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Dr Jane Cronin-Davis' doctoral research in forensic mental health

Dr Jane Cronin-DavisAt the start of my doctoral research in 2004, personality disorder services were a growing area of clinical practice for occupational therapists, although it had not been made evident that occupational therapy could address the diverse range of occupational needs of forensic patients (Mountain, 1998b). At the time, it was obvious to the researcher that there were significant gaps in the literature and evidence-base, particularly in terms of occupational therapy (COT, 2002; Duncan et al, 2003; Mountain, 1998a, 1998b).

The aim of the research was to explore occupational therapy practice with men diagnosed with personality disorder in high and medium secure hospitals, focusing on views and perceptions of patients, managers and occupational therapists. A qualitative methodology was used; Interpretative Phenomenological Analysis (IPA, Smith et al, 2009) with in-depth interviews as data collection. Nineteen participants were recruited from four different research sites in England; two high and two medium secure hospitals. There were three groups of participants: patients with a diagnosis of personality disorder (n=8), occupational therapy managers in forensic services (n=4) and occupational therapists (n=7) working with the patients.

Patients’ interviews suggested implications relative to their diagnoses; that they valued occupational therapy and their therapeutic relationships with occupational therapists. Some used occupational therapy as an escape from other therapies. Engagement in occupational therapy and specific occupations helped create their occupational lives.

Emergent themes from the managers’ analyses suggested they considered the personal and professional qualities required of occupational therapists to work with the patients; occupational therapy, theory and practice; and staff management issues.  They acknowledged the emotional stressors related to working with the patient group and a need to understand the diagnostic implications of personality disorder.

Themes from the occupational therapists’ data indicated they believed there were diagnostic implications on patients’ occupational performance; they considered their therapeutic relationships; and specific skills, knowledge and experience were required to work with the patients. They acknowledged the impact of the work environment and explored issues related to multi-disciplinary team working, risk management and occupational deprivation found in the forensic environment.

The findings indicated implications for education, occupational therapy practice and future research. The findings indicate that occupation-focused occupational therapy needs to be emphasised for men diagnosed with a personality disorder in a forensic setting.

 

References

Smith J, Flowers P, Larkin M (2009) Interpretative phenomenological analysis: theory, method and research. London: Sage.

Duncan E, Munro K, Nicol M (2003) Research priorities in forensic occupational therapy.  British Journal of Occupational Therapy Journal.   66(2), 55-63.

Mountain G (1998a) Occupational therapy in forensic settings: a preliminary review of the knowledge and research base. London: College of Occupational Therapists.

Mountain G (1998b) Occupational therapy services: securing the future. British Journal of Occupational Therapy, 61(5), 236-237.