Values and recovery in forensic mental health

Abstract

Background: Strength-based approaches to working with Mentally Disordered Offenders (MDOs) move from a focus on mental disorder and risk to a wider consideration of the individual that considers their strengths, personal priorities and competencies. There is an increasing emphasis on values and recovery in health and forensic mental health services. This represents a shift in perspective from a deficit focus to an abilities focus. There is however a paucity of research into values and strength-based approaches. This thesis portfolio aims to contribute to this area of research. Methods: A systematic review of the literature was conducted to review strengthbased approaches for mentally disordered offenders in forensic mental health settings. Four databases (MELINE, PsycINFO, EMBASE and SCOPUS) were searched and 10 studies were included in the review. The outcomes measures in the included studies were recovery, quality of life, violence/risk, recidivism, mental health symptoms, therapeutic milieu, and engagement. In the empirical study, a Grounded Theory Methods was used to build a theory of values of men in a medium secure unit who have offended. Interviews were conducted with nine inpatients in a Scottish medium secure unit. Results: The findings of the systematic review, although limited, suggest that a strength-based approach will facilitate outcomes in quality of life, recovery, mental health symptoms, violence, risk, recidivism, and engagement. Limited evidence was found and there was also a lack of consistent findings. Further consideration of the long-term impact of such an approach and further high-quality research is needed to establish the effectiveness of strength-based approaches. In the empirical paper, a model of values in mentally disordered offenders was produced. The expressed values of MDOs were made up four separate categories relating to: (1.) connecting with others; (2.) living a healthy life; (3.) being productive and contributing; and (4.) having agency and being in control. As part of the model, a consideration is given to the development of values throughout life and the barriers and opportunities that impact on an individual’s life and the impact that has on values. Conclusions: The findings of this thesis indicate that there is a benefit to using strength-based and values informed approaches to working with mentally disordered offenders. The findings of this research support the view that mentally disordered offenders share similar values to non-offenders. Further research is needed, to be able to clearly support the effectiveness of strength-based approaches and also to evaluate the use of values to guide clinical care and treatment.