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