Occupational Therapy News OTNews March 2020 | Page 21

FORENSIC SERVICES FEATURE
A central tenet of the recovery approach is about supporting
service users to take the lead in their own care and to make
personal choices about their life beyond their illness or hospital
admission (Mezey and Eastman 2009).
The ability to make personal choices is also a fundamental
aspect of social inclusion, and can be achieved if service users have
the confidence and self-esteem to make these choices and fully
engage in their communities (ibid).
A central aspect of my role is to support recovery and social
inclusion through the development of life skills and helping to
bridge the gap between the inpatient setting and the community,
in order to minimise the chances of readmission, and in this case,
reoffending.
However, in a forensic setting, social inclusion can prove
challenging as service users are much more likely to be socially
excluded, perhaps alienated from their communities, because of
engagement in antisocial or criminal behaviour, a lack of supportive
social networks, and through the deprivation of choice in many
areas of their lives.
Choice is restricted for forensic service users not only through
enforced admission to hospital, but also through the involvement of
the Ministry of Justice, both during admission and after discharge,
which influences and controls every aspect of the individual’s life.
Other barriers to social inclusion are those of socioeconomic
deprivation, a condition they may have experienced even before
admission to hospital, and the double stigma of living with both a
diagnosis of a serious mental illness and a criminal conviction.
Disenfranchisement is a tangible example of social exclusion
for this client group, as voting is a significant way for members of
a community to exercise choice and make decisions about things
that affect their lives.
Despite the fact that most forensic psychiatric service users
are unable to vote, I felt it was still important to engage them in
discussion on the subject and give them an opportunity to exercise
choice and to feel included in the community to which they belong
through the act of voting, which, despite it being simulated in this
situation, could be empowering.
What we did
With this in mind, I set about promoting the election, leading to a
mock vote on 12 December. I decided that our patient-run café,
which takes place on two mornings a week, was a good platform
for the main election activities. This is a project that promotes
recovery through engagement in pro-social activities and vocational
roles.
One month prior to the election, I placed election posters around
the unit, posing the question: ‘What’s your view?’ I also created a
poster for each of the five main political parties, outlining the policies
on 10 primary issues: Brexit; the NHS; crime; education; work and
benefits; housing; the environment; immigration; the economy; and
democracy.
These posters were exhibited in the café for service users
and staff to read at their leisure. Over the course of five weeks,
conversations would take place around the posters and
occupational therapy staff would gather themes from these, as well
as joining in the discussion.
For me, it was important to create a relaxed atmosphere, so that
service users felt comfortable about expressing their opinions and
asking questions, without fear of being judged or ridiculed.
I also encouraged staff to continue the conversation on the
wards, to understand the factors that service users considered
most influential when casting their vote.
On election day, I set up a ballot box with voting cards in the
café. Service users were invited to vote for their preferred party, with
an additional optional space to write a reason for their vote.
Staff then took the ballot box around the four wards to allow
those who had been unable to attend the café their chance to vote.
Votes were counted, with a percentage of the votes calculated
for each party, and the results were printed on a poster and
displayed in the café.
What we found
Twenty-one out of a possible 60 service users voted, which
constituted a 35 per cent ‘turnout’.
Our team was struck by the enthusiasm and level of interest
demonstrated by service users. Many were happy to discuss their
opinions and, in general, the range of views and level of knowledge
seemed to reflect what we would expect from the wider society as
a whole.
A substantial number were well informed and had a clear sense
of their political leanings; some expressed hope, while others
expressed feelings of anger and political disillusionment, and a few
said they felt they did not know enough about, or had no interest in,
politics.
Overall, most service users were open to engaging in ‘election
talk’ and were curious to know more, asking questions and
spending time reading the information posters.
Staff members tended to express surprise at the level of
knowledge and interest our service users demonstrated, which for
me was telling of our perceptions of the people we work with and
how we rarely make time to initiate these kinds of conversation.
This would appear to reflect staff attitudes across all mental
health inpatient services: a 2010 investigation found that over half of
the professionals interviewed said that it was the first time they had
been asked about their service users’ voting rights, and most had
assumed that service users on civil sections were unable to vote or
were simply not interested (Rees 2010).
I felt that the enthusiastic reception from service users was not
just about the content, but also engaging in conversations with staff
and peers that was not about their treatment.
Even occupational therapists, with our holistic approach to care,
may not always consider the wider socio-political context that
arguably straddles all areas of occupation.
In conversation and on the ballot paper, service users gave us
insight into the issues that mattered most to them and the reasons
for their vote.
OTnews March 2020 21