Developing the occupational therapist's role in a forensic support service

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A case study from the Cheshire and Wirral Partnership NHS Foundation Trust, examining a pilot programme to improve risk assessment within forensic support services.

What was the aim?

The trust's forensic support service received multiple referrals from acute mental health services requesting ill-defined 'forensic assessments' of patients with historical forensic risks.

Staff were seeking support to ensure the patient was safely discharged into the community. The forensic support service therefore needed to devise a way of assessing the risk a patient posed.

What was the solution?

The support service comprises five nurses and an occupational therapist (OT).

The OT is piloting an approach that involves holding meetings with all those involved in the patient's care to complete a '5 P formulation': problem, protective factors, perpetuating factors, precipitating factors, and predisposing factors.

During these sessions, the OT promotes the value of the patient's roles, values, occupation and strengths. The aim is to:

  • understand a person's risk profile using a structured method
  • encourage multidisciplinary approach to risk formulation
  • encourage OTs to promote the value of occupation and its impact on reducing the risk of violence.

What were the challenges?

As referrals come from acute services, the forensic support service must respond quickly so patients do not spend more time in hospital than is necessary.

What were the results?

The initiative is currently being evaluated. The trust hopes it will:

  • improve staff's understanding of forensic risk formulation
  • ensure forensic risks are considered fully before discharge, using a multidisciplinary approach
  • ensure that the forensic support service responds quickly to referrals from acute services
  • free time to complete more comprehensive risk assessments
  • be a role model for other OTs and promote the skills they can bring to risk formulation.

What were the learning points?

  • Be bold - service development is for everyone.
  • Take ownership of your role and continually try to develop it.

Want to know more?

Please contact Sara Ryan, occupational therapist: Sara.Ryan@nhs.net

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