Date Presented 04/04/19
Consideration of transitional housing in the forensic mental-health context has been limited. Largely, macro outcome measurement (recidivism or community tenure) has guided this work. While compelling, this does not speak to occupational performance outcomes or the practical impacts of day-to-day participation for consumers. Employing a qualitative phenomenological methodology, this study focuses upon consumer lived experience in transitional housing within the forensic mental-health context.
Primary Author and Speaker: Clark Heard
Contributing Authors: Jared Scott, Allan Tetzlaff, Heather Lumley
PURPOSE: This study considers the research question: “what is the meaning associated with participation in transitional justice housing for Forensic mental health consumers”? Transitional justice housing enables consumers of Forensic mental health services to move from care facility to community while maintaining key therapeutic supports. To date, transitional justice housing has been considered in the literature using conventional metrics (length of stay, community tenure); however, consumer narratives and related occupational performance outcomes have not been a focus.
DESIGN: A qualitative design consistent with Interpretative Phenomenological Analysis (IPA) was employed (Smith, Flowers & Larkin, 2009). Researchers recruited participants affiliated, via Disposition Order with the Southwest Centre for Forensic Mental Health Care in St. Thomas, Ontario, Canada. Participants were required to have resided, for at least six months, at a partnered transitional justice housing setting in London, Ontario, Canada.
A convenience sample (n=6), including 3 females and 3 males, consented to participate. Average age of participants was 47 years with a range from 36 to 64. Total tenure within the Forensic mental health system in Ontario was 7.6 years per participant with a range of 3.5 years to 11 years. The average length of stay in the partnered transitional justice housing was one year and eight months with a low of six months and a high of two and one-half years. Diagnoses present among the sample included schizophrenia, schizophrenia (paranoid type) and schizoaffective disorder.
METHOD: A standardized interview protocol was utilized with collected data coded for themes using an editing style of analysis. Three independent coders of varied clinical background coded the data. Definitions were developed and overarching themes identified. Coding agreement was found to be 87.2%. Several methods were employed to establish trustworthiness including member checking, triangulation by analyst and by theory/perspective.
RESULTS: Participant responses supported several key themes: 1) Challenges in adapting to the transitional housing environment enabled personal growth; 2) Participation in transitional justice housing fostered personal agency (belief, awareness, confidence, esteem, and hope); 3) Experiential learning enabled practical competency development; 4) Community living skill development was practical and transferrable.
Speaking to this latter point, one participant (#1) noted: “It’s given me a good review and presented me with further insight into my ability to live in the community and increased my capacity to live alone. It’s helped me by providing support. It’s been a good place to integrate me back into society and I think I’ll be successful in my integration to the community because of it. I’m sure I will be.”
CONCLUSION: What is the meaning of participation in transitional justice housing for Forensic mental health consumers? Participants in this study identified that such residence supported the opportunity to achieve personal growth/agency and autonomy while renewing community living skills in a respectful and supportive environment. Not every consumer will need this level of support; however, for Occupational Therapists the outcomes of this study speak to the centrality of relationally driven, immediately available and personally accountable transitional mental health care.
IMPACT STATEMENT: This study considered the lived experience of individuals participating in transitional justice housing in a Forensic mental health context. Their narratives speak powerfully to the need for similar programs to enable occupational performance and support transition from hospital setting to community.
References
Cherner, R., Nandlal, J., Ecker, J., Aubry, T., & Pettey, D. (2013). Findings of a formative evaluation of a transitional housing program for forensic patients discharged into the community. Journal of Offender Rehabilitation, 52(3), 157-180. doi: 10.1080/10509674.2012.754826
Cherner, R., Aubry, T., Ecker, J., Kerman, N. & Nandlal, J. (2014). Transitioning into the community: Outcomes of a pilot housing program for forensic patients. International Journal of Forensic Mental Health, 13, 62-74. doi: 10.1080/14999013.2014.885472
Graffam, J., Shinkfield, A., Lavelle, B. and McPhearson, W. (2004) Variables affecting successful reintegration as perceived by offenders and professionals," Journal of Offender Rehabilitation 40: 147-171. doi: 10.1300/J076v40n01_08
Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative pheonomenological analysis: Theory, method and research. Thousand Oaks, CA: Sage.
