Exploring the perspectives of occupational therapists regarding the local ot mental health service for service users linked to the criminal justice system

Abstract

Service users suffering from mental health issues who are linked to the criminal justice system, represent a particularly vulnerable population, often experiencing occupational deprivation, occupational alienation, social exclusion, and limited access to continuous mental health support. In Malta, there remains a significant gap in research exploring how OT services are delivered to this client group, and how OTs perceive and navigate these complexities. The study aimed to explore the perspectives of OT practitioners working in different mental health services regarding the OT services they provide to service users who are/were at some point in contact with the criminal justice system (CJS) for an offence or a series of offences. A qualitative research design was employed to reach the study’s objectives. Following ethical approval, the participants who fit the inclusion criteria were approached by an intermediary with a letter of information and consent. Purposive sampling was used and OTs working with service users who have either a case/s pending before criminal court, are out on bail /probation, are presently inpatients at Mount Carmel Hospital (MCH), or have in the past been incarcerated or admitted to a forensic ward at MCH, were selected. Following consent, the participants were interviewed. The study used a semi-structured interview as a data collection tool. The interview focused on the participants’ clinical intervention, challenges and opportunities, and how their service can be improved. They were audio recorded. Following thematic analysis, the following themes were identified: “Working OT Experience”, “Typical Clients”, “Common reasons for OT referral ”, “Duration of OT intervention”, “Assessment upon referral”, “Main challenges experienced when working with service users”, “OT Intervention”, “Motivation Level of OTs”, “Impact of Policies and Regulations”, “Training and Professional Development”, “Helpful Factors and Resources ”, “Emerging Practices and Innovations”, “Collaboration and Communication with Professionals and Entities”, and “Future Advancements”. Participants consistently reported structural limitations such as poor inter-agency collaboration and insufficient training in forensic mental health, hindering occupational engagement for service users. However, participants expressed strong professional commitment, often engaging in self-directed learning, interdisciplinary collaboration, and informal advocacy efforts. However, several OTs reflected on how working in isolation, without access to structured support systems, limited their impact on service delivery and intervention outcomes. This study highlighted occupational injustice experienced by service users, particularly those living in unstable conditions or facing legal and societal stigma. Participants called for the introduction of specialised forensic OT services and increased training opportunities to address the needs of this population.