Elsevier

Aggression and Violent Behavior

Volume 16, Issue 6, November–December 2011, Pages 472-484
Aggression and Violent Behavior

Rehabilitation frameworks in forensic mental health

https://doi.org/10.1016/j.avb.2011.03.003Get rights and content

Abstract

This paper examines current rehabilitation approaches to Forensic Mental Health Care. On this basis the authors identified three broad approaches to forensic mental health assessment and treatment: (1) Risk/Needs/Responsivity; (2) therapeutic models targeting individual psychopathologies; and (3) strength based models. Following a review of each model the authors conclude that strength based approaches such as the Good Lives Model has theoretical and practical advantages over the other two rehabilitation frameworks.

Research highlights

► Review of rehabilitation models evident in forensic mental health settings. ► Outline of core features of a rehabilitation model. ► Argument for use of strength based models to reduce risk and enhance offenders' well-being. ► Outline of the Good lives Model as an example of a strength based rehabilitation model suitable for use in forensic mental health settings.

Section snippets

Introduction, rationale, and methodology

Forensic mental health services represent the interface between the criminal justice and mental health services providing assessment and treatment for individuals with both mental illness and offending histories. While there are jurisdictional differences, forensic mental health populations typically comprise a heterogeneous group that include insanity acquittees, people found guilty but mentally ill, people found unfit to stand trial, and inmates seen in prison or transferred to mental health

Rehabilitation theory: features of a good forensic rehabilitation model

In order to critically evaluate each of the broad rehabilitation approaches used in forensic mental health it is first necessary to elucidate the theoretical basis of each model. We therefore start by specifying what is meant by the term rehabilitation theory and identify its essential features. We then go on to consider how this knowledge might inform a critical analysis of models of forensic rehabilitation. In doing so we identify key questions or issues that a sound rehabilitation theory

The risk need responsivity (RNR) model

In this section we review risk centered approaches to forensic mental health care. First, we outline the original Risk-Need-Responsivity (RNR) model of offender rehabilitation. We then review applications of the RNR model to a forensic population. Finally, we explore how RNR-derived approaches used in a forensic context conform to the essential features of a good rehabilitation theory outlined earlier.

Various models have been developed to guide clinicians in the process of managing risk of

Therapeutic models targeting individual psychopathologies

In this section we review literature that discusses application of therapeutic approaches to forensic clients where the focus is on the treatment of various psychopathologies and other clinical needs. First, we will explore the treatment literature for forensic clients including interventions for both major mental illness and personality disorder. We then go on to evaluate the reviewed literature with reference to the tenets of good rehabilitation theory

Despite frequent occurrence of psychotic

Strength based approaches to forensic mental health care

In this section we review the extremely limited literature on approaches to forensic rehabilitation that take a strength based, holistic perspective. These models go beyond the risk/treating illness dichotomy to a more systematic consideration of an individual's needs and strengths.

General discussion

Our review of the literature has highlighted four major points for discussion: First, there is a surprisingly small amount of literature pertaining to treatment and rehabilitation approaches to forensic mental health clients. We summarize areas of broad agreement in the extant literature and speculate on some of the reasons for the limited attention to treatment issues. Second, we discuss some of the problems associated with blending RNR and psychopathology paradigms with mentally disordered

Conclusion

The GLM-FM is a strength-based, client-centered, and recovery oriented approach that combines a humanistic approach to rehabilitation with the imperative of protecting society. In our view, effective and ethical interventions with mentally disordered offenders ought to explicitly address what is most important to offenders as well as aiming to reduce their potential for harming others. By virtue of its strength based orientation, the GLM-FM is ideally positioned to provide such therapeutic

Acknowledgment

We are grateful to Ceri Evans for his helpful comments on an earlier version of this paper.

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