Dying Inside

Earlier this year I listened to a radio programme broadcast on BBC Radio 4 about the growing phenomenon of older prisoners in the UK. The program was presented by Rex Bloomstein a documentary film-maker, whose films on human rights, crime and punishment and the Holocaust have become major themes in his work.

The programme explained how the UK has the largest European prison population of over 8000 older prisoners. This group of offenders is also the most rapidly growing, which is in part due to the fact that forensic evidence/advancement is continually developing and improving meaning that more 'historical' cases are now being solved. Also the number of offenders serving long term or life sentences has increased over the years. 

The programme spoke to a number of older prisoners who shared their experiences of being 'older' and living in prison either for the a long time or for some the rest of their lives. Older prisoners have a higher incidence of diabetes, hyper tension and coronary heart disease as well as the general mobility and cognitive disabilities which older people develop with age. However added on top of these are problems of adjustment, loss of liberty, loneliness and isolation caused by living away from family and loved ones. Living in a prison and/or secure environment where the majority of the population are younger individuals can prove to be a frightening and threatening environment for older prisoners/offenders which can have a detrimental effect on their mental health. 

There is currently no national strategy for older prisoners/offenders, meaning that this client group is at risk of being overlooked and needs not being met.

Whilst reflecting on my current client group in the secure unit where I work last week and realised that there were some reoccurring themes with regards to needs between the clients over the age of 50 (which is classed as being an 'older' offender). This was not surprising as it is universally acknowledged that with age comes different obstacles to overcome both physical and cognitively. What I realised through my reflection however was how this client group and their specific needs run the risk of being unintentionally overlooked by the service. I began to think back to my work experience in a Prison and found that the same issues arose. 

The diagram below depicts some of the common problems which in my experience older prisoners/offenders have faced.

From my work in a Prison setting I tackled some of the problems by doing things such as:

• Collaborating with the gym instructors to provide a separate gym room which did not have the 'loud' music channels playing in, had cardio. exercise equipment and which provided specifically designed exercise classes for the older client. 
• Providing different activities for the older clients to engage in, activities such as dominoes and card games which proved most popular.
• Setting up support groups/ social events for older clients.
• Practical solutions to physical/mobility problems such as moving the clients to a cell which was on the ground floor, had grab rails/ had little obstacles or stairs to negotiate.
• Finally many of the older clients complained about the noise which the younger clients make whether whilst socialising or when watching their TVs or playing their music loudly and late at night. By creating quieter sections on the wings where the older and quieter clients were based reduced this problem effectively.
• The provision of mobility and functional aids. Eg, wheelchairs, walking frames/sticks, grab rails etc.

This is obviously only a small snap shot into some of the solutions which can be found for meeting the needs of this particular client group and depending on the individual concerned solutions may differ or completely different needs may arise. 

With the increasing number of older prisoners/offenders in the UK, health professionals, including Occupational Therapists, should be ready to meet the needs and solve the problems of this client group and be more aware of the implication that being 'locked up' has on the older prisoner/offender. 

Kate.

Further information can be found at the following sites:

http://www.recoop.org.uk/pages/home/index.php

http://www.ageuk.org.uk/documents/en-gb/for-professionals/government-and-society/older%20prisoners%20guide_pro.pdf?dtrk=truehttp://

www.prisontalk.com/

Thoughts on a BJOT article.

The February edition of the BJOT arrived on my doorstep this week and I must admit the contents got me just a little excited - I'm just a little bit of an OT geek.
The article which struck my eye immediately, and unsurprisingly, is the focus for this blog post.

"The use of the Wii Fit in forensic mental health: exercise for people at risk of obesity." Nicola Bacon, Louise Farnworth and Richard Boyd, BJOT, Feb 2012 75(2)

The article looks at how OTs in Australia have utilised virtual reality technology to promote fitness and weight loss in a secure hospital. 

From working in a medium secure unit I have really noticed how at risk and already obese this group of clients are. This is due to many factors such as restrictions on physical activity and a lack of motivation however one large reason is due to the side effects of psychotropic medications. Adverse side effects of the medications used to treat the symptoms of psychoses often include sedation and decreased metabolism, leading to rapid weight gain.
These are definitely side effects which are discussed at work as being very problematic to this client group. It is also important to consider environmental difficulties in addressing weight gain. Within secure environments there are many physical, legal and institutional barriers which prevent clients from accessing exercise opportunities that are available in the general community. Although at my place of work there is some limited gym and sports hall access, due to the majority of the clients being between 20-30yrs old many of the sports which they are interested in, such as extreme and team sports are not accessible to them and that causes a lack of motivation to participate in the opportunities that are available.
This is where the authors of the article feel that virtual reality games such as the Wii fit can provide a stimulating and motivating medium for weight loss within secure settings.

The Wii fit which is a commercially available virtual reality system which utilises motion-sensitive technology to transfer players' movements onto a television screen and a virtual Wii environment. The Wii fit games allow individuals and multiple players to engage in an array of sports and fitness activities ranging from yoga to baseball to kayaking.
One particular benefit to the Wii fit is as follows:

"The 'gaming' factors of virtual reality (VR) technology such as earning points, are believed to help motivate and sustain players engagement in tasks. VR interventions also may be very normalising for forensic patients especially because the average demographic of a video game player is similar to that of the average forensic patient, a 30year old male."

Literature suggests that these Wii Sports games are motivating, enjoyable and realistic forms of physical activity for a variety of client populations although, until recently, little research has been focused on the forensic population.

The method of the study had participants playing the Wii fit up to four times a week in both individual and group sessions which lasted between 7 to 127minutes. The study only had a small population of two clients which were discussed however results showed that when using the Wii fit, participants increased their overall time spent actively moving their bodies in physical activity. Using the Wii fit also changed participants attitudes towards exercise as they realised that it could be 'fun' and 'challenging', especially when staff members also participated.

This article provided an interesting insight into a potential intervention which Occupational Therapists can utilise to both prevent and combat weight gain in secure units. The challenge for forensic occupational therapists is to find a 'better match between the person, environment and occupation in this scenario, in order to assist forensic mental health patients to participate in exercise within a secure setting, to improve their health and well being, and potentially to assist them to lose weight." The Wii Fit and other VR systems could be the perfect way to achieve this. 

Back to the blogging world...

Hello everyone,
As you may or may not be aware this blog has been rather quiet for a few months.
The past couple of months have seen me move away from my friends and family to start my first OT post! Despite being incredibly busy I have immensely enjoyed the transition from student OT to Band 5 OT and am so excited about the prospects that the job holds.

Now everything has settled down a little bit I hope I can continue with my regular blogs, so keep your eyes peeled folks!

Kate :)

Thoughts on a BJOT article.

Hello readers and welcome to my first post of 2012!
 I'm so excited with what this year has to offer - January alone will see me moving away from home and starting my first Forensic OT post, eek! So what better way to start of this year of blogging than posting about a BJOT article on Forensic OT practice.

"An evaluation of the impact of a social inclusion programme on occupational functioning for forensic users." Martin Fitzgerald. BJOT Oct 2011 Vol. 74 No. 10

Within Occupational Therapy the rehabilitation of forensic service users with serious mental health illness is an emerging specialism with a relatively limited body of supporting evidence behind it. This article aims to, and succeeds, in providing evidence for, and to guide, practice for Forensic OTs working within rehabilitation settings.

UK governmental policy and Mental Health agendas have focuses on and require health and social care professionals to REDUCE DISCRIMINATION and SOCIAL EXCLUSION of service users.
The article argues that Occupational Therapists have the potential to fulfill the social inclusion expectancy in policy.

In 2006, the OT team for the Forensic and high Support Directorate (FHSD) within Pennine Care NHS Foundation trust set up a Social Inclusion Programme with the following aims:

"..to increase engagement in community-based activity; to introduce complex task performance and goal-orientated activity to treatment; to engage patients in normative learning environments; to improve literacy and numeracy skills; and to provide a stepping stone to further education and work."

The social inclusion programme was made available to all 62 service users in four long-stay units in the FHSD, a low-secure, rehabilitation forensic service at Pennine Care NHS Foundation Trust. The programme entailed graded community engagement and one-to-one goal planning with a unit-based occupational therapist, in addition to normal treatment. As prerequisite referral criteria for admission to the FHSD, all service users had a history of poor insight and poor engagement; more than half had a history of violence, 46% had an index offence and all were subject to the Mental Health Act (1983). The programme utilised grading and adapting to encourage service users to attend activities and to develop through the program skill hierarchy.
The purpose of the evaluation of the programme was to test for a difference in occupational functioning between service users attending the social inclusion programme and those following usual treatment. Occupational functioning of the two groups was measured using the Model of Human Occupation Screening Tool (MOHOST).

Results showed that little difference in overall MOHOST scores between the social interaction programme and those following treatment as usual before intervention and a significant difference in the scores of the social interaction programme group following intervention. This difference continued to be evident in four of the six subscales scores, with motivation for occupation, pattern of occupation, motor skills and environment all showing significant difference.

The study therefore shows that social inclusion work can improve occupational performance for forensic service users and, therefore, recommends it as an occupational therapy intervention for forensic services.

The article was a really interesting read and the outcomes are certainly encouraging for both my self and hopefully other OTs working within/interested in this field of Occupational Therapy. 

What really struck me about this article was the literature review, or more to the point, what it contained. 

Firstly this section explored how most serious mental illness has an average onset of late adolescence and early adulthood; resulting in the interruption of secondary and tertiary education. This interruption can impair the development of essential social skills, such as problem solving, time management, motivation and the use of initiative. Social exclusion experienced as stigma and the reduction of participation in relationships and mainstream social, cultural and economic activities, can often result from these impairments. 

it is therefore important, in my opinion, that Ots have an awareness of this and of the developmental stages which may have been effected and limited due to the onset of a serious mental illness. With this awareness and a full assessment process (which undoubtedly would occur) OTs would be able to fully address these impairments and help service users regain maximum occupational and social functioning. 

The second part which really struck me was the following few sentences:

"Preece (1995) argued that in forensic services the medical model contributes to the experience of occupational deprivation because it shapes the types of professional intervention that lead to underachievement, low motivation and low selfesteem. Underachievement and low expectation can further decrease the service user’s social networks and occupational opportunity which, in turn, increases the experience of social exclusion (Link et al 1989)."

The reason this struck a cord with me is because of some recent discussion about forensic OT I have had with some of my friends and family. So often in today's society I find that people are very quick to jump down the medical model of prescribing medication to fix everything. Although undeniable medication does have a positive effect on individuals with serious mental health illnesses, I do not think it is the only solution. As the article goes on to discuss an occupational perspective is needed to support and develop treatment approaches. Occupational Therapy should be a key part of rehabilitation.

As mentioned above, I found this article a really interesting and encouraging read and would recommend you reading it if you have access to the BJOT journals. I also hope that my ramblings make sense and have proven to be informative.

Kate

All in Gods perfect timing, seeing the beauty in everything.

 I’ve been struggling with having to wait for things recently.

Waiting is one of the most difficult things to do, whether we're waiting for a phone call, the right job or an answered prayer. We become impatient and wonder why things are not happening when we want them to. It seems like the more we want something, the harder it is to wait - and we get impatient with God.

But we have to remember that God's timing is different than our own. He sees things from a different perspective and sees the whole picture, not just what we want, but what is best for us in the grand plan for our lives. All is part of a divine order and will be done in its own right and proper time. Of course, when we are hoping, praying and waiting for something, it's easy to forget this. After all, waiting is "remaining inactive in one place while expecting something." And being inactive means feeling powerless and at the mercy of the world - nobody likes that feeling. But we must keep in mind God's greater plan and His perfect timing:

“..And we know that in all things God works for the good of those who love him, who have been called according to his purpose." Romans 8:28

Yesterday God taught me two very important lessons.

1. God has perfect timing.
2. See the beauty in everything.

Most of you will know that I like to be creative. It is a rare moment when I’m not thinking of things I could either make or bake.

A few months ago for some bizarre reason I decided I was going to keep all my old toilet rolls, figuring that one day I would know what to make from them. Over the course of a few months on the back of my bathroom door hung a bag which gradually became full of toilet rolls. When it was full it just stayed there. I didn’t know what to do with 25 brown tubes, but I knew that one day I would. Yesterday that day came.

I looked at those tubes and saw something of myself. How I was feeling about myself. Dull, plain and useless. But God sees us differently, He does not see us as being “dull” or “plain” or “useless” He sees us as the beautiful creations which He Created and the beautiful and fruitful men and women of God whom we can be.

After lots of cutting, positioning and sticking together I ended up with this:

Finished and looking lovely in my room. :)

Everything has beauty but not everyone can see it.

Throughout this process God spoke to me. He told me about how before now making this wall art would have meant little to me, doing it now has taught me lessons and helped me grow that little bit closer to Him.

We can be just like the toilet rolls and God the “creator”, we may need to wait until the right time, be shaped, rearranged, stuck back together and held until we are fixed, but at the end of the day, when God has finished with the processes we will be able to shine in the beauty of what He created us to be.

God has perfect timing. He is never late. He is never early. He is never in a hurry. He is always on time. On His time. The hardest part to remember is that our time isn’t necessarily His time.

..and I make a vow as a child of God to try and stop looking in the mirror and seeing:

• ugly
• fat
• plain
• weak

BECAUSE I am now certain. Certain that when God looks at me and at you, at His creation, He only sees wonderful. He only sees beauty. He only sees precious.

It’s time for us to start seeing the beauty in everything, in Gods creations, and most of all; find the beauty in ourselves. For you are..“Fearfully and wonderfully made!” Psalm 139:14

You've got a place in this world.

Hey you!

The one hiding in the corner,

wondering if you're seen,

hoping you're heard.

You are.

You matter.

You have something to give.

Something good and right and beautiful and true.

And God sees it.

Sees you.

Right where you are.

He invites you to the centre of the floor,

to His waiting arms, to His unfolding plans.

We need you. Just as you are.

And we can't wait to see even more of the ways,

He's going to use you to light up the room and the hearts of all who are in it.

"For I know the plans I have for you," declares the LORD, "plans to prosper you and not to harm you, plans to give you hope and a future." Jeremiah 29:11

I read a poem earlier today entitled "Just think". I have no idea who wrote it but as i was reading it, taking in each of its statements, each of its promises, I was reminded and captivated by the knowledge that this IS truth. God designed, created, loves and has perfect plans for each and every one of us.

The poem reads:

"Just think,

you’re here not by chance,

but by God’s choosing.

His hand formed you and made you the person you are.

He compares you to no one else—you are one of a kind.

You lack nothing that His grace can’t give you.

He has allowed you to be here at this time in history,

 to fulfill His special purpose for this generation."

The world only gets one YOU!...

You with your gifts.

You with your smile.

You with those things you do.

So take your place,

take your chances,

take this moment to know...

You've got something to offer.

Something good and right and true.

Something God-given,

Heart-of-Heaven created.

And the rest of us need it, need you.

You may think it's no big deal.

Anyone could be that way.

Anyone could do it.

Nope.

Not true.

There's just one irreplaceable you.

"For we are chosen by God and precious to Him." 1 Peter 2:4

Mental Health Awareness.

Recently I have been really encouraged by the increase of adverts and campaigns in the public eye which openly talk about and promote the awareness of Mental Health/Mental Illness in society.

Rethinks' new campaign poster (2011).

Growing up I can't think of myself having any real knowledge or understanding of Mental Health problems or illnesses, other than opinions that were formed from watching TV programs, films or reading and hearing about incidents in the news/media.
So often the media portrays people with Mental Health illnesses and problems in a purely negative light which I believe caused the topic to not only become a taboo subject but one which evoked feelings of fear and allowed stigmas to develop.

At the weekend I was out shopping with my father when we both noticed how many disabled people we had seen whilst out, mainly those with Learning Disabilities -not only shopping themselves but also working in the shopping center. We began discussing how it wasn't that long ago that you would not really see those with disabilities, especially those with learning difficulties and also types of mental health problems out and about in the community. Although this is slightly steering away from mental health in particular, an increase in acceptance and integration of disabled individuals into society can only be applauded and encouraged. Along with physical and learning disabilities I believe Mental Health issues are also become more understood and less taboo.

Recently on the TV, in newspapers and in the media as a whole I have been encouraged by the increase of awareness campaigns and also positive stories which do not portray those living with mental illness as being 'monsters' as previous depictions have.
Also the increase of celebrities and well-known individuals speaking up about mental health issues is increasing and making it more of an understood and accepted part of society. After all statistics show that one in four will experience some kind of mental health problem in the course of a year ( http://www.mentalhealth.org.uk/help-information/mental-health-statistics/).

Notably people such as Demi Lovato who has bipolar disorder and has suffered from an eating disorder as well as self harm, and Ruby Wax who has experienced depression are now using their status in the public eye to raise awareness of Mental Health issues and to encourage people to discuss mental health issues openly. Ruby Wax is also setting up a website/social network for everyone who suffers or knows someone who suffers from Mental Illness. Its a brilliant way of providing much needed information and support for those who truly need it. (Link to the site can be found below)

Hopefully these positive changes will continue to become more and more apparent in society and Mental Health issues will no longer be associated with stigma and discrimination.

Some brilliant organisations and campaigns surrounding Mental Health which are well worth looking at:
http://www.rethink.org/
http://www.blackdogtribebeta.com/
http://www.mind.org.uk/
http://www.time-to-change.org.uk/

Kate.