Many mental health services working within Australian criminal justice, youth justice and forensic systems have in recent times implemented recovery-oriented approaches. They face many challenges operating in environments that limit liberty and autonomy and enforce obligations for legal accountability and treatment compliance.
Providing services in settings controlled by other authoritiesMental health services operating in courts, correctional facilities, community correctional settings, juvenile justice facilities and community-based programs and probation and parole programs do not have administrative control over the settings and programs in which they operate. The recovery aspirations, goals and plans of a person in the criminal justice, youth justice and forensic settings can be contrary to the responsibilities of the mental health service to maintain security and manage risk. Implementing recovery-oriented approaches in these settings involves considerable and persistent cross-agency negotiation and collaboration as well as open and transparent communication with the people who are in their services.
Understanding and navigating complex layers of coercionPeople in facility- or community-based institutional settings are frequently not motivated to engage in treatment because their mental health assessment, treatment or placement was ordered by courts or correctional authorities. People deprived of their liberty frequently view such orders as double jeopardy and fear that forensic patient status might delay their return to the community. Complex layers of coercion within these settings, and the obligation of practitioners to satisfy certain requirements (such as reporting) affect a person's willingness to accept a therapeutic relationship or mental health services. Transparency and open discussion of legal responsibilities are critical while practitioners actively seek opportunities to support people’s exercise of choice, self-management of risk and access to opportunities for learning, growth and development.
Strengths-based practice models are useful in embedding recovery practice in institutional settings. Wellness recovery action plans or similar recovery tools are also helpful.
Working with people who have experienced considerable adversityRecovery-oriented practice and service delivery acknowledges that many people in criminal justice, youth justice and forensic settings have experienced considerable social disadvantage and childhood adversity and trauma. Many have been in some form of care for significant periods. Their health is often poorer than other people with mental health issues. They may suffer from intellectual disability, acquired brain injury, alcohol and drug use and physical disabilities. Their involvement in the criminal justice system may compound an already poor sense of self-worth and efficacy. Responses need to be multidisciplinary, multiagency, cross-sectoral, and collaborative. Services need to reach out to the community and provide opportunities for community services to reach in.
Recovery approaches in criminal justice settings employ rehabilitation and throughcare10 models that support progressive recovery and focus on life skills, meaningful activity, education and vocational training and increased reconnection with the community (Simpson & Penney 2011). People are supported to reclaim control to the extent possible in the circumstances (Kaliski & de Clercq 2012). Follow-up is particularly important to ensure that recovery gains are not lost when a person returns to the general prison population upon discharge from forensic mental health facilities.
Incarceration adds to the isolation experienced by those who have already faced prolonged disconnection from their families (Dorkins & Adshead 2011). Recovery approaches support reconnection and the building of healthy relationships with family and friends.
Supporting people to reclaim meaningRecovery-oriented practice supports people in custodial settings to reclaim meaning and to build new identities. This includes:
- incorporating aspects of their former lives and acknowledging the events that led to their incarceration
- understanding the impact of their actions on their own lives and on the lives of others (Dorkins & Adshead 2011)
- managing their personal potential for risk.
Supporting the recovery of people who are detained for long periodsSome people will reside in maximum-security facilities for long periods, some indefinitely. Recovery-oriented practice and service delivery in criminal justice and forensic settings offers a means of optimising the lives of these people (Kaliski & de Clercq 2012). Practitioners seek to engage them in optimistic and hopeful discussion about their mental health issues, and their views on treatment and support. They seek to increase people’s self-esteem and create opportunities for building life skills, by enabling a better use of time, and by offering hope for eventual return to the community, a place to call home, autonomy, skills, a job, family and friends.
10 Throughcare is the coordinated, integrated and collaborative delivery of programs and services to offenders to reduce the risks of reoffending and enable successful integration into the community. Services are provided both during incarceration and after release (NSW Department of Corrective Services 2008; ACT Corrective Services 2010; Borzycki & Baldry 2003).