Current Issues in Forensic Mental Health Services. The Risk-Need-Responsivity Model

While stabilization focuses on basic mental health services (e.g., better behavior in prison and a decrease in recidivism), rehabilitation attempts to create a change in lifestyle and promotes prosocial behavior. The goal of rehabilitation is not merely symptom reduction but also a way to avoid antecedents and triggers. Simply put, the goal of rehabilitation is to provide the person with mental health problems a way of living a better life—one that allows the individual to thrive, not simply to survive. The World Health Organization defines health as not merely the absence of disease (and accompanying symptoms) but also as the ability to thrive.

Some people are not happy with the idea that criminals should receive rehabilitation, which is above and beyond basic mental health services. Critics of rehabilitation claim that criminals do not deserve more than basic care, that criminals should not receive extensive and expensive treatment, and that rehabilitative treatment is not effective. However, research reveals that rehabilitative treatment works and is financially sound. For many researchers and practitioners, the question is not whether rehabilitative mental health treatment works but it is what specific treatment works for which person and under what circumstances.

The Risk-Need-Responsivity Model. This Risk-Need-Responsivity model has shown promise since 1990. This model first focuses on risk assessment of the specific inmate. While it is difficult to predict exactly what one inmate will do in the future, individuals can be classified by risk of reoffending, such as high risk or low risk. Historically, risk assessment was a professional opinion based on those who worked with offenders. Physicians, psychologists, and correctional officers would provide inmate risk assessments based on their experience with inmates in general and their impression of a specific inmate. This method was later replaced by the use of actuarial assessments of inmates based on evidence-based information. In other words, collecting information about an inmate’s risk factors (e.g., substance abuse, violent behavior) predicted future behavior better than a professional’s opinion.

This newer method of assessment is similar to how insurance companies set policy rates. No one knows exactly who will get in a car accident, when the accident will happen, how much damage will be done, and what costs will be incurred. If an insurance company sets its customers’ premiums (how much each insured person must pay) too low, it will not have enough money to pay off claims and will go out of business. Conversely, if an insurance company sets the premiums too high, the company will not be competitive and go out of business. To stay in business, then, insurance companies must find a way to differentiate high-risk customers from low-risk ones. The insurance company, then, can charge high-risk customers more and low-risk customers less.

The justice system, using evidence-based risk factor analysis, is able to place inmates into higher and lower risk categories. The rehabilitative services must target those who are in the highest risk of reoffending because that is where the rehabilitative services will have the biggest impact. Then, the specific need must be targeted so it can be matched with the correct response. For instance, a person may have problems maintaining his or her composure and become too angry too quickly. To reduce this person’s risk of recidivism, anger management can be provided. If the inmate’s problem is interacting with people who are procrimina, then the person needs to develop relationships with people who are prosocial in their orientation. By doing this, correctional rehabilitative efforts do the most good for the most people. If rehabilitative efforts are not tailored to individuals, then the wrong kind of efforts will be spent on those who do not need them. The rehabilitative efforts, therefore, will not do the most good for the greatest number of people.