Issue of the One Size Fits All Approach to Treatment of Mentally Ill Offenders

‘One treatment fits all’. Discuss this in relation to psychological treatments for prisoners and offenders.

From the introduction of prisons, the opinions of both the public and government have had to find a balance between punishment and rehabilitation (Craig et al, 2013). Early research points to a split in the public’s ideas of sanctioning- ‘Although citizens clearly want offenders punished, they continue to believe that offenders should be rehabilitated’ (Cullen, Cullen and Wozniak, 1988, p. 305). This juxtaposition is about being hard on crime but also that punishment should be paired with rehabilitation, that treatment may work and prisoners should be given a chance at redemption (Craig et al, 2013). This approach to offending, of punishment accompanied with rehabilitation, suggests that public opinions of crime are not straightforward (Craig et al, 2013). With prison populations increasing, rehabilitating offenders successfully is often considered the number one goal of criminal justice systems around the world (Craig et al, 2013). The Ministry of Justice found that in 2016 the overall reoffending rate was 29.4%, with adult offenders having a reoffending rate of 28.6% and 40.4% for juvenile offenders (Ministry of Justice, 2018). Providing psychological treatments for offenders may help to reduce the reoffending rates, along with meeting the goals of rehabilitation alongside punishment. However, given the diverse nature of the prison population, it may be that different treatments are needed for different offenders, and that is what this essay will examine.

In 1990, Andrews, Bonta and Hoge published an article stating three principles for effective offender rehabilitation: Risk, Need and Responsivity (Andrews et al, 2011). The RNR model of offender rehabilitation explains both the determinants of continuous criminal behaviour, and various suggestions for lowering criminal engagement (Polaschek, 2012). The risk principle suggests that people’s likelihood of engaging in crime changes over time, and this likelihood can be predicted from various factors, such as previous criminality (Polaschek, 2012). The risk principle suggests that more crime can be prevented by targeting those who are higher risk, and so programme intensity should matched to each offender’s risk level (Polaschek, 2012, Andrews et al, 2011). The need principle relates to assessing criminogenic needs and using treatment to target them (Andrews et al, 2011). Criminogenic needs (Otherwise known as dynamic risk factors) are characteristics of people and/or their lives that cause crime to be viewed favourably over non-criminal activity (Andrews et al, 2011). The RNR model posits 8 central risk/need factors, such as antisocial associates and antisocial contagions (Andrews et al, 2011). The responsivity principle is considered the ‘how’ of intervention (Andrews and Bonta, 2010) and is about tailoring interventions to each offender to engage, help them learn and change (Polaschek, 2012). General responsivity is about general techniques such as teaching skills and encouraging pro-social behaviour whereas specific responsivity is about modifying strategies and the variations amongst offenders in the styles and types of treatments they respond to (Andrews et al, 2011, Polaschek, 2012).

Various treatments for offenders adhere to the RNR model but differ in the nature of their treatment. For example, the High-Risk Special Treatment Units (HRSTU’s) in New Zealand provide primarily CBT treatment and assessment over 8 to 12 months for high risk offenders whilst adhering to the RNR model (Polaschek et al, 2018). However, the various treatments used in juvenile offender differ from the HRSTU’s but still adhere to the RNR model (Brogan et al, 2015). For example, Functional Family Therapy (FFT) works with moderate to high risk youth and spends much of the treatment focusing on the dynamics of the family through home visits (Brogan et al, 2015). In FFT, the family is seen as one entity and problems are viewed to stem from relational issues generally as oppose to one family member specifically (Trupin, 2007). Therefore, whilst the adherence to the model is the same, in that both examples of treatment adhere to the RNR model, the treatments themselves remain vastly different. This is especially so given the one treatment is for high risk adults and the other is for moderate-to high risk young people. Given the dramatic differences in reoffending rates for adults and youth, it could be seen that one model fits all as oppose to one treating fitting all.

Research suggests treatments designed and delivered in line with the RNR model lead to reductions in recidivism in sexual offending (Hanson et al, 2009), violent offending (Dowden and Andrews, 2000) and general criminal offending (Andrews et al, 1990). These programmes are more beneficial than those that inconsistently adhere to the principles, and criminal punishments alone (Andrews et al, 1990). Further research suggests that treatment programmes achieve the biggest reductions in recidivism when all three principles are followed; the effect size drops when only two or less principles are followed (Andrews and Bonta, 2010). However, program integrity, staff selection and training, characteristics of the therapist and acceptance of and adherence to the RNR model also influence the outcomes of treatment (Andrews and Dowden, 2005; Dowden and Andrews, 2004; Gendreau and Goggin, 1996). Despite much research, why treatment is effective for some and not others remains unclear (O’Brien et al, 2016). Therefore, it is vital to understand the factors that cause low engagement in treatment and treatment non-completion, so interventions can be more effectively be targeted to meet individual needs (O’Brien et al, 2016) Offender engagement in treatment is a vital first step for offenders changing their behaviour; if treatment is not attended or engaged with, offenders will not internalise the key concepts of treatment and thus long term change in offender behaviour is unlikely (O’Brien et al, 2016). Low engagement and high rates of non-completion are regular problems faced in offender rehabilitation, suggesting that offenders aren’t sufficiently invested in changing their behaviour (McMurran and Ward, 2010). In a review of cognitive-behaviour treatment programmes, McMurran and Theodosi (2007) found that 48% of community based offenders and 15% of offenders in prison-based treatments dropped out of treatment early. Those who fail to complete treatment are less likely to get suitable levels of treatment to reduce their risk of reoffending (Hansen et al, 2002; McMurran and Ward, 2010). These results question the responsiveness of current treatment programmes to individual needs of offenders, and shows how important it is to examine how to alter, change or reorganise programs to match offender requirements (O’Brien et al, 2016)

 Research has increasingly come to suggest that the same treatment doesn’t work for all offenders (Stith et al, 2004). There are various internal responsivity factors that can impact the effectiveness of treatment programmes but benefiting or limiting treatment engagement (O’Brien, 2016). Therefore, adequately assessing these factors could help identify needs and readiness for treatment, with specific attention needing to be paid to the misalignment between offender readiness for treatment and the goals of the intervention programme (O’Brien, 2016). Reducing such barriers to treatment participation may allow offenders to engage with the treatment process, therefore reaping the benefits (O’Brien, 2016). Such factors that may interfere with the treatment process include mental illness (Prins and Draper, 2009), trauma (Najavits, 2006), motivation and readiness (Day et al., 2006), denial and minimisation (Henning and Holdford, 2006), psychopathy (Harris and Rice, 2006) and cognitive impairment (Beail and Jahoda, 2012)

References

• Andrews, D. A., Bonta, J., & Hoge, R. D. (1990). Classification for effective rehabilitation: Rediscovering psychology. Criminal Justice and Behavior, 17(1), 1952. doi:10.1177/ 0093854890017001004
• Andrews, D. A., & Dowden, C. (2005). Managing correctional treatment for reduced recidivism: A meta-analytic review of programme integrity. Legal and Criminological Psychology, 10 (2), 173187. doi:10.1348/135532505×36723
• Andrews, D. A., & Bonta, J. (2010a). The Psychology of Criminal Conduct (5th ed.). Newark, NJ: Matthew Bender.
• Andrews, D., Bonta, J., & Wormith, J. (2011). The Risk-Need-Responsivity (RNR) Model. Criminal Justice And Behavior, 38(7), 735-755. doi: 10.1177/0093854811406356
• Brogan, L., Haney-Caron, E., NeMoyer, A., & DeMatteo, D. (2015). Applying the Risk-Needs-Responsivity (RNR) Model to Juvenile Justice. Criminal Justice Review, 40(3), 277-302. doi: 10.1177/0734016814567312
• Craig, L., Dixon, L., & Gannon, T. (2013). What Works in Offender Rehabilitation: An Evidence Based Approach to Assessment and Treatment. Chichester: John Wiley & Sons.
• Cullen, F.T., Cullen, J.B. and Wozniak, J.F. (1988) Is rehabilitation dead? The myth of the punitive public. Journal of Criminal Justice, 16: 303–317.
• Dowden, C., & Andrews, D. A. (2000). Effective correctional treatment and violent reoffending: A meta-analysis. Canadian Journal of Criminology, 42, 449467.
• Dowden, C., & Andrews, D. A. (2004). The importance of staff practice in delivering effective correctional treatment: A meta-analytic review of core correctional practice. International Journal of Offender Therapy and Comparative Criminology, 48(2), 203214. doi:10.1177/ 0306624£03257765
• Gendreau, P., & Goggin, C. (1996). Principles of effective correctional programming. Forum on Corrections Research
• Hanson, R. K., Bourgon, G., Helmus, L., & Hodgson, S. (2009). The principles of effective correctional treatment also apply to sexual offenders: A meta-analysis. Criminal Justice and Behavior, 36(9), 865891. doi:10.1177/ 0093854809338545
• Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329343. doi:10.1093/clipsy.9.3.329
• McMurran, M., & Theodosi, E. (2007). Is treatment non-completion associated with increased reconviction over no treatment? Psychology, Crime & Law, 13(4), 333343.
• McMurran, M., & Ward, T. (2010). Treatment readiness, treatment engagement and behaviour change. Criminal Behaviour and Mental Health, 20, 7585.
• Ministry of Justice. (2018). Proven Reoffending Statistics Quarterly Bulletin. London: Ministry of Justice.
• O’Brien, K., Sullivan, D., & Daffern, M. (2016). Integrating Individual and Group-based Offence-focussed Psychological Treatments: Towards a Model for Best Practice. Psychiatry, Psychology And Law, 23(5), 746-764. doi: 10.1080/13218719.2016.1150143
• Polaschek, D. (2012). An appraisal of the risk-need-responsivity (RNR) model of offender rehabilitation and its application in correctional treatment. Legal And Criminological Psychology, 17(1), 1-17. doi: 10.1111/j.2044-8333.2011.02038.x
• Polaschek, D., Yesberg, J., & Chauhan, P. (2018). A Year Without a Conviction: An Integrated Examination of Potential Mechanisms for Successful Reentry in High-Risk Violent Prisoners. Criminal Justice And Behavior, 45(4), 425-446. doi: 10.1177/0093854817752757
• Trupin, E. (2007). Evidence-based treatment for justice involved youth. In C. L. Kessler and L. J. Kraus (Eds.), The mental health needs of young offenders: Forging paths toward reintegration and rehabilitation (pp. 340–367). West Nyack, NY: Cambridge University Press.