A review and comparative analysis of the risk-needs-responsivity, good lives, and recovery models in forensic psychiatric treatment

Abstract

Forensic mental health care primarily focuses on aspects of safety. Treatment is involuntary, and personal rights are highly restricted. Both direct and indirect coercion and significant power imbalances can impede not only the psychological state of inpatients but also their treatment motivation and the therapeutic process in general. However, successful treatment is essential to enable patients to regain their freedom. Therefore, the question arises whether and how health professionals, without disregarding the potential risks, can enable forensic psychiatric patients to experience meaningfulness and self-efficacy in their lives. In offender rehabilitation, the Risk-Need-Responsivity (RNR) model and Good Lives Model (GLM) are widely established theories. The RNR model focuses not only on the risk of recidivism but also on those needs of a person that provoke or prevent criminal behavior and the individual’s ability to respond to various kinds of interventions. In contrast, the GLM aims to reduce the risk of re-offending by enabling an individual to live a “good life,” i.e., a meaningful and fulfilling life. Originally developed in correctional services, i.e., for offenders without severe mental disorders, both the RNR model and the GLM have also been tested in forensic psychiatric treatment contexts. The Recovery Model is based on the concept of personal recovery in mental health care and is understood as the development of a sense of purpose and mastery in one’s own life during the process of coping with the sequelae of a mental disorder. It is a central element of rehabilitation in general, but is also being increasingly applied in forensic psychiatric treatment settings. This review aims to compare the central concepts of the three models, in particular regarding personal development, and the current evidence for their efficacy in mentally disordered offenders.

The meaning of the recovery process and its stages for people attending a mental health day hospital: A qualitative study

“…19 However, in other more restrictive areas, such as forensic psychiatric nursing, the salient aspects of the recovery process for people with mental health problems were disconnection, hopelessness, negative identity experience as an offender, lack of meaning and perceived disempowerment. [20][21][22] In the context of mental health care in day hospitals, mental health care is offered within the community at times when the person's needs are acute. This care is provided by a multidisciplinary team for a period of no more than 3 months and avoids admission to an acute care unit, which is usually considered detrimental to the lives of people with mental health problems.…”

“…People cared for in the community give special relevance to interpersonal and self‐connection in their recovery process, through inclusion in one's own community, receiving support when needed and being able to progress through loss 19 . However, in other more restrictive areas, such as forensic psychiatric nursing, the salient aspects of the recovery process for people with mental health problems were disconnection, hopelessness, negative identity experience as an offender, lack of meaning and perceived disempowerment 20–22 …”

“… 19 However, in other more restrictive areas, such as forensic psychiatric nursing, the salient aspects of the recovery process for people with mental health problems were disconnection, hopelessness, negative identity experience as an offender, lack of meaning and perceived disempowerment. 20 , 21 , 22 …”

Changing GEARS: Development and Validation of Gendered Emerging-Adult Rehabilitative Strengths Measures

“…The narrow scope of such models overlooks adaptive elements of individuals, and so hampers the ability of these individuals to successfully rehabilitate and reintegrate into society (Donnelly, 2021). In forensic assessment, rehabilitative models are those that help to guide JICs towards desistance (Lutz et al, 2022;Tomlin & Jordan, 2022;Wanamaker et al, 2018). In contrast to the 'nothing works' doctrine of JIC treatment (Martinson, 1974) -a sort of academic 'witch hunt' wherein ineffective interventions were being identified and refuted -forensic scholars pushed for evidence-based correctional rehabilitation in search of 'what works' (Dowden & Andrews, 1999b;MacKenzie, 2006).…”

“…Dynamic strengths have been criticized for lacking a structured, theoretical foundation (Thornton, 2013), and many dynamic factors still suffer from conceptual ambiguity or insufficient rationales for inclusion in assessments (Ward & Beech, 2015). The lack of clarity regarding relationships between dynamic strengths and risks has made the utility of strengths unclear to practitioners (Lutz et al, 2022). Together, many disparate measures that include strengths assessment (to some degree) -along with little external evidence of their efficacy-may create confusion or tentativeness regarding the perceived utility of each strength, in regards to associations with desistance.…”