| Optimism in treatment programmes had
its boom throughout the western world in the 1960s and '70s. Modern
methods were to 'repair' perpetrators of violent crime so that these
could successfully be reintroduced into society. These sentiments
won perhaps extra ground in Sweden due to the heritage of Myrdal
and the ideas of social engineering. This era of prison and forensic
mental health care was therefore characterised by a strong belief
in the significance of structural and social factors on criminality.
The scientific grounds were non-empirical and primarily sociological,
inspired by the leading ideologist of the time. The individual therapists
were said to be driven by a strong feeling of solidarity with the
person convicted. Prison and forensic mental health treatment programmes
were often created and operated by 'devotees', and involvement and
a passion for justice in themselves were generally considered instrumental.
The 1980s saw a decline in willingness and an economic recession
that, in North America above all, lead to a marked backlash. The
heterogenic treatment models and programme activities that had sprouted
in the preceding years were evaluated. These investigations all
pointed with a disquieting consistency in the same direction: The
treatment methods had at best no effect whatsoever, at any case
not on the frequency of a return to crime. Many studies even indicated
that the forms of therapy that were used, environmental therapy
and forms of group psychotherapy (which would nowadays be considered
rather experimental by those in the profession), increased the likelihood
of reoffence. No treatment programmes were found anywhere that could
be shown to have positive results. One expression that was coined
during this era was 'Nothing Works!'.
Unsurprisingly, these findings were crushing for those involved
in the prison service, forensic mental health services and other
organisations working with violent offenders. These discoveries
came in the 1980s at the same time as a dramatic shift in the social
climate, in which general opinion was now for 'tougher measures'
and a return to a more classic view of criminal law, which is reflected
in legislation and other areas. At the same time, the 'Nothing Works'
era provided space for a whole new generation of practitioners and
researchers who wished to tackle the problem with a more pragmatic
and empirical approach.
Recent years, in both prison and forensic mental health care, have
been witness to a new direction that runs parallel to the evidence-based
medicine that is now established within healthcare. In several areas
of the world during the 1990s, new treatment programmes were implemented
in which a follow-up using empirical evaluations was an integral
part. This development was most pronounced in Canada.
The expression 'What Works!' came about in Canada as a reaction
to Nothing Works! but also a descriptive doctrine for the era that
we in Europe and North America are still clearly in to this day.
Programmes must work and lead to measurable decreases in the likelihood
of reoffending among the groups receiving treatment. If not, they
should be wound up.
The ambitions of the What Works! spirit are strong within the Swedish
prison and probation service. Several structured programmes that
fulfil the general criteria for integrity and documentation have
been developed during the 1990s, partly in collaboration with the
CVP research group. Particularly worthy of mention are the programmes
aimed at sexual offenders and perpetrators of violence in close
relationships (domestic violence). However, to take the next step,
persons with scientific expertise must evaluate these programmes.
This should be done checking carefully for relevant confounders
and using a randomised controlled trial format.
The subject of this study group is thus interventions aimed at reducing
or managing the risks of violence. This includes programmes within
the prison and probation service, as described above, and work within
child psychiatry, schools and the social services. The aim is to
be able to describe which interventions work and why.
Scientific Theme Coordinator: Niklas
Långström.
|
Martin Lardén
