Meet Senior OT Sally Lamshed: dedicating her career to helping participants transition better from prison to the community

Like all our clinicians, Sally Lamshed helps people living with disabilities enjoy a better quality of life. Her participants, however, makes her role at Better Rehab unique, as they are transitioning back into the community from prisons and secure facilities across Victoria. It’s a specialty she chose not long into her career, despite being an emerging practice area which few OTs choose.

“I love the work that I do. It’s an area of OT I’m really passionate about. I have a strong belief that everyone deserves quality care and support, and the right to participate in occupations, regardless of what they have done to become involved in the justice system,” explains Sally.

In addition to providing OT to her participants, most of whom have an intellectual disability, Sally advocates for the rights of all people with disabilities in the justice system to receive the supports they need to help them adjust to life back in the community.

Supports are crucial according to overseas and local research, including an Australian study that found that most people in prison are not adequately prepared for community re-entry, leaving without appropriate support to find stable accommodation, connect with their community and engage in meaningful activities. And while about half of all people in prison return to custody within two years of their release, almost three quarters of those with an intellectual disability return in this same period.

“The more I have worked with participants in this system, the more passionate I’ve become about the need for occupational therapy advocacy, I find it a challenging but extremely rewarding practice area,” she says.

Why participants within the justice system?

After graduating as an occupational therapist in 2016, Sally became interested in occupational justice, a concept which promotes a person’s right to have their basic needs met and equal opportunities and resources to reach their potential and engage in meaningful occupation. This interest led Sally to occupational deprivation, a facet within occupational justice, which is the prevention or preclusion of a person from participating in necessary or meaningful activities.

Prolonged occupational deprivation has ‘serious consequences’, according to Occupational Therapy Australia as it reduces people’s capacities and affects their health, wellbeing, and quality of life. Research has found that occupational deprivation while in custody impacts integration back into the community, an issue Sally has witnessed first-hand and hopes to resolve through her OT work and advocacy.

Realising that she could make a positive impact on people with disabilities who experience occupational deprivation and lack adequate supports after their release, Sally completed a Specialist Certificate in Criminology (Forensic Disability) to expand her knowledge and skillset in this area of OT.

“Once I started working with the prison population, I never looked back,” she says.

What a typical day looks like

For Sally, “preparing participants for life outside is the biggest part of my role” and this involves working with them on the development of life skills.

“Prison is a structured and controlled environment where people are required to make very limited decisions, don’t have to plan their day, and many aren’t preparing their own meals. When people are released, they need to perform these daily tasks again. Many of my participants had limited life skills before they went to prison, so we often need to start with the basics.”

When Sally’s participants are first released, she typically completes intensive sessions with them. “The first priority is often scheduling and developing a new routine with them at home and in the community. The day is no longer structured for them as it was in prison and this transition can be an incredibly destabilising experience.”

Sally also works with participants on their emotional regulation, to address behaviours of concern, and to develop provide skills for maintaining healthy relationships. Her work can also include what occupational therapist, researcher and lecturer Dr Rebecca Twinley has coined ‘the dark side of occupation’, which are activities that may be health compromising or viewed as deviant. “It’s really important to destigmatise people’s participation in certain occupations. I often use the metaphor of a garden, if we take out an activity such as substance use, then we need to put something back in its place which meets a similar need – needs could include social connection or coping with distress.”

Challenges of working in this specialty area of OT

One challenge Sally faces on a regular basis is balancing the demands of the justice system and the NDIS with her role as an occupational therapist. “OT is focused on the individual, whereas the justice system is necessarily focused on the safety of the community – sometimes they aren’t in harmony, which is challenging.”

Another challenge is finding support workers to meet the complex needs of participants, which she says demand compassion and de-escalation skills while tolerating a level of risk.

“Support workers are essential to achieving goals in the community. I regularly meet with them to provide training as well as reflective practice to enable them to sustain and develop within their roles and improve participant outcomes. The right support workers are the greatest asset.”

Sally also wants to highlight that Aboriginal and Torres Strait Islander peoples with cognitive disabilities are significantly over-represented in the Australian justice system and, as a result, she is working with a higher proportion of participants form this background. “Working with Aboriginal and Torres Strait Islander people is something I’m proud that I can assist with in partnership with their communities, however I cannot overstate the devastation of working with this population experiencing incarceration. It’s one of the most challenging parts of the work.”

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