Authors (including presenting author) :
Lai SK(1), Lam HC(1), Mok CM(1), Tsang MY(1)
Affiliation :
(1)Occupational Therapy Department, Castle Peak Hospital
Keyword 3: :
Mental Disorder
Keyword 4: :
Forensic Psychiatry
Keyword 5: :
Occupational Therapy
Keyword 6: :
Quality of Life
Introduction :
Occupational Therapy in forensic psychiatry empowers individual by using meaningful activities to rebuild life skills, promote independence and sense of purpose. Intensive rehabilitation was provided for forensic inpatients with criminal involvement by multi-disciplines before reintegrating into the community. However, as a necessitate of violence management to ensure safety, traditional forensic mental health service was always regarded as paternalistic and coercive by the service users. Despite having liberty and freedom curtailed, recent study suggested that opportunities exist to meaningfully involve forensic patients in the design, delivery and evaluation of rehabilitation programmes, so as to promote patient engagement and treatment outcomes. By actively empowering patients in the rehabilitation process, it is hypothesized that the recovery journey and quality of life for forensic inpatients could be enhanced.
Objectives :
The objective is to evaluate the effectiveness of Occupational Therapy Empowerment Programme in promoting recovery and quality of life for forensic inpatients. Risk assessment would also be conducted to investigate the change in violence risk factors.
Methodology :
This evaluation adopted a single group pre-post design. Forensic inpatients who were referred to Occupational Therapy Department and were recruited to the Multi-Activity Centre (MAC) or Community Reintegration Unit (CRU) were selected for analysis. The Programme comprised of: i) Individualized and collaborative treatment goal setting; ii) Patient-led committee composed of staff and patient representatives, which act as patient involvement in shared decision making on the arrangement of rehabilitation programme; and iii) Positive experiential learning to promote patient engagement, self-efficacy and quality of life. Baseline and post-intervention assessment were conducted using i) Hope Scale, ii) General Self-Efficacy Scale (GSE), iii) World Health Organization-Five Well-Being Index (WHO-5), and iv) Short-Term Assessment of Risk and Treatability (START). All outcome measures were analysed using paired t-test, and p value< 0.05 was adopted for statistical significance.
Result & Outcome :
Thirty-one forensic inpatients with mean age of 48.7 years (SD=13.4) were evaluated. Participants were mostly male (74.2%) with schizophrenia spectrum disorders (90.3%). Significant improvements were observed in the total score of Hope Scale (t=2.81, p< .01), GSE (t=2.10, p< .05) and WHO-5 (t=2.17, p< .05). Regular multi-disciplinary risk assessment (START) also demonstrated significant reduction in violence risk factors (t=-2.51, p< .05) and improvement of protective factors (t=3.51, p< .01). These findings suggest that an empowerment-based OT programme can effectively enhance recovery while simultaneously reducing violence risk in forensic settings.
