Quality of life across an inpatient forensic mental health care pathway. A cross sectional study looking at associative factors & implications for occupational therapists.

Forensic psychiatric care is aimed at improving mental health and reducing the risk of recidivism of mentally disordered offenders. This patient group reside in therapeutically safe and secure environments for many years.... [ view full abstract ]

Forensic psychiatric care is aimed at improving mental health and reducing the risk of recidivism of mentally disordered offenders. This patient group reside in therapeutically safe and secure environments for many years. Improving quality of life should be a core priority in the treatment of these patients from an occupational therapy perspective. The aim of this study is to develop an understanding of what factors are associated with improved quality of life in this setting.

We measured quality of life, ward atmosphere, meaningfulness of activity (EMAS), occupational functioning (SOFAS), neurocognition (MCCB) and a range of variables for 52 forensic inpatients with schizophrenia and schizoaffective disorder.

There were strong correlations (p<0.001) between perceptions of meaningfulness of activity and improvement in quality of life. Increased occupational functioning (SOFAS) predicted increased meaningfulness of activity (EMAS). Increased occupational functioning and neurocognition (MCCB) predicted increased meaningfulness of activity and engagement in over 10 hours vocational activity per week. Impaired occupational functioning and neurcognition were associated with decreased meaningfulness of activity.

Availability of meaningful activity for patients in this setting was the strongest associative factor with improved quality of life from a range of objective and subjective measures. Higher functioning patients that are exposed to a variety of activities of adequate challenge appraise activity as being more meaningful.
Matching activities to abilities, providing a choice and incorporating patient perspectives into the prescription of activities are important points to consider when planning and providing activity in forensic inpatient settings.