Being in a Secure Forensic Psychiatric Unit: Every Day is the Same,Killing Time or Making the Most of It

Abstract

Institutional environments are challenging settings in which to provide rehabilitation. This study describes the time use of a group of inpatients, the majority diagnosed with schizophrenia, in a secure forensic psychiatric unit in Australia. Time diaries, interviews and fieldnotes were collected over 5 weeks. Eight participants completed time diaries for two consecutive days, of whom five were also interviewed using the Occupational Performance History Interview II.

The participants' time use was dominated by personal care and leisure occupations. In general, the participants were dissatisfied with their time use, describing themselves as ‘bored’ or ‘killing time’. Many perceived that the environment created barriers to their participation in valued occupations, yet some also found occupations that provided solace, challenge or a connection with the outside world.

The findings indicate the importance of understanding individuals' unique occupational histories, interests and skills in order to create opportunities to engage them in relevant occupations that use personal resources, as part of forensic rehabilitation programmes, and the utility of the Occupational Performance History Interview II in this context. Further research exploring patient and staff perspectives on the challenges of occupational programming in forensic settings and the longitudinal impact of such programming on inpatients' occupational functioning, health and wellbeing is recommended.