. Additional help was provided for those with known literacy issues and those who were unlikely to return the forms independently.

The occupational therapists also produced a ‘Things to do when isolating’ booklet that included activity ideas, relaxation and breathing techniques, self care and hygiene tips. The prison print shop produced booklets so they were available on all wings.  The booklet was available with a mixture of pictorial activities and text to reflect varying levels of literacy. All individuals on our caseload had either an individualised care plan or one to one discussion around their needs in which resources for in cell activities were discussed and provided.

Advocacy
The work increased the service’s understanding of the realities of being housed in such a small and restrictive environment without access to a wider range of options to occupy mind and your body. By listening to the experience of people who previously had periods of isolation, the occupational therapists had a much clearer narrative of the impact and experience of this.

The outcomes of these temporary care plans were shared with all those in the team that were working with the individual to widen knowledge throughout the prison.

Outcomes
Support was informed by people with lived experience. New people entering the system had tailored activities during the isolation period.
The isolation pack was shared with other services on forums.

The ‘Things to do when isolating’ booklet can be adapted and continue to be of used post Covid-19 isolation regulations given that our population spend so much time in their cells.

References

93. The King’s Fund (2021) Developing place-based partnerships: the foundation of effective integrated care teams. London: The King’s Fund. Available at: https://www.kingsfund.org.uk/sites/default/files/2021-04/developing-place-based-partnerships.pdf

95. Department of Health and Social Care (2021) Care and support statutory guidance. London: DHSC. Available at: https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance

97. Great Britain. Parliament (2014) Care Act 2014. London: Stationery Office. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents

98. Welsh Government (2014) Social Services and Well-being (Wales) Act 2014.Cardiff: Welsh Government. Available at: https://gov.wales/sites/default/files/publications/2019-05/social-services-and-well-being-wales-act-2014-the-essentials.pdf

99. Great Britain: Parliament. The Mental Health Act 1983). London: Stationery Office.  Available at: https://www.legislation.gov.uk/ukpga/1983/20/contents


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