Therapeutic jurisprudence and mental health tribunals: changing patterns of demand and its impact

For decades the mental health system has been ‘in crisis,’ with too little funding, too much demand and fragmented services. In England and Wales, decisions made concerning the care and treatment of those suffering from a mental disorder is governed by the Mental Health Act 1983 (as amended) (MHA 1983). Detention under the legislation is fraught with conflict; patient and clinical views are often at odds. Mental health tribunals enable patients to seek a review of their case and the legality of their detention. This paper argues that with the increased use of formal detention under the MHA 1983, the caseloads of mental health tribunals have similarly risen. Whether it is possible to advance therapeutic benefit to psychiatric patients attending tribunals is open to question. While mental health tribunals have a role to play in generating a positive psychological impact on an applicant, there is a risk that time and resource pressures may inhibit the adoption of a therapeutic approach. This paper considers the key drivers that are currently pushing detention rates up, the impact this is having on mental health tribunal caseloads and whether it is possible to bring therapeutic jurisprudence to the patient.     

Measuring the subjective perceptions of risks and rewards of Chinese juvenile thieves

Offenders’ readiness to engage in changes that will reduce their risk of reoffending is now recognized to be as important as the design and delivery of programmes that support such change. Interest is growing in both how to increase engagement in change processes, and how to measure any improvements in engagement. This study evaluated the effects of a brief offending-focused motivational interviewing (MI) intervention on reconviction in male prisoners serving sentences for diverse crimes. Men who undertook MI were significantly less likely to be reconvicted than those who did not. The results also served to validate a stage-based measure of readiness to change derived from Prochaska and DiClemente's Transtheoretical Model. Prisoners who were offered MI increased their readiness to change by an average of one stage, while the scores of men who were not remained unchanged. Furthermore – whether men undertook MI or not – change in stage of change predicted reconviction. This was a high-risk sample, making the results intriguing for at least two reasons. First, reductions in recidivism are usually achieved only with much more intensive programmes for high-risk men. Second, according to ‘traditional’ cognitive–behavioural rehabilitation theory, programmes need to target change in dynamic risk factors directly to reduce reconviction risk. That these results were obtained with men whose initial motivation was low, and in the absence of any ‘traditional’ criminogenic rehabilitation, raises questions about whether there is more than one mechanism involved in desistance.     

How do therapists contribute to therapeutic change in sex offender treatment: An integration of the literature

Abstract

Psychotherapy research suggests that therapists contribute to the process of therapeutic change. Research into sex offender treatment has tended to focus on the content rather than the process of therapeutic change. This paper reviews the evidence for the role of therapist characteristics in relation to therapeutic change in sex offender treatment. A literature search of a number of electronic databases and additional manual searches identified a total of 15 relevant articles. Studies were carried out in different treatment contexts and with a variety of methodological approaches. A number of therapist characteristics were identified in relation to the process of therapeutic change in sex offender treatment. Due to the methodological limitations of the studies, no conclusive evidence was found for the contribution of therapist characteristics to treatment efficacy. Nevertheless, the findings may have some clinical utility in relation to improving the therapeutic effectiveness of sex offender treatment.     

New Zealand's special treatment units: the development and implementation of intensive treatment for high-risk male prisoners

In the late 1980s, New Zealand developed two highly innovative residential treatment programmes for serious offenders that blended together the strengths of structured cognitive behavioural group programmes and therapeutic community approaches. Since the mid-1990s this hybrid model – recently advocated as a fruitful direction for future offender programme development – was adopted and further refined for use in New Zealand's four high-risk special treatment units (HRSTUs). We outline the HRSTU model, noting the challenges and potential benefits of providing an intervention that integrates therapy, resocialisation and reintegration experiences for high-risk, high need, low responsivity clients: many with significant psychopathic features. On average, the majority of those referred to HRSTUs complete the programme and make small but significant amounts of change on important treatment goals. But most changes remain tentative, suggesting the importance of more supportive aftercare. Although an earlier evaluation of the first unit to open found the programme to be modestly effective in reducing recidivism, an outcome evaluation currently underway will help establish whether improvements since that time are associated with reductions in disciplinary infractions and recidivism.