Occupational Therapy with Long-Stay Service Users

  • Judith PettigrewEmail author
  • Roisin O’Regan
  • Alyssa Kidd
  • Padraic O’Flynn


The purpose of this chapter is to present an overview of occupational therapy intervention with long-stay forensic mental health users. It begins by defining occupational therapy and summarising its origins and domain of concern. The foundation of occupational therapy intervention is the promotion of health and well-being through engagement in meaningful occupation and the development of life skills and competencies to enable participation. The theoretical underpinning of occupational therapy emphasises the importance of understanding the transactional relationship between the individual, their environment and their occupations and understanding how these interactions can influence health and well-being. This unique perspective can contribute to all forensic contexts and at every stage of a service user’s journey, from pre-admission assessments to discharge, and can particularly augment and enhance occupational opportunities for long-stay users. The chapter provides an overview of approaches and interventions focused on well-being/quality of life and participation in meaningful occupations. It concludes by outlining some areas for future occupational therapy research.



We would like to thank Katie Robinson and an anonymous reviewer for comments on an earlier draft.


  1. 1.
    American Occupational Therapy Association. Definition of occupational therapy for the AOTA Model Practice Act. Bethesda, MD: AOTA; 2014.Google Scholar
  2. 2.
    World Federation of Occupational Therapists. Statement on occupational therapy. London: WFOT; 2010.Google Scholar
  3. 3.
    College of Occupational Therapists. Recovering ordinary lives: the strategy for occupational therapy in mental health services 2007–2017. Literature review. London: COT; 2006.Google Scholar
  4. 4.
    Couldrick L, Alred D. Forensic occupational therapy. London: Whurr; 2003.Google Scholar
  5. 5.
    College of Occupational Therapists (COT). Occupational therapists’ use of occupation-focused practice in secure hospitals: practice guideline. London: COT; 2012.Google Scholar
  6. 6.
    Wilcock AA. An occupational perspective of health. Thorofare, NJ: Slack Inc; 1998.Google Scholar
  7. 7.
    Yerxa E, Clark F, Frank G, Jackson J, Parham D, Pierce D, Stein C, Zemke R. An introduction to occupational science, a foundation for occupational therapy in the 21st century. Occup Ther Health Care. 1989;6:1–17.CrossRefGoogle Scholar
  8. 8.
    Carlson M, Park D, Kuo A, Clark F. Occupation in relation to the self. J Occup Sci. 2012;21:117–29.CrossRefGoogle Scholar
  9. 9.
    Jackson J. Sexual orientation: its relevance to occupational science and the practice of occupational therapy. Am J Occup Ther. 1995;49:669–79.CrossRefGoogle Scholar
  10. 10.
    Rebeiro KL. Enabling occupation: the importance of an affirming environment. Can J Occup Ther. 2001;68:80–9.CrossRefGoogle Scholar
  11. 11.
    Whiteford G. Occupational deprivation and incarceration. J Occup Sci. 1997;4:126–30.CrossRefGoogle Scholar
  12. 12.
    Peloquin SM. Moral treatment: contexts considered. Am J Occup Ther. 1989;43(8):537–44.CrossRefGoogle Scholar
  13. 13.
    Peloquin SM. Moral treatment: how a caring practice lost its rationale. Am J Occup Ther. 1994;48(2):167–73.CrossRefGoogle Scholar
  14. 14.
    Schwartz KB. History of occupation. In: Kramer P, Hinojosa J, Royeen CB, editors. Perspective in human occupation: participation in life. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 18–31.Google Scholar
  15. 15.
    Wilcock AA. Occupation for health: volume 2; a journey from prescription to self health. London: British Association and College of Occupational Therapists; 2002.Google Scholar
  16. 16.
    Pettigrew J, Robinson K, Dunne B, O’Mahoney J. Major trends in the use of occupation as therapy in Ireland 1863-1963. Ir J Occup Ther. 2017;45(1):4–14.CrossRefGoogle Scholar
  17. 17.
    Quiroga VA. Occupational therapy: the first thirty years, 1900–1930. Bethesda, MD: American Occupational Therapy Association; 1995.Google Scholar
  18. 18.
    Dunton WR. Reconstruction therapy. Philadelphia: W.B. Saunders Company; 1919. 07/06/2017
  19. 19.
    Peloquin SM. Occupational therapy service: individual and collective understandings of the founders, part 1. Am J Occup Ther. 1991;45(4):352–60.CrossRefGoogle Scholar
  20. 20.
    O’Sullivan E. Textbook of occupational therapy with chief reference to psychological medicine. London: H.K. Lewis; 1955.Google Scholar
  21. 21.
    Schmiedebach HP, Priebe S. Social psychiatry in Germany in the twentieth century: ideas and models. Med Hist. 2004;48(4):449–72.CrossRefGoogle Scholar
  22. 22.
    Christiansen C, Haertl K. A contextual history of occupational therapy. In: Schell BA, Gillen G, Scaffa M, Cohn ES, editors. Willard and Spackman’s occupational therapy. 12th ed. Philadelphia: Lippincott Williams & Wilkins; 2014. p. 9–34.Google Scholar
  23. 23.
    Pettigrew J, Robinson K, Moloney S. The bluebirds: world war 1 soldiers’ experiences of occupational therapy. Am J Occup Ther. 2017;71(1):7101100010p1–9.CrossRefGoogle Scholar
  24. 24.
    Manuel K. The scheme of curative workshops in the orthopaedic centres of the United Kingdom. Am J Orthop Surg. 1918;XIV(3):149–56.Google Scholar
  25. 25.
    Kelly B. He lost himself completely’: Shell shock and its treatment at Dublin’s Richmond War Hospital, 1916–1919. Dublin: The Liffey Press; 2014.Google Scholar
  26. 26.
    Reynolds J. Grangegorman: psychiatric care in Dublin since 1815. Dublin: Institute of Public Administration in association with Eastern Health Board; 1992.Google Scholar
  27. 27.
    Lloyd C. The role of occupational therapy in the treatment of the forensic psychiatric patient. Aust Occup Ther J. 1987;34(1):20–5.CrossRefGoogle Scholar
  28. 28.
    Chui AL, Wong CI, Maraj SA, Fry D, Jecker J, Jung B. Forensic occupational therapy in Canada: the current state of practice. Occup Ther Int. 2016;23(3):229–40.CrossRefGoogle Scholar
  29. 29.
    Farnworth L, Morgan S, Fernando B. Prison-based occupational therapy. Aust Occup Ther J. 1987;34(2):40–6.CrossRefGoogle Scholar
  30. 30.
    Chacksfield JD. Forensic occupational therapy: is it a developing specialism? Br J Ther Rehabil. 1997;4(7):371–4.CrossRefGoogle Scholar
  31. 31.
    Hitch D, Hii QK, Davey I. Occupational therapy in forensic psychiatry: recent developments in our understandings (2007–2013). Br J Occup Ther. 2016;79(4):197–205.CrossRefGoogle Scholar
  32. 32.
    Lin N, Kirsh B, Polatajko H, Seto M. The nature and meaning of occupational engagement for forensic clients living in the community. J Occup Sci. 2009;16:110–9.CrossRefGoogle Scholar
  33. 33.
    Long CG, McLean A, Boothby AJ. Factors associated with quality of life in a cohort of forensic psychiatric in-patients. Br J Forensic Pract. 2008;10:4–11.Google Scholar
  34. 34.
    Andreasson H, Nyman M, Krona H, Meyer L, Anckarsäter H, Nilsson T, Hofvander B. Predictors of length of stay in forensic psychiatry: the influence of perceived risk of violence. Int J Law Psychiatry. 2014;37:635–42.CrossRefGoogle Scholar
  35. 35.
    Davoren M, Byrne O, O’Connell P, O’Neill H, O’Reilly K, Kennedy HG. Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission. BMC Psychiatry. 2015;15:301.CrossRefGoogle Scholar
  36. 36.
    Duncan EAS. Forensic occupational therapy. In: Creek J, Lougher L, editors. Occupational therapy and mental health. 4th ed. Edinburgh: Churchill Livingstone; 2008. p. 513–34.Google Scholar
  37. 37.
    Molineux ML, Whiteford G. Prisons: from occupational deprivation to occupational enrichment. J Occup Sci. 1999;6:124–30.CrossRefGoogle Scholar
  38. 38.
    Cronin-Davis J, Lang A, Molineux M. Occupational science; the forensic challenge. In: Molineux M, editor. Occupation for occupational therapists. Oxford: Blackwell; 2004. p. 169–79.Google Scholar
  39. 39.
    Morris K. Occupational engagement in a regional secure unit. PhD. Lancaster: Lancaster University; 2012.Google Scholar
  40. 40.
    Cordingly K, Ryan S. Occupational therapy risk assessment in forensic mental health practice: an exploration. Br J Occup Ther. 2009;72(12):531–8.CrossRefGoogle Scholar
  41. 41.
    Farnworth L, Nikitin L, Fossey E. Being in a secure forensic psychiatry unit: every day is the same, killing time or making the most of it. Br J Occup Ther. 2004;7(10):430–8.CrossRefGoogle Scholar
  42. 42.
    Wilcock AA. An occupational perspective of health. Thorofare: Slack Incorporated; 2006.Google Scholar
  43. 43.
    Townsend E, Wilcock AA. Occupational justice and client-centred practice: a dialogue in progress. Can J Occup Ther. 2004;71(2):75–87.CrossRefGoogle Scholar
  44. 44.
    O’Neill C, Heffernan P, Goggins R, Corcoran C, Linehan S, Duffy D, et al. Long-stay forensic psychiatric inpatients in the Republic of Ireland: aggregated needs assessment. Ir J Psychol Med. 2003;20:119–25.CrossRefGoogle Scholar
  45. 45.
    Rutherford M, Duggan S. Forensic mental health services: facts and figures on current provision. Br J Forensic Pract. 2008;10:4–10. Scholar
  46. 46.
    Lindstedt H, Grann M, Soderlund A. Mentally disordered offenders’ daily occupations after one year of forensic care. Scand J Occup Ther. 2011;18(4):302–11.CrossRefGoogle Scholar
  47. 47.
    Saxena S, Orley J, WHOQOL Group. Quality of life assessment: the world health organization perspective. Eur Psychiatry. 1997;3:263–6.CrossRefGoogle Scholar
  48. 48.
    Craik C, Bryant W, Ryan A, Barclay S, Brooke N, Mason A, Russell P. A qualitative study of service user experiences of occupation in forensic mental health. Aust Occup Ther J. 2010;57:339–44.CrossRefGoogle Scholar
  49. 49.
    O’Flynn P, O’Regan R, O’Reilly K, Kennedy HG. Predictors of quality of life among inpatients in forensic mental health: implications for occupational therapists. BMC Psychiatry. 2019;18:16.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Judith Pettigrew
    • 1
    Email author
  • Roisin O’Regan
    • 2
  • Alyssa Kidd
    • 2
  • Padraic O’Flynn
    • 2
  1. 1.School of Allied HealthUniversity of LimerickLimerickIreland
  2. 2.National Forensic Mental Health ServiceCentral Mental HospitalDublinIreland

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