Forensic Psychiatry and Occupational Therapy

FORENSIC PSYCHIATRY AND OCCUPATIONAL THERAPY:
INTRODUCTION:
IMPORTANCE OF RELEVANT LEGISLATION:
Forensic mental health services specialise in the treatment of people with mental disorders as
related to legal principles. The word ‘forensic’ means ‘belonging to, or suitable for, the court or
public discussion’. The forensic mental health services are used to divert the person with mental
illness out of the criminal justice system and into mental health and social care services.
If the court finds that the accused is not capable of understanding the proceedings or is not fit to
plead, the court shall direct that the accused be detained in a psychiatric hospital. Where the
accused is directed to such a hospital, the accused may, if he/she is capable of understanding the
proceedings so far as to make a proper defence, be tried and prosecuted for the offence. If the court
finds that the accused was not criminally responsible due to mental illness, he/she can be found
not guilty or directed to be detained in a psychiatric hospital or prison. The accused’s capacity to
appreciate the wrongfulness of the act can lead to diminished responsibility and will be taken into
account with sentencing. The aim of forensic health services is to ensure care and treatment at all
different levels.
Assessments, Treatment and Planning aim to:
 Improve clients mental state and physical health

 Improve social functioning
 Improve selfcare
 Reduce aggressive and defiant behaviour
 Promote coping skills
 Encourage community integration
OCCUPATIONAL THERAPY MODELS USED:
1. Occupational Behavioural model (Mary Reilly)
The treatment of the forensic patient should activate the residual forces of the individual and equip
him/her with the abilities to perform his/her expected roles and responsibilities in the community,
the client should take responsibility in their treatment. This ensures that patients not only obtain
necessary information but also get to practice the life skills applicable.
2. Model Of human Occupation:
Links aspects of the model by determining the values, interests, and personal causation of the
patient in order to better understand their habits, roles and to also change their ability to perform
something based on their experiences.
Habits and roles are often resistant to change, but disturbed by the onset of the mental illness, some
relearning or developing of new habits may occur. The occupational therapist uses this assumption
to change habituation through sustained practice. By involving patients in structured activities on
a regular basis.
It is important to remember that the physical, social, cultural, economic and political aspects have a
huge impact on the motivation, organisation and occupational performance of the patient.
The Occupational therapists aims to:
 Reshape occupational abilities and identities in order to create new living experiences
based on the mental and physical capabilities in order for them to be able to perform their
expected roles and responsibility within community.
 Reshape and refine occupational identity and occupational competence that was lost with
the onset of the mental illness.
 Through participation in therapeutic occupations in a consistent manner, the mentally ill
patient reaches a level of mastery and becomes occupationally adaptive, and his/her
behaviour becomes healthier.
3. Vona Du Toit Model of Creative Ability
The model is useful when the patient cannot participate in standardised assessments and then could
be well described to the medico-legal fraternity using levels of motivation and action.
4. The Activity Performance Outcomes Measure:
Allows therapist to provide evidence of outcomes of services, track changes and look at trends and
determine the effect of chosen programme on client.
Assess 8 domains mainly:
 Process skills (cognitive skills)

 Communication and interaction skills
 Life skills
 Balanced lifestyle
 Role performance
 Motivation
 Self-esteem
 Affect
OCCUPATIONAL THERAPY ASSESSMENT AND TREATMENT:
The occupational therapist must determine the sequence of events in the life of the forensic mental
health service user to have a good understanding of his/her volition, habituation and occupational
competence.
Assessments that can be Utilised:
 COPM: Can be conducted through observations

 Collateral information: caregivers, close relatives, friends and colleagues.
 Assess behaviour and interpersonal relationship as patients struggle with substance abuse
 Emotional insight as it is usually poor.
THE OVERALL AIM:
The occupational therapist should strive to include stimulating activities in the programme, taking
into consideration cultural differences in the population. The overall aim should be to improve, as
far as possible, and maintain the functioning levels of the patients through structured and
unstructured activities with the underlying aim of preventing/diminishing institutionalization to
ensure the successful reintegration of patients into the community.
Patients experience occupational deprivation as they are held in specific environment.
Possible Intervention:
 Provide opportunities for the patients changing the environment in order to encourage the
development of skills. Within a working environment, create positions to develop the
appropriate interpersonal skills. Eg., developed a coffee shop for the low-security wards,
thereby developing skills in cooking, baking and serving but also to fulfilling the aim of social
skills training.
 Occupational group therapy can be used for social skills training to include anger
management, anxiety management, conflict resolution and assertiveness training.
 Personal management
 Recreation and leisure:
 Table activities e.g board games.
 Sporting events or activities, eg., soccer games between selected teams with
supporters for each group.
 Activities involving music, for example, dances, manufacturing of musical
instruments and forming a band.
 Skills development:
Develop skills by engaging in work related activities, these provide structure and a sense
of belonging that enhances self-image. They can act as external motivators, especially if
work performance is connected to wages
The changing focus related to the level of security in the wards/units

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FORENSIC PSYCHIATRY AND OCCUPATIONAL THERAPY:

IMPORTANCE OF RELEVANT LEGISLATION:

Assessments, Treatment and Planning aim to:

 Improve clients mental state and physical health

OCCUPATIONAL THERAPY MODELS USED:

1. Occupational Behavioural model (Mary Reilly)

2. Model Of human Occupation:

The Occupational therapists aims to:

3. Vona Du Toit Model of Creative Ability

4. The Activity Performance Outcomes Measure:

Assess 8 domains mainly:

 Process skills (cognitive skills)

OCCUPATIONAL THERAPY ASSESSMENT AND TREATMENT:

Assessments that can be Utilised:

 COPM: Can be conducted through observations

THE OVERALL AIM:

Patients experience occupational deprivation as they are held in specific environment.

The changing focus related to the level of security in the wards/units

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