Executive Summary

Through personalised, graded OT intervention, Simon rebuilt confidence, digital skills and independent travel after decades in secure settings. His progress showcases the transformative power of Occupational Therapy in restoring identity and enabling meaningful community participation. Case study by Rachel Rowe, Regional Lead OT, Cygnet. Learn more: https://join.cygnetgroup.com/ot-life

Case Study

Background: Simon was transferred to our low secure personality disorder service in 2021. He has a history of over 20 years in prison and medium secure settings. From a Model of Human Occupation (MOHO) perspective, this prolonged institutionalisation impacted his volition, habituation, and performance capacity, resulting in occupational deprivation and reduced independence.

Initial Assessment: On admission, Simon demonstrated difficulties with activities of daily living (ADLs), particularly digital literacy. He reported low confidence (personal causation) when using smartphones and computers, highlighting reduced volition and limited exposure to technological changes in the community.

OT Intervention: Building Skills and Confidence Occupational therapy intervention focused on improving occupational competence through structured, person‑centred 1:1 sessions. Tasks were graded and adapted to support skill acquisition, with an emphasis on repetition and real‑world application. Over time, Simon’s confidence and motivation increased, reflecting improved volition and performance capacity.

Community Mobility and Graded Exposure Community mobility was also significantly impacted. Simon had not used public transport for over 20 years and experienced high anxiety around travel, limiting his ability to engage in community‑based occupations. From a MOHO perspective, this indicated disrupted habituation and environmental barriers.

A graded exposure approach was implemented, beginning with supported bus journeys and progressing to trams and trains. This incremental method enabled Simon to rebuild travel‑related routines, develop practical skills, and increase confidence. Through consistent occupational engagement, he demonstrated improvements across all MOHO domains.

Outcomes and Progress Simon progressed to unescorted leave and is now independently using public transport, travelling up to 400 miles weekly to support his discharge planning. This reflects increased occupational competence, established routines, and a stronger occupational identity.

Looking Ahead Simon’s progress highlights the importance of addressing the interaction between volition, habituation, performance capacity, and environment in supporting recovery. Engagement with Occupational Therapy has been critical in enabling him to work toward discharge to his preferred location. He is currently awaiting a parole board hearing, representing a significant occupational transition and an opportunity to further develop meaningful roles within the community.