The work of forensic occupational therapists in solitary confinement: An international survey

Occupational therapists provide care in forensic mental health settings, including in solitary confinement. This study aimed to describe the work and experiences of occupational therapists in forensic solitary confinement internationally.

A cross-sectional online survey was used to collect quantitative and qualitative data, analysed using descriptive statistics and reflexive thematic analysis respectively.

There was no consumer or community involvement.

Data from 44 survey participants (50% from the United Kingdom) were analysed. Recovery principles, the Model of Human Occupation, and person-environment-occupation frameworks guided clinical reasoning. Risk assessment, working with correctional staff, and the physical environment, such as the door hatch, were described as being both enablers and barriers. The most frequent interventions were conversation, reading, games, music, and advocating for item and activity access. Occupational therapists' stress levels varied; debriefing with colleagues, supervision, separating work and home life, and work-related humour were the main coping strategies. Four themes were developed from the qualitative data: (a) We need to be flexible and responsive, (b) risk management affects what we do and how we do it, (c) we are reliant on others to fulfil our role, and (d) working in this environment is emotionally taxing.

The findings provide preliminary evidence of occupational therapists' work in solitary confinement internationally. Enablers and barriers of the physical environment, the role of support staff and resources in therapy provision, staff stress levels and coping strategies, and regulation variations across countries might impact occupational therapists' work. Further research is needed to explore the evidence for adapting and using interventions from acute and subacute mental health settings in secure forensic settings, and whether the Royal College of Occupational Therapy guidelines for practice in secure settings could be adapted for use in forensic solitary confinement settings.