OTSurveyAustralian occupational therapy journal2025

The work of forensic occupational therapists in solitary confinement: An international survey.

Ellie Cassels-Kleinman, Annette Joosten, Lorrae Mynard and 1 others

PMID 40993968

WHAT IT FOUND

Managing risk decided whether a session happened, whether it took place inside or outside the cell, how many staff were needed, and what objects could be used.

Therapists said watching patients' distress was their main stress, and debriefing with colleagues was how most coped.

Key findings

01Risk management decided the shape of therapy: whether it could happen, where it happened, how many other staff were needed, and what resources were available.

02Most therapists worked through a closed door or a transparent barrier. They described not being able to get close to the patient, having to shout to be heard, restricted or no eye contact, not seeing facial expressions, and no privacy, all of which got in the way of therapeutic engagement.

03Every therapist said they checked whether their activities worked, but most did it informally, using patient feedback (92%), staff feedback (86%), and behaviour change or a move to a less restrictive setting (76%).

STILL TO COME

How it was doneWhat they foundWhat it means for OTs

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What it does not show

Participants were recruited through the authors' own networks and by snowball sampling, so this is whoever the authors could reach. The study could not calculate a response rate, and 10 of the 44 surveys were only partly completed, so numbers for individual questions are often based on 25 to 37 people rather than 44. Half the participants worked in the United Kingdom, so this describes practice there more than it describes practice internationally. Therapists from Victoria, Australia, were excluded, which is the one region where this work has previously been studied. Including them might have changed the picture. The survey was in English only, so therapists with limited English may not have taken part. The authors did not collect whether participants worked in male, female or juvenile settings, or the ages of the patients they worked with. The survey ran in 2020 during the COVID-19 pandemic, which the authors think may have reduced the number and spread of responses.

Declared interests

The authors declare no conflict of interest. The paper does not state who funded the study. Ethics approval was granted by the Australian Catholic University Human Research Ethics Committee.

The easy way to misread this

Do not read this as evidence that occupational therapy works in solitary confinement. It reports what 44 therapists said they do, half of them working in the United Kingdom and recruited through the authors' own networks, and the authors themselves say more research is needed before there is evidence that these interventions are effective.

Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →