Chapter 3 – Treatment Pathways

There are two main interacting factors to consider here, which are represented in the figure below:

Offenders therefore fall into four categories:

  1. Determinate and high responsivity: prisoners on a determinate sentence can choose whether to engage in accredited programmes. When they have high responsivity, they are both capable of engaging in the programmes (e.g. intellectually able) and motivated to participate. Additional consideration will be given to their level of need and the timescale in which to work (i.e. length of sentence).
  2. Determinate and low responsivity: prisoners who are low in responsivity may be less amenable to treatment due to their lack of motivation and/or capacity to derive benefit from therapies (e.g. literacy levels). When these individuals are on determinate sentences, there is little in the way of external incentives that can be offered to encourage participation. The focus will need to be on psychologically informed management approaches (see chapter 4).
  3. Indeterminate and high responsivity: prisoners on indeterminate sentences who are high in responsivity (determined by their capacity and motivation to engage in treatments) should be offered the full range of accredited programmes available in prison, according to their criminogenic and emotional needs.
  4. Indeterminate and low responsivity: prisoners on indeterminate sentences who are low in motivation or capacity to derive benefit from accredited programmes should be engaged in a constructive waiting relationship (which is outlined below) Here the role of the prisoner is to take responsibility for demonstrably lowering his risk; the role of the practitioner is to maximise the opportunities for collaboration and progress. It is important to build in annual reviews as the situation may change.

Constructive waiting relationship

For under-motivated, treatment resistant prisoners:

  • Consider letter contact outlining treatment options
  • Minimise language which implies obligation or compulsion
  • Emphasise the prisoner’s choice and control over treatment options
  • Offer telephone/videolink contact to talk through options.