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Table 2 Theoretical background for scoring DUNDRUM-3

From: Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital

Units of meaningful change

Cycle of change [19]

Engagement [18]

Recovery [20]

Hierarchy of needs [21]

Spiritual and cultural integration

4: not ready to move down a level of security

Pre-contemplation.

Reluctance/ resistance

Moratorium

Physiological needs

Alienated

3: ready for a move e.g. from high to medium security

Contemplation & preparation, ambivalence

Passive engagement

Awareness, finding hope

Safety and basics of life

Can engage only in ‘trading’ interactions on an impersonal or binary basis.

2: ready for a move e.g. from medium to low security

Action / decisional balance

Active engagement

Preparation, search for personal resources and external help, taking responsibility

Friendship and family relationships

Accepts and commits to communal and social customs and affiliations.

1: ready for a move to supported community living e.g. conditional discharge or community treatment order

Maintenance, supported

Positive engagement

Rebuilding, taking positive steps, establishing a positive identity

Self-esteem, confidence, social standing

Accepts and commits to communal and social concepts of value and virtue.

0: ready for independence

Maintenance, stability

Taking personal responsibility

Growth / sense of control / looking forward, finding meaning and purpose in life

Self-actualisation

Expresses self in creative and communicative ways.

Self-transcendence

Fulfils roles and shares own resources (time, effort) for communal good