Occupational Therapy News OTnews April 2019 | Page 24

FEATURE MENTAL HEALTH
The transition to an occupational
therapy-led service
Sophie Bate, Tanya Marriott and Alice Vanstone
look at the establishment of an occupational therapy-
led ward in secure mental health services
I
n November 2016, Connelly House transitioned from
a traditional medical approach to an occupational
therapy-led service.
The service is part of the open cluster in the
secure directorate. A six-bed male rehabilitation ward
within Langdon Hospital in Devon, the site provides
support to individuals who, as a consequence of their
mental health needs, have had contact with the criminal
justice system.
These individuals require a safe and secure
environment that enables them to receive a wide range
of treatments, therapies and care to support their
recovery and reduce risk.
With an increasing demand on specialised mental
health services and the NHS being required to ‘do
more with less’ (Hurst and Williams 2012), an innovative
solution among secure mental health services was
required to ensure resources are effectively and efficiently
utilised, with patient-centred care at the core.
Purpose for change
A pioneering redesign and restructure of Connelly House
was identified by Devon Partnership Trust to utilise
and maximise occupational therapy skills to creatively
manage an open rehabilitation ward.
This has supported the nursing shortages across
Langdon Hospital by redirecting qualified nursing staff to
higher acuity wards.
Occupational therapy provides effective rehabilitation
in supporting patients to develop functional skills
towards their discharge and community reintegration
(COT 2017). This supports the service in reducing length
of stay and overall cost implications.
24 OTnews April 2019
The identity and culture of Connelly House has
developed occupationally with an ethos of ‘doing’.
Through engagement in meaningful occupations,
patients develop skills to manage risk, reduce relapse
and reoffending behaviours to support a sustainable
reintegration into community.
Davis et al (2007) found that engagement in
meaningful occupation is the most effective tool in
reducing reoffending.
The emphasis on meaningful engagement, role
and skill development and pro-social relationships was
pivotal in redesigning the service and achieving client-
centred outcomes for patients.
The secure patient group often experiences
occupational imbalances, where occupations are usually
confined, restricted and prohibited.
Occupational therapy is a unique intervention, which
enables participation in occupation through grading or
adaptation of the environment, meeting the demands of
security and risk management without loss of value and
meaning (COT 2017).
Furthermore, occupational balance is promoted
through the occupational therapists’ application of
therapeutic use of self and the routine of the ward;
enabling and supporting patients to develop their own
pro-social occupational identities through application of
the relational model.
A collaborative approach is essential within a
rehabilitation ward to ensure patients are able to manage
their own recovery, recognise their relapse indictors and
identify coping strategies.
Initially, care-plans and discharge pathways appeared
to be service led, and it was evident education around