A service development proposal for implementation and evaluation of Sue Parkinson’s ‘Recovery through Activity’ intervention for service users in a Forensic Mental Health Unit.

Abstract

Executive Summary This service development project was carried out in partnership with a forensic mental health service that provides assessment and rehabilitation for adults with complex and enduring mental health conditions, some of whom have been in contact with the criminal justice system. The purpose of this project was to develop a proposal for the implementation and evaluation of Sue Parkinson’s ‘Recovery through Activity’ (RTA) intervention (Parkinson 2014). Please see (appendix 2) for a group profile, and overview of the intervention. The proposed intervention is intended for implementation within a medium secure ward. Service users are often diagnosed with complex mental health needs, and can have multiple diagnoses of a mental health condition, learning disability and/or personality disorder (Royal College of Occupational Therapists 2017). Common diagnoses include schizophrenia, bi-polar affective disorder, and personality disorder (Couldrick and Alred 2003). Enduring mental health conditions can have a significant impact on occupational participation and cause individuals to become less engaged in daily occupations (Law 2002). Additionally, within secure environments service user’s opportunities to spontaneously engage in occupations of one’s own volition can be significantly limited and essentially lead to occupational deprivation (Whiteford et al. 2020). This can be influenced by the individual’s mental health, safety risk, legal status, institutional regulations and policies (Royal College of Occupational Therapist 2017). Long-term effects of occupational deprivation within secure environments can include, difficulty transitioning into the community, social isolation and exclusion, and difficulty structuring time in a meaningful way (Long et al. 2008). Furthermore, a significant absence of occupation can have serious negative effects on mental and physical wellbeing (Wilcock and Hocking 2015). To attempt to address such issues, the implementation of the RTA programme was suggested. RTA is an occupation-focused intervention which aims to improve occupational participation for individuals experiencing barriers to their preferred activities and occupations. It explores the importance of 9

activity to service user’s recovery and acknowledges the important link between occupational balance and wellbeing. It seeks to enable participants to recognise the long-term benefits of occupational participation on mental health and wellbeing through exploring the value of a range of leisure, self-care and vocational activities (Parkinson 2014). A systematic review of the literature was carried out to inform the development of the proposal, and establish the potential benefits and limitations of the RTA programme for this specific population. Planning for implementation and evaluation of the programme was accomplished through collaboration with the project partner, drawing on their expertise in forensic mental health, and ensuring what was being proposed was in line with the services requirements. The outcome of this project was an intervention protocol to help support implementation and evaluation of the intervention within the service.