Time use in forensic psychiatry: a naturalistic inquiry into two forensic patients in Australia

This study presents the time use for two Australian forensic patients diagnosed with paranoid schizophrenia and in custody for violent offenses across two institutional environments. During the course of the study, both participants weremoved from a prison environment to a newly built secure mental health unit, and data was collected for both sites. The study was conducted as a naturalistic inquiry. Data was collected using a 48-hour time diary, semi-structured interview, the Occupational Performance History Interview II, observation of the environment, a review of policies governing the two settings and a staff focus group with four health professionals. The prison environment was marked by social isolation, occupational imbalance, engagement in delusionally driven activities, and an overall sense of fear and danger. While these themes were not as prevalent at the new unit, the participants’ lives were still dominated by sleeping, passive leisure activities, and restricted access to normal activities of daily living. Other findings from this study suggests that understanding each forensic patient’s individual occupational history and illness experience is essential to fully understanding their current time use, and its relationship to health promoting occupational engagement. Both the OPHI-II and the time diaries proved to be effective tools in gathering information to fully understand the person’s lived experience.