Ot in prison
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Occupational therapy can help reduce recidivism rates in prisons. OT focuses on improving inmates' life skills, social skills, emotional regulation, and cognitive abilities to help them better cope with prison life and successfully reenter society. An OT working in a state psychiatric hospital sees the need for OT programs within prisons directly. OT can address issues like restlessness, social isolation, and lack of problem-solving skills through meaningful occupations. The goal is for OT programs in prisons to decrease recidivism and prison violence over 5 years by enhancing inmates' independence and quality of life. Funding sources like the Second Chance Act could support OT salaries and treatment supplies for under $800,000 over 5 years.
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Ot in prison
- 1. Occupational Therapy in the Prison Setting By: Jessica Melton, OTS
- 2. History and Laws 1972: American Medical Association 1976: Estelle vs. Gamble 1983: NCCHC 8th Amendment
- 3. Current Trend: Forensic Psychiatry
- 4. Occupational Therapy in a State Psychiatric Hospital Paul McCarty, OTR works with mentally ill inmates who have been sent to the hospital for treatment. He works with patients for an average of 12 weeks, but often they unexpectedly discharge back to prison. Paul sees a need for OT in the actual prison setting… Why??
- 6. RECIDIVISM A National Problem
- 7. What’s OT Got to Do With It? Restlessness/agitation- poor emotional regulation Social isolation decreased social participation/skills Structured environment lack of problem-solving and adaptation skills History/Background/No meaningful occupations poor self-esteem and self-efficacy
- 8. Occupational Adaptation Prison Style
- 9. MISSION to facilitate the cognitive abilities, social skills, life skills, and emotional regulation skills needed both to cope with prison life and develop the capacity for successful reentry through interventions that allow opportunity for occupational engagement and improved self-efficacy.
- 10. Impossible?? Tool-use policies Safety and Security Stigmas and Attitudes of other professionals “Survival” mentality Life sentences Funding
- 11. The Vision Recidivism will decrease as a result of occupational therapy programs in prisons. Violence within the prisons will decrease due to decreased agitation. Occupational therapy will bring a unique perspective to the evaluation and treatment of inmates that will begin a new trend in prison healthcare.
- 12. Goals/Objectives GOALS: 5 years OBJECTIVES: 6 months Reduce recidivism by increasing independent living skills. Decrease prison violence and mental instability. Increase quality of life and social participation of inmates. Inmates will increase independence in daily living skills by improving cognition required for tasks. Inmates will improve emotional regulation skills through group participation. Inmates will increase self-efficacy via high-success rate tasks, and demonstrate a cooperative effort in group tasks.
- 13. Funding The Second Chance Act Beaird Foundation Involve the NCCHP or other NPO
- 14. Resources Needed MANPOWER! Support from community Alliances for transition period A Non-Profit Organization to support project A Government agency or official to endorse project Plenty of TIME to PLAN EVIDENCE conduct a study
- 15. GIMME THE MONEY! Proposed budget is for 5 years, since federal grant expects long term goals to be projected for 5 years. This will give time to show evidence of success and hopefully the government will choose to permanently fund OT in the prison system.
- 16. How Much? Treatment Supplies Documentation/ Evaluation Supplies Compensation for community members’ involvement/rental of space Salaries for 2 OTs Grand Total 8,000/year 1,000/year 20,000/year 130,000/year 159,000/year x 5 years=$795,000.00 Or, without OT salaries: $145,000
- 17. References Anno, J.W. (1992). Crisis in correctional health care: The impact of the national drug control strategy on corrective health services. Annals of Internal Medicine, 177 (1), 71-77. Glaser, J.B. (1993). Correctional health care: A public health opportunity. Annals of Internal Medicine, 118 (2), 139-145. Posner, M.J. (1992). The Estelle medical professional judgment standard: The right of those in state custody to receive high-cost medical treatment. American Journal of Law and Medicine, 347 (1). Schindler, V.P. (2000). Occupational therapy in forensic psychiatry. In Cotrell, R.P. (Ed.), Proactive approaches in psychosocial occupational therapy, 319-325. Thorofare, NJ: Slack, Inc. Steler, L. & Whisner, S.M. (2007). Building responsibility for self through meaningful roles: Occupational adaptation theory applied to forensic psychiatry. Occupational Therapy in Mental Health, 23 (1), 69-84. Townsend, E. & Wilcock, A.A. (2004). Occupational justice and client-centered Practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71 (2), 75-87. Whiteford, G. (1997). Occupational deprivation and incarceration. Journal of Occupational Science, 4 (3), 126-130.
Editor's Notes
- Prior to 1972, wardens and correctional officers were the primary healthcare providers for the incarcerated. In 1972, the AMA started making standards of care for inmates, and after Estelle vs. Gamble, a lawsuit in which serious medical conditions of an inmate were neglected, the Supreme Court ruled this cruel and unusual punishment via the 8th amendment and subsequently the Non-Profit Organization entitled the National Commission for Correctional Health Care was created, which created mandates that not only were the incarcerated not to be neglected, but that all healthcare needs were to be provided to them regardless of cost. This is supposed to include any reccommendedrehabilitaiton.
- Forensic psychiatry is a field for those who are mentally ill within the criminal justice system. Inmates are transferred to maximum security hospitals for rehabilitation, but once stable, go back to jail or prison. Occupational therapists do work in this area, but skills do not usually transfer once patients are back in prison.Despite efforts for reform, prison healthcare remains a Reactive instead of PROactive practice.
- Paul is contracted with the University of Texas Medical Branch in Houston, TX. They have a contract with the Texas Justice system to provide services to mentally ill inmates in the maximum-security hospital setting. He works on goals such as improving problem solving, increasing self-efficacy through high-success rate tasks, learning socially appropriate behavior and emotional regulation skills for coping, increasing independence in living skills, and building up prevocational skills.
- Occupational deprivation is a term that refers to depriving an individual of any active engagement or participation in meaningful activity, which subsequently strips them of self-esteem, self-worth, and self-determination. It also breeds anger, frustration, and agitation and causes a degeneration of cognitive skills necessary for daily life.
- One article discusses a sheltered workshop in which inmates were able to work in three different working areas and work their way up the chain to leadership positions as their social, technical, problem-solving, and cognitive skills emerged. The outcome was that they all became more engaged and self-determined. They learned what it was like to have an adaptive response to the environment. OA is important because the prison environment is so different from the real world that one must learn internally how to apply the adaptive response in the future to a new situation.
- Some prisons do not allow inmates to use any type of tools, making treatment activities limited. Security is always an issues, since some inmates have a tendency to be violent or lose control. Most of the time, correctional employees will have a negative attitude toward “rehabilitating criminals.” The survival mentality is the norm in prisons; they are dangerous and one has to always be on hyper-alert mode, making getting inmates to relax, open up, and participate may be difficult. If an inmate is serving a life sentence, you must tailor goals more toward coping and finding meaning within the facility. Funding is limited and teachers are already in prisons in this area providing prevocational and sometimes substance abuse education. OTs have to be paid more and so it is a barrier.
- Ideas: sheltered workshops to make things for community, things like household type chores and fish tank to take care of with responsibilities being divided to build a sense of community, social events to be planned by entire group.
- The U.S. Department of Justice has a Reentry Demonstration project budget for around $55 million to be distributed to local or state units of government for the year 2011. The grant money is to be used to prevent recidivism by targeting the causes such as poor social skills, poor adaptive abilities, and lack of job and life skills. The grant requires that the grantee make many alliances within the community, such as with law enforcement agencies, correctional officers, and community non-profit organizations. The grant also requires that the grantee create a reentry task force for successful reintegration after release. The federal grant requires a 25% cash contribution from the grantee, so this would be applied for through a private funding foundation such as the Beaird Foundation, which is set up to help community members become better equipped to better themselves and to provide opportunity to those who do not have it currently. It would require that an NPO actually apply for the money, so it would require that an NPO endorse the project and apply.The NCCHP is an NPO set up to create standards for equal healthcare for incarcerated individuals.
- Control group could be receiving the standard education and “therapy” provided now at the facility. Would need at least 20 participants in OT treatment group.
- It would depend on whether or not the OT(s) were already working for a company with a contract with the government and salaries already paid that way. However, most of these contracts exist for forensic hospitals, not within prisons, so a lot of red tape would have to be cut through to get on the grounds. Another possible expense would be to pay some rent to use a building or room on the grounds for services.