Unlocking potential: Occupational therapy in the justice system 

Elaine Rutherford is a clinical specialist occupational therapist working in a Category B prison in South Wales. With over 20 years of experience, she is dedicated to helping individuals in the criminal justice system regain independence and build better futures through person-centred therapy. In this blog, Elaine shares her experiences, offering a glimpse into the challenges and rewards of occupational therapy in a prison setting.

My journey as an occupational therapist  

I began my occupational therapy training back in 1999 at the University of Wales College of Medicine (now Cardiff University). Since then, I’ve held roles in social services, secure psychiatric services, and neurodegenerative locked rehabilitation. Currently, I work for Cwm Taf Morgannwg NHS Trust, funded by Bridgend County Borough Council, to support local authority obligations under Part 11 of the Social Services and Wellbeing Act 2014 within the prison estate. I have started the third year of my Master’s in Professional Practice at the University of South Wales. 

My occupational therapy degree was one of the first problem-based learning courses in the UK. It marked a significant shift from traditional classroom teaching, which took some adjustment, but it really helped me grow as a person-centred practitioner with strong clinical reasoning skills. When working with individuals who’ve been marginalised and often feel powerless in their care or future, focusing on their strengths and collaborating to create an achievable plan is something we, as occupational therapists, are uniquely equipped to do. 

How I found myself working in the criminal justice system 

Throughout my career, I’ve always been interested in the connection between occupation, health, wellbeing and the criminal justice system. Research shows that individuals living in the most deprived areas of the country are over ten times more likely to spend time in prison. In my various roles, I’ve worked with offenders and ex-offenders experiencing challenges related to occupational dysfunction. 

When I came across the role with Bridgend County Borough Council at the prison, it felt like the perfect fit - combining many aspects of the different roles I’ve held over the years, all in one. 

Working as an OT in a prison 

My role focuses on three main areas: 

• initial assessment and intervention: supporting prisoners in managing daily activities within the prison environment. Many prisoners lose access to emotional, psychological and practical support from community services, family and friends, or find themselves in environments not suited to their functional needs 
• education and skills practice: working with people with disabilities who require equipment provision or adaptive techniques to manage independently during their sentence 
• release planning: ensuring individuals have access to appropriate living environments and support upon release, as well as helping them prepare for changes in functional demands in the community. 

Challenges of working in a prison environment 

Challenges fall into three categories: organisational, professional and demographic. 

• Organisational: Working in a prison environment with safety, security and routine restrictions can sometimes be a challenge for health and social care professionals promoting person-centred care and independence. Building strong relationships with officers and other agencies within the prison is key to navigating issues like prison schedules and access to wings that may be unsettled. 
• Professional: Being the sole occupational therapist in the prison can feel isolating at times due to the complexity of decision-making and risk management considerations, however the uniqueness of the role is what I thrive on. I stay connected with community OTs in Bridgend and OTs in local acute hospitals and have support of local authority and health board managers. The growing demand for OT services, while positive, can also be a source of pressure as occupational therapy becomes more valued across the prison system. 
• Demographic: The prison population has a higher health and social care burden than the community, with frailty appearing at younger ages, alongside high levels of psychiatric disorders and substance misuse. 

I’m hopeful that the Occupational Therapy Workforce Strategy for Wales and the work of RCOT’s Justice Sector Reform will create more opportunities for OTs to shape proactive integrated services in custodial settings to move beyond medical model-based prison healthcare which often lacks sufficient AHP representation. 

What I love about my role 

Hearing individuals talk about their occupational histories, uncovering strengths they didn’t know they had, and helping them build a positive, stable future through occupation is what motivates me every day. 

I’m also excited to see occupational therapy gaining recognition and OT presence is being requested by agencies like the Parole Board, MAPPA panels and Offender Management. 

There’s a growing demand for OT’s input, particularly in assessing individuals’ potential to function independently upon release. 

Building connections with the University of South Wales to provide student placements and overcoming the challenges that come with that has been really rewarding, and I hope it continues. 

No two days are the same, my caseload is varied, and the team at the prison is supportive and great to work with. 

What would I say to a student considering a role as an occupational therapist in a prison setting? 

Go for it! Take every opportunity for placements that comes your way and see how you feel.  

Occupational therapy roles in prison can vary - we work within specialist services such as mental health care or Integrated Autism Services, primary care and social care teams throughout prisons in the UK. 

Prison settings offer the chance to deliver person-centred therapy that makes a real difference to people’s futures. As professionals it also gives a fantastic foundation working with individuals facing a range of complex interlinked physical and mental health challenges. 

Are you considering a career in occupational therapy?

If you’re ready to embark on a career that changes lives, let Elaine’s experiences inspire you. Occupational therapy offers countless opportunities to make a real difference, and we’re here to support you every step of the way.

From resources and networking to a community of passionate professionals, discover how RCOT membership can empower you to achieve your goals.

Discover more inspiring learner and practitioner stories in our ‘OT in action: real stories, real impact’ blog series and explore our resources for students and aspiring OTs.

Ready to take the next step? Learn how we can support you on your journey to becoming an occupational therapist.