People with severe problematic personality traits and offending histories: What influences occupational participation?

Abstract

Background: Occupational participation is important for personality disordered offenders (PDOs) because it is integral to health and desistance from offending. What influences occupational participation is unknown for PDOs in the community, limiting effective intervention to affect change. In England and Wales, the Offender Personality Disorder Pathway aims to improve outcomes for people considered highly likely to have a severe personality disorder and who present a high risk of reoffending, who are determined to be PDOs on the basis of a structured assessment. This study identified the influencers of occupational participation for the population who receive this service.

Method: In this critical realist, qualitative study, narrative interviews were conducted with 18 PDOs supervised by probation in England. Transcripts were analyzed using a grounded theory approach to establish influencers of occupational participation.

Results: Four themes describe influencers of occupational participation: function of occupations; influence of the past; external forces; and learning and adaptation. The latter theme reflected understandings of occupational adaptation described by the Model of Human Occupation.

Conclusions: An intervention to increase prosocial occupational participation should be developed and evaluated for PDOs in the community, taking account of occupational participation over the life course.

Keywords: Forensic psychiatry; Personality disorders; Quality of life.