Time use of patients in a secure forensic hospital: A mixed methods study

IntroductionForensic mental health services balance recovery-focussed therapy with risk management, which may limit opportunities for participation in meaningful occupation. Previous research describes forensic patients in secure settings participating mainly in passive leisure and sleep. This study aimed to use quantitative and qualitative evidence to investigate how patients in the sub-acute and rehabilitation units of an Australian forensic hospital perceive and use their time and to discuss how the findings compare with the previous study within the organisation, published in 2004.MethodAn explanatory sequential mixed methods design was used with convenience sampling of patients and purposive sampling of staff. Patients completed time use diaries followed by semi-structured interviews. Staff perceptions were obtained via survey.ResultsSeven male patients with a diagnosis of schizophrenia and five staff members (three occupational therapists and two nurses) participated. Time use diaries indicated patients spent most time in personal care, passive recreation, and leisure activities. Qualitative data illustrated patient time use was influenced by the individualised meaningfulness of activities. Patients drew meaning from past roles, personal interests/needs, and their goals for recovery. While patients had some choice over how time is spent and with whom they chose to engage, external factors such as staff/program availability prevented their having full control. Staff provided additional perspectives on the links between time use and recovery, identifying enablers and barriers to meaningful time use.ConclusionPatient time use has not changed significantly when compared to past research, although perceptions of time use are more future and recovery-focussed. The amount of time recorded in activities typically associated with recovery does not necessarily capture the quality and benefit of that time use. Patient participation continues to be influenced by broader systems. Forensic mental health services provide recovery-focussed therapy while also managing risks, which can limit the activities patients can do. Past research has described forensic patients spending a lot of time sleeping and doing passive leisure activities.This study explored how patients in the sub-acute and rehabilitation units of an Australian forensic hospital used their time, and how they felt about it. These findings were compared with findings of a past study within the same service.Patients completed time-use diaries then shared more information in interviews. Staff views about patient time use were shared in a survey. Seven male patients with a diagnosis of schizophrenia and five staff members (three occupational therapists and two nurses) participated. Patients spent most of their time in personal care, passive recreation, and leisure activities. They spoke about the meaning of their activities, including their roles, interests, needs, and recovery goals. Sometimes they had control over how they spent their time, and other times they had to wait for staff or programs to be available. Staff talked about how patient time use was linked to their recovery, and noted things that can help or prevent patients using their time meaningfully.Compared with previous research, the way patients use their time has not changed. There is a change in the way patients think about their time use, with them now reflecting more on recovery and the future. The structures of the forensic system continue to influence patients' participation in activities and how they use their time.