**2.3. Forensic hospitals**

**2.2. Prisons**

54 Occupational Therapy - Therapeutic and Creative Use of Activity

periods of time [3].

Prisons are classified as high, medium and low security institutions that are typically used for convicted criminals who have been sentenced to at least a year of imprisonment in U.S. Federal Bureau of Prisons. In addition, depending on the severity of the crime, some individuals are sentenced to either state or federal prisons. However, compared to jails, prisons offer a far more stable environment for the inmates and restrict their interaction with society for longer

The primary purpose of prisons is to ensure public safety and the security of inmates. In addition to incarcerating criminals, prisons offer them programs to address their criminogenic needs related to education, substance abuse, employment and transition to the community. Basic services in prisons involve intake and screening of psychotropic medicines and to provide occupational therapy services. Those services are substantially provided for prisoners to decrease their social isolation and increase their problem solving and adaptation skills, self-efficacy and self-esteem. The occupational therapy services also promote emotional regulation abilities and social and emotional skills in order for the inmate to deal with prison life and take this opportunity to improve on self-efficacy and occupational engagement [15].

**1.** High-security units: Individuals classified as high risk to public safety have been sentenced to life imprisonment and are receiving long term treatment, are housed in high-security prisons. The physical environment in these facilities consists of a number of physical and structural barriers between the facilities and the external environment of the institution. In high-security prisons with highest number of staff, and both multiple and single cells, criminals remain in their cells or in an outer cage in the facilities' yard. Each cell is equipped with a toilet, screwed to its floor, and prisoners are permitted up to three 10-min showers per week. Movement is firmly restricted and activity within the cellblock does not occur without other constraints, such as handcuffs, leg irons and corrective officer escorts [3]. Orientation can be considered as essential because it gives the staff the chance to be acquainted with the prisoners. The ward program focus areas, such as improving awareness of self, others and the environment; orientation to time, place and situation; probing cognitive abilities and teaching of new skills to improve leisure time use and psychomotor

**2.** Medium-security prisons: Those institutions house individuals with a criminal background and requiring 2–5 years of treatment [17]. Medium-security prisons, where prisoners' accessibility to prison gardens and exercise areas, libraries, showers and health services are high, offer far more opportunities in terms of interaction, movement and activity inbetween prisoners [3]. Medium-security prisons usually have a wide diversity of workoriented and treatment programs. Parole is more frequently granted in medium-security prisons and may be classified as supervised (always less than 1 h), limited (sent to wards for only 1 or 2 h), occupational therapy parole (join structured activities or subcontract work) and unlimited parole (mostly on weekends and during the week when they do not

activation, should be maintained after discharge [16].

join specific rehabilitation activities).

Forensic psychiatric settings are generally located in secure units that rehabilitate individuals deemed unfit to stand trial or not criminally responsible. Those inmates pose a serious threat to either themselves or others because of severe mental illness. A forensic psychiatric setting provides treatment-based approaches with a view to rehabilitating patients while keeping the public safe. Patients, temporarily transferred from correctional facilities or incarcerated environment, are assessed and treated for mental illness in the facility that consists of secure, closed and open common units [17].

Forensic psychiatric hospitals reintegrate patients systematically into the community with well-equipped and specialized clinical services, as well as an exhaustive range of vocational and rehabilitative programs. Treatment is typically long-term, in order to improve and safely stabilize patients' mental well-being.
