Sensing freedom: Occupational therapists’ perspectives on sensory processing and occupational participation in forensic mental health – A qualitative study

Introduction: Forensic mental health provides rehabilitation to individuals who have experienced mental health crises, typically with involvement from the criminal justice system. Occupational therapists facilitate occupational participation for community reintegration. There is growing interest in the relationship between sensory processing and mental health, but limited discussion exists regarding how this relationship influences participation within these settings and how occupational therapists can integrate sensory processing knowledge into occupation-focused practice. This study explored occupational therapists’ practice-based experience of addressing service users’ sensory processing in a forensic mental health setting. Method: A hermeneutic phenomenological design was used to explore occupational therapists’ practice-based experiences. Online semi-structured interviews were conducted with eight forensic mental health occupational therapists recruited nationally. Data were analysed using reflexive thematic analysis. Findings: The following five key themes were constructed: security trumps therapy, the secure environment is untherapeutic, sensory needs influence occupational participation, sensory processing issues link with trauma history and clinical interest is impeded by uncertainty. Conclusion: The findings highlight the need to integrate sensory processing knowledge into occupation-focused practice to enhance occupational participation. Occupational therapists are also well placed to contribute sensory processing knowledge to service-level multidisciplinary sensory-informed approaches that aim to reduce service user distress. What the study has added: This study highlights the importance of sensory-informed, occupation-focused practice in forensic mental health. It offers practice-based experiences to support occupational therapists to address occupational deprivation within restrictive environments. Key findings: Restrictive forensic environments influence sensory experiences and impact meaningful rehabilitation participation.