Mentally ill offenders are individuals diagnosed with a psychiatric disorder who are concurrently involved in the criminal justice system. This arm comprises 12 purposively sampled mentally ill offenders residing in the Prisoners' Ward, Central Prison, Puzhal, Chennai, Tamil Nadu, India. Participants will receive a structured 12-week MOHO-based occupational therapy intervention consisting of 24 sessions delivered twice weekly by a trained occupational therapist. Sessions will incorporate MOHO constructs - volition, habituation, and performance capacity - to address occupational dysfunction. Activities will focus on self-care, daily living, communication, interpersonal skills, and community reintegration. Life skills will be assessed using the Vellore Occupational Therapy Evaluation Scale (VOTES) and quality of life will be measured using the WHOQOL-BREF at baseline and post-intervention.

Description of MOHO (Model of Human Occupation):

The Model of Human Occupation (MOHO) is a client-centred occupational therapy theoretical framework developed by Gary Kielhofner in 1980. MOHO explains how humans are motivated to engage in occupation, how occupational patterns are organised, and how occupation is performed within the environment. It is built upon three core subsystems:

Volition- refers to the motivation for occupation, encompassing personal causation, values, and interests

*Habituation- refers to the organisation of occupation into patterns and routines through roles and habits Performance Capacity- refers to the physical and mental abilities that enable occupational performance

MOHO emphasises that meaningful occupational engagement is essential for health, well-being, and quality of life. It considers the dynamic interaction between the person, their occupation, and the environment. MOHO-based interventions are widely used in psychiatric and

Mentally ill offenders frequently experience significant deterioration of essential life skills due to prolonged institutionalization, psychiatric symptoms, and limited occupational engagement. Life skills rehabilitation is therefore critical in this forensic population for the following reasons:

Addresses occupational dysfunction by targeting volition, habituation, and performance capacity through MOHO-based intervention Reduces recidivism by equipping offenders with practical competencies necessary for community reintegration Enhances quality of life across physical, psychological, social, and environmental domains Supports forensic psychiatric rehabilitation** through structured, evidence-based occupational therapy Promotes social inclusion by fostering self-efficacy, role competence, and community participation Empowers a vulnerable population by addressing occupational needs and supporting recovery-oriented outcomes

Quality of life (QoL) is a fundamental outcome measure in the rehabilitation of mentally ill offenders. It reflects an individual's perceived well-being across physical, psychological, social, and environmental domains. Among mentally ill offenders, QoL is severely compromised due to psychiatric illness, incarceration, stigma, and occupational deprivation.

Improving QoL is essential in forensic rehabilitation because:

Reflects holistic recovery beyond symptom reduction, encompassing functional independence and well-being Measures rehabilitation outcomes across physical, psychological, social, and environmental domains using WHOQOL-BREF Supports reintegration by improving social participation, interpersonal functioning, and community living Reduces institutionalization effects by restoring meaningful occupational roles and routines through MOHO Promotes mental health recovery by addressing individual occupational needs and priorities