exercise therapists and activity workers . They are all dedicated to improving patient access to meaningful , therapeutic and skills-based activities that support progress towards community living and greater levels of independence .
Improving motivation is a core challenge in forensic occupational therapy and it is common for patients to withdraw from therapy . Re-motivation can be a complex process . Many patients have spent long periods of time isolated within institutions such as a prison , that provide limited opportunity to explore and pursue interests .
These experiences often result in patients having unmet sensory needs and a lack of selfawareness regarding sensory triggers .
Developing coping strategies can enable patients to self-regulate during times of distress . Skills that are valuable to managing life in the community . With all this in mind , I began to consider how virtual reality could provide us with a tool to offer self-soothing environments for our patients .
I felt that using VR headsets would enable our patients to temporarily escape from the ward environment and I hoped this would enhance their ability to develop regulation skills .
With the support of a large occupational therapy team , I planned to promote one-to-one guided mediation sessions , using VR headsets for patients within the assessment forensic ward .
What sessions did we provide ?
After much trial and error , we selected VR apps that provided a range of natural environments and guided breathing exercises without the need for familiarity with controls . This aspect of the app enabled patients with limited technological skills to engage .
We began facilitating one-to-one sessions with patients within quiet rooms on the ward . Prior to commencing the sessions , patients could select aspects of the programme from a printed document .
Choices included the spaces they wished to visit , the type of meditation to engage with and the sounds they found relaxing . The sessions lasted for 20 minutes and involved passive breathing instructions , mindfulness techniques and fine motor movement .
These exercises also provided instant feedback ; where a patient takes a deep breath , the headset recognises the movement and responds with visual and verbal instructions . Sessions were also graded depending on the patient ’ s ability to process verbal information and manage controls .
Five patients at different stages of their treatment engaged with the weekly sessions on the assessment ward over a period of three months . Each patient managed to remain engaged for the duration of each session . They were able to follow the application ’ s verbal instructions with minimal support from staff .
Patients ’ feedback was overwhelmingly positive ; all reported feeling more relaxed during and / or after each session .
One patient commented that this ‘ makes me feel like I ’ m home ’. Another stated he could ‘ stay in this space for hours ’ and it felt like he was ‘ somewhere completely different , on holiday , not the ward ’.
These patients were also keen to explore new apps . Suggestions were varied , but the majority requested applications that offered active participation and the ability to navigate freely . In particular , real-life environments were asked for . Patients spoke about places they wished to visit , for example seeing the Pyramids or walking the streets of New York . Four of the five patients did not have leave outside of the hospital and three had spent the majority of their adult lives within institutions .
Potential and future plans
I believe the feedback and engagement from our patients has demonstrated the unique benefits virtual reality can provide within mental health services and secure environments – offering an immersive escape within an otherwise restrictive environment .
These apps can equip people with skills to self-sooth and engage with relaxation techniques .
In response to our patients ’ experience of the sessions , we plan to continue expanding the project across other forensic wards , documenting any impact the virtual reality sessions can have on reducing incidents within units .
I have also been exploring a variety of other , more interactive , applications that offer more active engagement . In particular , the possibility of offering a virtual escape and sense of freedom is an area I wanted to pursue . The use of Google Earth , for example , will provide patients with endless possibilities to navigate spaces that mirror real life environments .
Words MICHAEL MCMANUS , Clinical Specialist Occupational Therapist , Bethlem Royal Hospital , South London and Maudsley NHS Foundation Trust michael . mcmanus @ slam . nhs . uk
June 2023 OTnews 33