Effects of psychological therapies on wellbeing and risk reduction in forensic settings

Purpose Adult male prisoners experience disproportionately high rates of mental illness, self-harm and violent behaviour compared to the general population. Many enter custody with pre-existing psychological difficulties, and the prison environment can exacerbate risks to self and others. This study aims to investigate the pre- to post-intervention effects of psychological therapy on multiple domains of well-being and risk among adult male prisoners in the UK, using the Clinical Outcomes in Routine Evaluation (CORE) framework to monitor clinical changes in a high-risk forensic population. Design/methodology/approach A retrospective, observational design was used to analyse secondary data from a large sample of incarcerated adult males (n = 375) who completed at least one evidence-based psychological therapy programme. Within-subject clinical changes were evaluated across 10 CORE subscales from pre- to post-intervention. Repeated-measures MANOVA and pairwise contrasts examined differences in treatment trajectories based on baseline risk status (low-risk, n = 282; high-risk, n = 93). An exploratory analysis also assessed whether therapeutic gains varied across different ethnic groups. Findings Significant improvements occurred across all CORE domains, with the largest effects found in trauma (d = 0.71) and subjective well-being (d = 0.76). Repeated-measures MANOVA revealed significant main effects for time and risk status, alongside significant interaction effects for social relationships, anxiety, trauma and risk subscales. High-risk individuals demonstrated larger pre-to-post gains. Crucially, only the baseline high-risk group exhibited a significant post-treatment reduction in the risk of harm to others (d = 0.49). Treatment gains were largely consistent and equitable across ethnic groups, with minor variations. Research limitations/implications Methodological limitations include the lack of a control group and the use of a single instrument to assess clinical outcomes. Practical implications This study demonstrates that brief, individual talking therapies significantly alleviate psychological distress and reduce self-reported risk in custodial settings, supporting wider integration of evidence-based psychological services within forensic healthcare. It is also highlighted that some effects were more pronounced for individuals who were assessed as higher risk in the baseline assessment. Social implications By demonstrating that psychological therapies substantially reduce severe mental distress and self-directed or interpersonal risk, this research highlights a critical pathway for improving broader community safety. Addressing the acute psychological vulnerabilities that drive custodial violence and self-harm creates a safer environment for both prison staff and residents. Originality/value This study provides an important real-world application of the CORE framework within a large UK custodial sample (n = 375), addressing a major gap in empirical forensic literature. While previous research often relies on generic or small-scale evaluations, this study offers robust evidence that talking therapies simultaneously improve subjective well-being and reduce self-reported institutional risk.