Forensic: Challenges for OT

Institutional Limitations

 When institutionalized, individuals are unable to choose meaningful occupations and are only able to perform certain occupations when permitted which results in a lack of autonomy and control (Ozkan et al., 2018). Individuals often report feeling bored, frustrated, and occupationally alienated (Craik et al., 2010). Facilities often have an impoverished occupational environment in general. Due to safety, occupations are also often only at designated times, locations, and have limited resources (Craik et al., 2010). Level of security, opportunities for occupational participation, availability of meaningful occupations, and participation with strangers were reported as barriers to participation. Overall, a lack of autonomy, control, and unstructured time use has the potential to impact an individual's routines, habits, and volition (Ozkan et al., 2018). Occupational deprivation is also a barrier to occupation-based treatment (Craik et al., 2010). 

Limited Education 

Although the principles of OT clearly apply to forensic populations, there is still little education provided to students regarding forensic populations specifically. A lack of knowledge about risk-assessment, available community support resources for these populations, safety considerations, and trauma has the potential to impact interest and confidence in the practice area. However, working within forensic settings is similar to working within any other mental health setting.

Mindset

Working with individuals within correctional settings requires a unique perspective, set of skills, and attitude that will enable an OT to be open-minded to providing services to "the bad guys" (Munoz, 2011). Striving to understand each client's story, consider their story within an environmental and socio-cultural context, and meanings within their story are typical expectations of an OT in any setting (Munoz, 2011). However; OT's have their own set of biases. These biases may pose a challenge when working with forensic populations. OT's may find it difficult to provide services to individuals that may have knowingly behaved in ways that go against the their own personal morals and values.

Emerging Area

OT is a frequently misunderstood profession (Newton, 2007). Furthermore, forensic OT is still considered an emerging practice area that requires further research to gain more understanding and guidance about OT's role and the effectiveness of treatment. Although OT has been involved in the mental health field for over 70 years, it's role is still unclear (Rojo-Mota et al., 2017). This could be due to the limited amount of research performed that supports OT's role in the mental health setting (Rojo-Mota et al., 2017). Limited research, a lack of practice guidelines, and being misunderstood by other members on their interdisciplinary team pose challenges for an OT in this practice area (Royal College of Occupational Therapists, 2017).

Job Characteristics

Jobs are available in this practice area; however, there fewer opportunities than in other areas. At times, these facilities do not submit job postings on traditional job-seeking websites. Also, it is difficult to find individuals who are interested in taking a job in this practice area. If an OT working in this practice area decides to leave their position and an organization has difficulty filling it, the position may be absorbed completely rendering no OT at that facility. In other instances, there are often no existing positions available, such as within residential rehabilitation programs, and an OT interested in working within this practice setting must create their own position thus requiring advocacy efforts, program development, and often preliminary volunteer work to get in the door. Another consideration is that employment in this practice area is likely to pay less than other OT practice areas. Mental health and non-traditional practice areas tend to have lower reimbursement rates. 

Funding

Little funding is allocated to rehabilitative services for these populations. Meanwhile, OT treatment comes at a high cost (Pergolotti et al., 2018), especially when compared to many other services.