Special issue on therapeutic environments in forensic settings

Citation

Freestone, M. and Vandevelde, S. (2014), "Special issue on therapeutic environments in forensic settings", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 35 No. 3. https://doi.org/10.1108/TC-07-2014-0025

Special issue on therapeutic environments in forensic settings

Article Type: Guest editorial From: Therapeutic Communities: The International Journal of Therapeutic Communities, Volume 35, Issue 3

Forensic settings are not the most intuitive hosts for therapeutic communities. Most forensic services place a high premium on a "command and control" model of security, which is often directly at odds with therapeutic input (Kaye and Franey, 1999), particularly when this is democratic in nature (Moore and Freestone, 2006) or involves former community members as part of the treatment programme (Pan et al., 1993). As if to compound this tension, a number of so-called therapeutic communities established in forensic settings have become notorious in their failure either to intervene effectively with their clients (Rice and Harris, 1993) or to operate at a basic level of safety for staff, patients or the public (Fallon et al., 1999). Curiously, those majority TCs who have operated successfully in forensic environments for many years, such as HMP Grendon (Shuker and Sullivan, 2010), or the many hierarchical services in the USA (DeLeon, 1997; Wexler and Prendergast, 2010), seem not to attract the same level of attention from press or academia as the small number of spectacular failures.

Yet enthusiasm for the TC approach - whether an impulse (Kennard, 2012) or otherwise - remains in forensic services across the world; and perhaps this is not surprising for, when operating effectively, a therapeutic community or enabling environment represents a uniquely humane (Cullen, 1994), efficient (Zhang et al., 2009) and effective (Lösel, 1995; Lees et al., 2004; Wilson et al., 2014) approach to the management of offenders who would otherwise struggle either in the wider community or indeed with their lives in correctional services. This makes some of the trenchant opposition to, or ignorance of, the benefits of the therapeutic community approach, which seem to exist at the highest levels of some clinical professions (Gask et al., 2013; National Institute for Health and Care Excellence, 2009) an ongoing concern and underlines the importance not just of research - for even this brief editorial references plenty of that - but for the promotion and active de-stigmatising of the model.

Therefore, we are proud to present this new collection of papers from an international collection of authors that we believe gathers information on some of the most interesting current developments in the evolution of the therapeutic community or the enabling environment in forensic settings. We are very encouraged by the multi-disciplinary and integrative approaches adopted by all of these papers, and hope this shows as a good sign that we are entering a fertile period for the recognition and evolution of TC-based approaches.

An excellent example of this evolution is the new Offender Personality Disorder Pathway in the UK, for those in prison who exhibit behaviours that may prevent or delay their successful rehabilitation (Joseph and Benefield, 2012). This programme has uniquely drawn heavily on the principles of therapeutic communities, especially in the notion of a Psychologically Informed Planned Environment (Ministry of Justice and Department of Health UK, 2012), whilst also retaining a cautious distance from the name "therapeutic community". We feel very fortunate to have this initiative represented in this Special Issue in the paper by Natalie Bond, and Linda Gemmel, which gives a rich exploration of the changing role of the prison officer in such a new environment, including the challenges of working with a difficult client group and the inevitable dynamics that develop between staff.

Some of the most important developments for TCs within forensic settings have come from synergies of thought between forensic and therapeutically oriented approaches. The Good Lives Model (Ward and Stewart, 2003) has had an enormous impact on interventions in forensic services in providing a positive, client-centred that was previously lacking, and we are delighted to have a paper by Tony Ward and his colleagues Clare-Ann Fortune and Devon Polaschek, exploring the application of the Good Lives approach within therapeutic environments. Of particular interest in this paper is how much pre-existing overlap the authors are able to highlight between the two approaches and how their combination may serve to "smooth the transition" from institution to community for forensic clients.

Although the democratic tradition of TCs may have evolved from a psychoanalytic base, it is most encouraging to see that - like the group therapy approach - many forensic TCs have chosen to incorporate techniques and lessons from cognitive therapies into their practice. The paper by Jenna McWilliams and colleagues in this Issue evaluates such an integrated programme applied to a particularly challenging group, intellectually disabled offenders, who have been the subject of much recent interest as clients who benefit from an environmental approach.

The path towards "recovery and desistance" of many offenders with co-occurring problems (that includes addiction or other mental health conditions) has been shown to be characterised by multiple treatment episodes (see e.g. Martin et al., 2011), due to the relapsing nature of both criminal involvement as well as substance abuse problems. Therefore, safeguarding continuity of care, for instance by linking prison- and community-based services is an important challenge in the field of substance abuse treatment and offender rehabilitation (Belenko et al., 2013).

The study by Stassen, Habets and colleagues offers more insight into the functioning and some early results of the InReach programme that aims to support the transition from correctional to community-based forensic treatment services for mentally ill criminal offenders in Flanders, Belgium. What makes this project particularly interesting is its focus on motivating persons unwilling to enter forensic treatment. Two case examples illustrate the complex support needs that many of these mentally ill offenders are facing, which also relates to the alignment of available treatment services and the particular needs of each individual client.

Also the paper by Ciska Wittouck and colleagues addresses the functioning and the effects of an initiative to divert criminal offenders, in this case with substance abuse problems, to treatment services. The paper concerns an evaluation of the Ghent drug treatment court for drug-involved criminal offenders, which was implemented from 2008 onwards. While previous international studies have primarily evaluated drug treatment courts with regard to criminal recidivism, the present paper focuses on outcomes related to psychosocial indicators and substance abuse. This heightened interest in more "recovery-oriented indicators" is in line with other recent studies that have investigated the effects of TC-treatment with regard to more subjective outcomes, such as personal well-being and social inclusion (Vanderplasschen et al., 2013).

We hope readers find much of interest in this diverse group of papers that push forward both academic study and clinical thought within the field, and would like to invite comment or critique on any of the papers or approaches featured here.

Mark Freestone and Stijn Vandevelde

References

Belenko, S., Hiller, M. and Hamilton, L. (2013), "Treating substance use disorders in the criminal justice system", Current Psychiatry Reports, Vol. 15 No. 11, pp. 1-11

Cullen, E. (1994), "Grendon: the therapeutic prison that works", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 15 No. 4, pp. 301-11

DeLeon, G. (Ed.) (1997), Community as Method: Modified Therapeutic Communities for Special Populations in Special Settings, The Greenwood Publishing Group, Rochester, NY

Fallon, P., Bluglass, R., Edwards, B., Fallon, P., Bluglass, R. and Edwards, B. et al. (1999), Report of the Committee of Inquiry into the Personality Report of the Committee of Inquiry into the Personality Disorder Unit, Ashworth Special Hospital Disorder Unit, Ashworth Special Hospital, Vol. 1 (Cm 4194, II) Stationery Office, London

Gask, L., Evans, M. and Kessler, D. (2013), "Personality disorder", BMJ, Vol. 347, p. f5276

Joseph, N. and Benefield, N. (2012) "A joint offender personality disorder pathway strategy: an outline summary" Criminal Behaviour and Mental Health, Vol. 22 No. 3, pp. 210-17

Kaye, C. and Franey, A. (1999), Managing high security psychiatric care, Jessica Kingsley, London

Kennard, D. (2012), "The therapeutic community impulse: what makes it grow?", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 33 Nos 2/3, pp. 110-6

Lees, J., Manning, N. and Rawlings, B. (2004), "A culture of enquiry: research evidence and the therapeutic community", Psychiatric Quarterly, Vol. 75 No. 3, pp. 279-94

Lösel, F. (1995), "The efficacy of correctional treatment: a review and synthesis of meta-evaluations", in McGuire, J. (Ed.), What Works: Reducing Offending, Wiley, Chichester, pp. 79-111

Martin, S.S., O'Connell, D.J., Paternoster, R. and Bachman, R.D. (2011), "The long and winding road to desistance from crime for drug-involved offenders: the long-term influence of TC treatment on re-arrest", Journal of Drug Issues, Vol. 41 No. 2, pp. 179-96

Ministry of Justice and Department of Health UK (2012), A Guide to Psychologically Informed Planned Environments (PIPEs), Ministry of Justice and Department of Health, London

Moore, C. and Freestone, M. (2006), "Traumas of forming", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 27 No. 2, pp. 193-210

National Institute for Health and Care Excellence (2009), "Borderline personality disorder: treatment and management", CG 78, National Institute for Health and Care Excellence, available at: www.nice.org.uk/nicemedia/pdf/cg78niceguideline.pdf

Pan, H., Scarpitti, F.R., Inciardi, J.A. and Lockwood, D. (1993), "Some considerations on therapeutic communities in corrections", in James, A.I. (Ed.), Drug Treatment and Criminal Justice, Sage, Newbury Park, CA, pp. 30-43

Rice, M.E. and Harris, G.T. (1993), "Ontario's maximum security hospital at Penetanguishene: past, present and future", International Journal of Law and Psychiatry, Vol. 16, pp. 195-215

Shuker, R. and Sullivan, E. (2010), Grendon and the Emergence of Forensic Therapeutic Communities: Developments in Research and Practice, Wiley-Blackwell, Chichester

Vanderplasschen, W., Colpaert, K., Rapp, R.C., Pearce, S., Broekaert, E. and Vandevelde, S. (2013), "Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective", The Scientific World Journal, doi:101155/427817

Ward, T. and Stewart, C.A. (2003), "The treatment of sex offenders: risk management and good lives", Professional Psychology: Research and Practice, Vol. 34 No. 4, pp. 353-60

Wexler, H.K. and Prendergast, M.L. (2010), "Therapeutic communities in United States' prisons: effectiveness and challenges", Therapeutic Communities, Vol. 31 No. 2, pp. 157-75

Wilson, K., Freestone, M., Hardman, F., Blazey, F. and Taylor, C. (2014), "Effectiveness of modified therapeutic community treatment within a medium secure service for personality-disordered offenders", Journal of Forensic Psychiatry and Psychology, doi:10.1080/14789949.2014.908317

Zhang, S.X., Roberts, R.E.L. and McCollister, K.E. (2009), "An economic analysis of the in-prison therapeutic community model on prison management costs", Journal of Criminal Justice, Vol. 37, pp. 388-95, doi:10.1016/j.jcrimjus.2009.06.006

Further reading

Campling, P., Davies, S. and Farquharson, G. (2004), From Toxic Institutions to Therapeutic Environments: Residential Settings in Mental Health Services, The Royal College of Psychiatrists, London

About the Guest Editors

Dr Mark Freestone is a Clinical Research Fellow, based at Violence Prevention Research Unit, Wolfson Institute for Preventive Medicine, Queen Mary University of London, London, UK.

Dr Stijn Vandevelde is a Professor of Orthopedagogics, based at Ghent University, Ghent, Belgium.