A specialist working with people in Edinburgh prison says better focus on rehabilitation and recognising the role of mental heath in every prisoner’s wellbeing is essential, both in prison and when returning to their community.

Talking to healthandcare.scot, the Occupational Therapy Lead for HMP Edinburgh shares the vital role this unique service in Saughton plays.

Heather McLachlan who leads the occupational therapy (OT) service says very few prisons in Scotland had provision for OT when she began developing the service for Edinburgh:

“It amazed me. If we’re wanting to rehab people back out into the community, OT would seem the logical resource – or certainly one of the logical resources – to have within the prison for that.

“It’s taken a long time, but I think Scottish Prison Service were keen – certainly our governor was keen to have the resource in, which is great.”

Heather started building the OT service in 2019 and says even now, five years on, there are a lot of misconceptions around what occupational therapy is.

She says often people confuse it with occupational health – which relates to workplace health and wellness – whereas OT is a rehabilitation specialism that offers a holistic approach to support individuals’ mental health.

In a prison setting this includes helping improve wellbeing by assessing people within the prison around their daily living, their relationships and positively managing the environment they are in.

“We usually use activity throughout our sessions, low-level activities like dominoes or cards to support an assessment but also a conversation flow to start building the therapeutic relationship. It drops a barrier of feeling that someone is sitting across from you assessing and creates a more positive environment.

“We’ve had such good feedback from prisoners about how OT has helped them.”

One of the challenges the team face is, as Heather puts it, “negotiating the fact that you’re in the prison” and finding therapeutic space within this environment.

Heather says was initially difficult in terms of figuring out how OT can fit within the system:

“I work for the NHS but we work within the prison service – I think of myself as a lodger in their house. Ultimately, the prison decides what happens in the prison.

“You’ve got 900 prisoners, probably all of whom could do with some sort of occupational therapy, so I spent a few months doing a mapping project.”

Now, Heather explains that while people in prison face a similar range of mental health struggles as the rest of society, it is compounded by their environment.

Self-identity

Many people living in prison experience isolation and anxiety around leaving their cells and struggle with their sense of self-identity, and with building structure and routine within those set for them.

Heather explains that a lot of people adopt a “prison persona” to cope, and occupational therapy helps look beyond prison too.

As well as Heather, the OT team has a second occupational therapist and a support worker.

They support people in the prison to look how they are spending their time in their cells or if they leave, how they are socialising and engaging in other social relationships.

This extends to each individual’s contact with family or friends, which Heather says is key to both good mental health and the process of rehabilitation.

She says that while a lot of the occupational therapy they deliver reflects what someone would receive through the NHS outside of a prison, the context creates “a whole different ballgame”:

“The actual occupational therapy doesn’t change much; you work in a client-centred nature with a non-judgemental approach which can be challenging in a prison.

“Trust is a massive thing for building therapeutic relationships and can take quite a long time to build first.”

Building from that point of trust, often OT helps individuals see that while they are in prison, it’s not the only thing that defines them, encouraging them to maintain positive connections and relationships with the outside world.

For some, this starts from confidence and communication within prison, to group work and then supporting them to move from the hall into the education spaces and cleaning jobs within prisons.

With reports of human rights failings in prisons and Scotland’s chief inspector of prisons calling for radical reform to refocus Scotland’s prisons on rehabilitation, Heather says bridging the gap into their own community for prisoners who are leaving is key:

“It’s a big thing that’s missing, the prison service needs to be more rehab focused, we need to work with people in prisons to build on their skills and resilience and support them back into the community.

“And having services that support them on the outside too – those imminent days when they come out of prison, a lot of people are homeless, may have lost their home. They need to be able to register with a GP, go to the job centre.”

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