Abstract
BackgroundThe effectiveness of offending behaviour programs in forensic mental health settings is not well established. Thus this study aimed to evaluate the Reasoning and Rehabilitation Mental Health program (R&R2 MHP) among a mentally disordered offender (MDO) population.MethodsA sample of 121 adult males drawn from 10 forensic mental health sites completed questionnaires at baseline and post-treatment to assess violent attitudes, locus of control, social problem-solving and anger. An informant measure of social and psychological functioning, including disruptive behaviour, was completed by unit staff at the same time. At three month follow-up patients completed again the violent attitudes and locus of control questionnaires. The data of 67 patients who participated in the group condition were compared with 54 waiting-list controls who received treatment as usual.Results78% of group participants completed the program. In contrast to controls, significant treatment effects were found at outcome on self-reported measures of violent attitudes, rational problem-solving and anger cognitions. Improvements were endorsed by informant ratings of social and psychological functioning within the establishments. At follow-up significant treatment effects were found for both violent attitudes and locus of control.ConclusionsR&R2 MHP was effective in a sample of MDOs and had a comparatively low drop-out rate. Future research should use a randomized controlled design.
Highlights
The effectiveness of offending behaviour programs in forensic mental health settings is not well established
Significantly fewer treatment as usual (TAU) participants were drawn from low security but there were no significant differences between R&R2 and TAU for age, previous number of admissions or convictions and Patient Motivation Inventory (PMI) motivation to engage in treatment
There were no significant differences between completers and non-completers in age, previous convictions, previous admissions, and PMI motivation
Summary
The effectiveness of offending behaviour programs in forensic mental health settings is not well established. This study aimed to evaluate the Reasoning and Rehabilitation Mental Health program (R&R2 MHP) among a mentally disordered offender (MDO) population. The number of people residing in secure hospitals and prisons is increasing [1] and reconviction rates suggest that within 5 years of release 15% of mentally disordered offenders (MDOs) will re-offend; 3% of whom will commit serious violent offences [2]. As prison and hospital populations are growing and the risk of re-offending remains, there is an increased demand for evidencebased treatments and rehabilitation strategies to alleviate this pressure. There is general agreement that criminal history, procriminal attitudes, associates and antisocial personality represent the “big four” risk factors [4] and it follows skills, interpersonal cognitive problem-solving skills, creative thinking, critical reasoning, social perspective-taking, values enhancement, emotional management and helper therapy (peer mentoring) [10,11]. R&R has been widely researched; meta-analyses have supported its efficacy in a variety of settings with heterogeneous offenders and showing program attendees were 14% and 21% less likely to reoffend compared with controls when delivered in institutional and community settings respectively [12,13]
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