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A non-randomised controlled trial of the R&R2MHP cognitive skills program in high risk male offenders with severe mental illness

Vivienne C-Y Yip12, Gisli H Gudjonsson23, Derek Perkins2, Amie Doidge2, Gareth Hopkin2 and Susan Young12*

Author Affiliations

1 Department of Forensic and Neurodevelopmental Sciences, PO23, King’s College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK

2 Broadmoor Hospital, Crowthorne, UK

3 Department of Psychology, PO77, King's College London, Henry Wellcome Building, De Crespigny Park, London SE5 8AF, UK

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BMC Psychiatry 2013, 13:267  doi:10.1186/1471-244X-13-267

Published: 18 October 2013



The growing popularity of offending behavior programs has led to the interest of whether such programs are effective with mentally disordered offenders. This study aimed to evaluate the effectiveness of the Reasoning and Rehabilitation program adapted for offenders with severe mental illness (R&R2 MHP).


A sample of 59 adult high risk males detained in a high secure hospital completed questionnaires at baseline and post treatment to assess violent attitudes, anger, coping processes and social problem-solving. An informant measure of social and psychological functioning, including disruptive behavior, was completed by staff at the same time. The data of 30 patients who participated in the group condition were compared using intention to treat analysis with 29 controls who received treatment as usual.


80% of group participants completed the program. In contrast to controls, significant medium-large treatment effects were found at outcome on self-reported measures of violent attitudes, social problem-solving and coping processes. Improvements were endorsed by informant ratings of disruptive behavior, social and psychological functioning.


The R&R2MHP had a comparatively low dropout rate and was effective in a sample of high risk mentally disordered offenders requiring detention in high security. Future research should use a randomized controlled design.

Trial registration

Current Controlled Trials ACTRN12613000216718.

Mentally disordered offenders; Treatment outcome; Reasoning & Rehabilitation; Cognitive skills